How can acne scars be removed?
Depending on the size, shape and location of the acne scars on the body (for example, on the forehead, on the entire face or on the back), different methods can be considered for their removal. Basically, acne scars can be treated by the following methods:
- Laser therapy (CO2 laser, Fraxel laser, Erbium:YAG laser)
- Surgical scar correction
- Icing treatment
- Grinding treatment
- Chemical peeling
- Dermabrasion
- Microdermabrasion
- Injection with cortisone
- Collagen injection
- Microneedling
These methods of treatment are performed by a dermatologist or a plastic surgeon. The dermatologist or plastic surgeon decides which method is best suited to treat the acne scars in the individual case.
Depending on the procedure, the treatment of very large acne scars sometimes requires an inpatient stay in the hospital. In many cases, however, the treatment is performed on an outpatient basis. However, most of these treatment methods require several sessions with the doctor.
Surgical scar correction, icing treatments and laser therapy require extensive aftercare. Affected persons may be absent from work and private life for a few days after the treatment.
Laser against acne scars
The standard method of acne scar removal is functional laser therapy with a CO2 laser or Erbium:YAG laser. With the CO2 laser, the doctor primarily performs deeper ablations. With the Erbium:YAG laser, he shoots small holes into the skin (fractional lasers). These heal back with healthy connective tissue, which smoothes and tightens the skin.
Alternatively, the doctor removes excess scar tissue in layers with a laser. He then uses a small needle to direct a pulse of heat into the skin, which stimulates the growth of normal, smooth collagen tissue that replaces the hardened collagen tissue of the acne scars.
Overall, the treatment extends over several appointments, as pre- and post-treatments are necessary.
A possible risk of laser therapy is the incorrect application of the technique. In that case, the surrounding tissue may be destroyed and the skin may be severely irritated.
Surgical scar correction
Acne scars can also be removed with the help of surgery. The surgeon first removes the excess tissue using a special incision technique. Then he places the wound edges close together and sutures them together. It cannot be ruled out that this will also leave a scar, albeit smaller.
The doctor only performs surgical scar correction in the case of larger acne scars.
During icing treatment, the doctor freezes the scar tissue at minus 180 degrees Celsius with liquid nitrogen. This causes the tissue to die and is then removed in a surgical procedure.
Grinding treatments
Grinding treatments are used by the treating physician for acne scars with sharp edges as well as hypertrophic acne scars. In these cases, the doctor grinds off excess tissue with a diamond burr. The patient receives general anesthesia for this procedure.
Small bumps often remain after the treatment.
Chemical peeling
In a chemical peel, the practitioner applies a special substance to the skin, which causes the skin to peel off in different layers. The result is smoother skin.
The physician often uses highly concentrated trichloroacetic acid (TCA) for this form of acne scar treatment. The acid content here is between ten and 100 percent. Up to an acid content of 30 percent, it is possible to perform acid peels on one’s own; from 30 percent, treatment is performed by a cosmetician or dermatologist, and from 40 percent, only by a dermatologist.
Acid treatment is painful and may cause irritation and redness of the skin, depending on the skin type. In addition, it does not always improve the appearance of acne scars. Only the application of highly concentrated acid shows very good success. Afterwards, however, the skin is usually reddened for a long time.
Dermabrasion
In dermabrasion (skin abrasion), the doctor uses a fine burr to grind away the top layer of skin, also removing excess scar tissue. The skin appears smoother and more uniform.
Dermabrasion is used primarily for large, superficial and sharp acne scars. Often, the doctor performs it under general anesthesia in stationary conditions. After the treatment, patients must not expose the treated skin area to UV light (sun, solarium) for several months.
Microdermabrasion
In microdermabrasion, the doctor shoots fine, small crystals onto the skin to remove the top layer of skin. This method is somewhat gentler than the previously mentioned techniques and usually leaves no marks on the face after treatment.
The effect is similar to that of a mechanical peel. Depending on the size and depth of the acne scars, several sessions over several weeks are necessary. One session lasts about 15 to 30 minutes and is usually painless.
