Acne scarring is a frustrating problem for both patients and physicians. It has a high prevalence (up to 95% in studies) and can be psychologically devastating to patients with severe cases. The cause of acne scarring is complex and poorly understood.
Dr. Fife has a special interest in the treatment of acne scars in patients of all races and skin types. He spent 2 years working under renowned acne scarring therapy experts in Orange County, CA and Chicago, IL. His training taught him that every acne scarring patient cannot be approached in the same way—each case must be carefully evaluated, treated by the most appropriate modality, and monitored closely postoperatively for side effects.
The Surgical Dermatology & Laser Center offers comprehensive treatment of acne scarring. Treatments offered include: subcision, Fractional CO2 laser, chemical peels, fillers injected underneath scars, and mini-excisions of large scars. Dr. Fife spent 2 years working under leading experts in acne scarring therapy in Orange County, CA and Chicago, IL and has participated in clinical studies on various acne scarring treatments. During your consultation with Dr. Fife, your specific scars are categorized (rolling, boxcar, icepick, hypopigmented, etc) and a treatment plan will be tailored for your specific skin tone and scars, which can significantly improve the appearance of the skin.
Fractional CO2 Laser
Fractional lasers have revolutionized the treatment of acne scarring. The procedure involves the delivery of a laser beam which is broken up into hundreds of very small columns, which put tiny holes in the skin. As these small wounds heal, new collagen is laid down underneath the skin (a process called “collagen remodeling”), which can smoothen out the surface of the skin. To see a video of fractional CO2 therapy, click here. Advantages over traditional CO2 resurfacing include faster healing time and a slightly lower risk of complications. As part of a comprehensive acne scarring treatment plan, fractional laser resurfacing can improve skin which has been damaged by prior severe acne. Click here for more information, including preoperative and postoperative instructions.
Subscision
Subscision is an excellent treatment for “rolling” or “boxcar” type acne scars, which often have fibrous attachments holding the base of the scar down to the underlying deeper tissue. After the surrounding skin is numbed with a local anesthetic, a small needle is carefully inserted under the skin to sever and release these attachments beneath the scar. During the healing process, collagen remodeling occurs and new collagen is laid down underneath the scar, further improving the smoothness of the skin. Occasionally a filler substance can also be injected under the scars after subscision to make the scar look less visible and to produce the results wanted. Dr Fife is an expert in subscision techniques, and was asked to direct a clinical study involving subscision and filler injections for acne scarring for Northwestern University.
Chemical Peel
Chemical peels work by producing a controlled injury to the top layers of the skin, which is followed by a healing response that produces smoother, softer, more youthful skin. Superficial chemical peels are useful for decreasing the signs of aging such as fine lines, but can also be used to treat brown spots, melasma, acne, acne scarring, and keratoses. Superficial chemical peels are safe in all types of skin, including ethnic skin. There is virtually no downtime after such peels.
Chemical peels are used in two ways for acne scarring:
- The first method is the CROSS technique, in which a small amount of high concentration of trichloroacetic acid (TCA) is placed directly into an acne scar, creating a wound. The collagen remodeling and healing process that ensues can smoothen out the skin at the site. Usually multiple treatments are required.
- The second method is a total face chemical peel, in which a lower concentration of TCA, Jessner’s solution, salicylic acid, or glycolic acid. The skin is rejuvenated as it heals.
Click here for a more detailed explanation of chemical peels, including pre and postoperative instructions.
Dermabrasion
Dermabrasion is an excellent technique for improving skin damaged by acne scars. Different from “microdermabrasion,” dermabrasion is a procedure in which layers of skin and underlying scar are precisely removed with a small, hand-held medical-grade sander. Different sized diamond-studded tips can be used which precisely match the size of the patient’s specific scars or the area to be treated. The procedure requires local anesthesia for comfort, and the skin usually heals in 7 to 10 days.
Mini-excision of scars
Certain scars such as very deep scars or scars that project outward from the skin are often best removed surgically. The scar is cut out completely and the skin edges are carefully brought together with sutures. The final scar is much less visible than the original acne scar.
Laser Resurfacing
Complete CO2 laser resurfacing is an effective treatment for acne scarring which has been used for many years. It involves the complete removal of layers of the skin by a laser. It has largely been replaced by fractional CO2 laser resurfacing (which puts small holes in the skin instead of completely vaporizing it), but in certain situations it still may be the optimal therapy.
Filler Injections
Injectable filler substances such as collagen, Restylane, Juvederm or Radiesse can be injected under acne scars to smoothen out the skin. The improvement in the appearance of the skin is immediate and lasts for many months as the material slowly degrades. Part of the improvement may be permanent.
Combination Treatments (Comprehensive acne scarring therapy)
Often a combination of procedures is required to provide the maximum amount of improvement in acne scarring. Fractional laser therapy may be combined with chemical peels, subscision, and/or fillers to provide you with the best improvement to your scarring as possible. A treatment plan is organized for each patient’s specific scars. This comprehensive acne scarring therapy will give the highest chance for improvement in acne scarring.
31 Responses to “Acne Scarring”
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Hi Dr. Fife,
I’m not seeing much or really any improvement from the last 2 procedures. I was rearching on the Subcutaneous Incision procedure, is this a good treatement for rolling scars? When you get a chance can you email me downtime, # of treatments,price, etc.
I don’t think I will be able to come back until after Decemeber, depending on price. Or should I do another dermabrasion?
Thanks so much for all your input
Take Care,
Amanda
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