Acne scars result from more severe forms of acne, notably cystic acne. People who pick or squeeze their acne can cause additional damage to their skin, which causes an even stronger inflammatory response. According to many studies, prolonged inflammation is linked to more extensive scarring. Therefore, it is important for patients to refrain from touching their blemishes to prevent further scarring down the line.
The three most common types of acne scars are ice pick, boxcar, and rolling scars. These scars have one thing in common: they all dip below the level of surrounding healthy skin due to the depletion of collagen. Because of this, with certain lighting, these dipped scars can cast noticeable shadows on the face and be aesthetically displeasing.
Ice pick scars are characterized as narrow indentations in the skin that usually result from severe cystic or papular acne burrowing deep in the skin. Among the three, ice pick scars are the most severe due to their tiny diameter and depth of penetration. They often appear on the forehead, cheekbones, and nose.
Among the three, ice pick scars are the most difficult to treat because of their narrowness and depth of penetration. In general, we have found that ice pick scars respond well to phenol CROSS, our frontline treatment method. However, patients with more severe ice pick scars may benefit more from punch excision, a process in which a small “cookie-cutter” tool is used to punch out the ice pick scar. In this manner, we ensure that the scar is removed in its entirety, as opposed to other treatments that merely treat the surface.
Boxcar scars have sharp defined boundaries with more geometric indentations in the skin.Boxcar scars result from collagen depletion caused by acne breakouts, leaving a visible depression behind on the skin. Boxcars are typically shallower and wider than ice pick scars, and have vertical walls with an even, flat base.
Although boxcar scars can be treated with a variety of procedures, many of them, including laser, dermabrasion, and microneedling, work superficially and are ineffective for deeper scars.At our clinic, subcision, punch excision, and collagen stimulators are the most effective and long-lasting treatment options available. We will perform a thorough evaluation of each of your boxcar scars to customize your treatment plan.
Rolling scars develop when fibrous tissue tethers the epidermis to the underlying subcutaneous tissue, creating sloping and wave-like indentations in the skin. Rolling scars are shallow and soft
depressions that become more noticeable when skin ages and loses its elasticity. Rolling scars can disappear over time but may require intervention depending on their severity.
Because rolling scars are the softest among the different scar types, they respond the best to subcision followed by collagen stimulation. We will perform a thorough evaluation of your rolling scars to assess their severity and depth to determine what layers will need to be subcised. It is important to manually sever the fibrotic tethers in multiple layers to completely remodel the skin. Any treatments that do not target these tethers will not solve the root cause of rolling scars.
Scarring is more common with poorly resolved cystic or nodular acne. In addition, it has an even greater likelihood of occurring when irritated or squeezed. Therefore, the first step to prevent scarring is to simply leave your acne lesions alone. It is difficult at first, but is worth the patience at the end.
At the same time, it is also important to ensure that your acne lesions do not become over-inflamed. The prolonged inflammation of your active acne will also increase scarring. Steroid injections, notably kenalog injections, are highly effective in quelling inflammation of your acne and thereby limit scarring.