In this procedure, the doctor injects cortisone directly into the scar. This causes the scar tissue to die and the scar to flatten. However, this method does not renew the tissue, which means that the somewhat whitish scar tissue still stands out against the skin after treatment. This treatment is especially suitable for hypertrophic scars.
Collagen injection
This treatment method is used by physicians for atrophic acne scars. Here, the doctor injects collagen into the scar – thus artificially filling it up, the scar tissue lifts and adjusts to the level of the surrounding skin.
Microneedling
In microneedling, the doctor pricks the affected skin with many fine needles. These special needles are located on a small hand roller called a dermaroller.
The resulting micro-injuries have a stimulating effect on the skin’s metabolism. It is also believed to promote the formation of new blood vessels and new collagen, making scar contours appear finer.
If necessary, the doctor combines the treatment against acne scars with a fruit acid peeling.
What home remedies can help?
In order to remove acne scars, various home remedies are recommended in advice books, which are supposed to help against acne scars pure or, for example, in the form of ointments or creams.
Home remedies have their limits. If the symptoms persist for a long period of time, do not improve or even get worse, you should always consult a doctor.
How do acne scars develop?
If acne scars develop, they are usually particularly severe cases of the disease – or the pimples, pustules or blackheads were treated unprofessionally.
If you squeeze pimples and blackheads yourself, for example, bacteria very quickly get into the wound, multiply well in the secretion contained and cause inflammation. The normal connective tissue is destroyed and replaced by non-specific tissue.
This differs in appearance from the rest of the tissue, is less well supplied with blood, possibly hardens and retracts inward. That is why acne scars are so conspicuous. In terms of color, acne scars are first red and later white.
Whether acne scars develop depends not only on the form of acne, but also on the individual skin type and age. In older people, the skin does not regenerate as well as it does in younger years, so acne scars are a common consequence of the disease here.
Different acne scars
Not all acne scars are the same. Depending on the place of formation and expression, a distinction is made:
Atrophic acne scars
Atrophic acne scars are mainly caused by long-term inflammations and suppurations, such as those that occur when a person picks at pimples themselves.
In detail, physicians distinguish between different types of atrophic acne scars:
- Worm-shaped scars (V-shaped scars) have a diameter of less than two millimeters and extend funnel-shaped deep and steep-walled into the lower dermis or even into the subcutis.
- Varioliform scars (U-shaped scars) resemble chicken pox scars. They range in diameter from 1.5 to four millimeters and are shallow or deep, round or oval, and steep-walled.
- Wave-like scars (M-shaped scars) are shallow and have a diameter of four to five millimeters. They are formed by connective tissue strands that connect the dermis to the subcutis.
Hypertrophic acne scars
These acne scars protrude from the skin and form visible, rough thickenings because too much new tissue has formed to repair the wound. They are whitish or skin-colored and may itch or hurt. Hypertrophic acne scars develop primarily on the shoulders and décolleté in people with a genetic predisposition.
Hypertrophic acne scars also include bridge scars as well as keloids.
Acne scars: prognosis
Your dermatologist will decide which therapies are suitable for you based on the clinical picture of your acne. Likewise, the result of the treatment depends on the skin type.
In general, the prognosis for the treatment of acne scars is good. In many cases, the doctor removes acne scars in such a way that they are barely visible or not visible at all.
In general, of course, shallower and smaller acne scars can be treated more quickly and with better results than larger and deeper acne scars. In some cases, deep scars cannot be made completely “invisible” even with several treatments.
Preventing acne scars
Acne scars cannot always be prevented. In any case, it is helpful if you do not squeeze pimples and blackheads yourself, so that self-inflicted inflammation of the skin does not occur.
In severe acne cases, the inflammatory processes of the skin can no longer be self-controlled. Therefore, it is important to treat acne medically as early as possible so that inflammation of the hair follicles and skin can be reduced and bacterial infections can be fought early. This helps to prevent acne scars later on.
