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How to Treat Every Type of Acne Scar, According to a Dermatologist

Derm-approved treatments for those post-breakout marks.
How to Treat Every Type of Acne Scar, According to a Dermatologist
IMAGE BJ Pascual from Preview Archive
Derm-approved treatments for those post-breakout marks.

To banish all reminders of your last breakout, the trick is to find out what you're dealing with exactly. Acne scars come in all shapes, colors, and sizes, and zapping them correctly requires a lot of help from a pro. So, we asked Dr. Gaile Robredo-Vitas of BeautiqueMD to step in and give us the basics a skincare geek should know.

Before starting with any scar treatments, Dr. Gaile makes sure to prep her patient beforehand. "I do this to minimize the risk of side effects such as hyper- or hypo-pigmentation and to get the best out of the treatment," she explains. This includes recommending the use of mild cleansers, sunscreen, collagen-boosting products, as well as stopping smoking and starting a healthy diet. These alone could make a difference in your skin, especially if you're still breaking out. All set? Learn about the different kinds of scars and their treatments below!

MACULAR SCARS (Flat scars)

Pigmented yet flat scars fall under this category, and according to Dr. Gaile, this type can heal and fade on its own overtime. That said, there are ways to make the disappear faster, depending on the color of their pigment. To know the difference, erythematous scars are reddish in color, hyperpigmented ones are brown, while hypopigment scars are pale!

How to treat them:

1. Lightening Creams - These are applied to the scar to reduce the amount of melanin on the area.

Best for: Hyperpigmented scars

2. Pulsed Dye Laser (PDL) or Intense Pulsed Light (IPL) - Lasers that target hemoglobin to make reddish post-acne marks less prominent.

Best for: Erythematousmacular scars

3. Resurfacing Treatments - Includes treatments like microdermabrasion and chemicals peels that remove the topmost layers of skin to encourage new skin to form.

Best for: Hyperpigmented and Hypopigmented macular scars

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DEPRESSED OR ATROPHIC SCARS

These are the scars that give the skin visible texture in the form of pitted scarring. "Most acne scars on the face are depressed scars, and [these] form as a result of loss of tissue or from the body producing too little collagen," says Dr. Gaile.

There are three types of atrophic scars, namely:

1. Icepick scars - Small holes in the skin that can be mistaken for large pores

2. Boxcar scars - Depressed scars that are angled or have demarcated edges

3. Rolling scars - Depressed scars with smooth contours and edges

How to treat them:

1. Resurfacing Treatments

As mentioned above, these treatments encourage the formation of new skin over the affected area. If your scars aren't too deep, this can contour their edges to reduce their appearance.

Best for: Depressed yet shallow scarring

2. Laser Treatments

Non-ablative Fractional Laser Resurfacing - Targets small fractions of the skin at a time with a laser beam. Results will be gradual, but visible improvement is promised within three to four months.

Ablative Fractional Laser Resurfacing- A more aggressive laser that delivers heat underneath the layers of the skin to promote collagen production and smooth out skin texture.

Best for: Widespread acne scarring

3. Fractional Radiofrequency (RF)

Similar to laser resurfacing, RF promotes collagen production with the use of heat. It requires multiple sessions.

Best for: Widespread acne scarring, icepick, rolling and boxcar scars

4. Collagen-Induction Therapy

Also known as microneedling or dermarolling, this uses a needle-studded roller that punctures small holes into the skin to encourage collagen production.

Best for: Widespread acne scarring, icepick, rolling and boxcar scars

5. Soft Tissue Fillers

A temporary treatment that plumps and smooths out acne scars to reduce texture. These can last from six months up to two years.

Best for: Few depressed scars, rolling, and boxcar scars

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6. Subcutaneous Incisional Surgery or Subscision

An outpatient treatment that involves injecting a scar to lessen texture.

Best for: Rolling and boxcar scars

7. Excision or Punch Replacement Graft

"In excision, the doctor cuts into the skin to remove the acne scar and then closes the wound with stitches," explains the derm. Meanwhile, in punch replacement grafting, a skin graft is taken from elsewhere (usually behind the ear) to fill the depressed scar.

Best for: Icepick scars

8. TCA CROSS (Tricholoroacetic Acid Chemical Reconstruction of Skin Scars)

"This procedure involves depositing small amounts of TCA at high concentration (70–100%) onto the surface of the atrophic scar," explains the derm. Basically, this helps form new collagen fibres in the skin to reduce the shadowy cast over depressed scarring.

Best for: Icepick, rolling, and boxcar scars

RAISED OR HYPERTROPHIC SCARS

Hypertrophic scars are produce when we produce too much collagen that attempts to heal damaged skin, leading to a raised scar. This type of scar usually appear on areas like the nose, jawline, chest, and back, and are very common within people of color.

How to treat them:

1. Intralesional Steroid Injections - The scar is injected with medicine to soften and flatten.

Best for: Painful, raised scars

2. Pulsed Dye Laser - Addresses itchy and painful scars while reducing its color and raised appearance.

Best for: Erythematous to violaceous (purplish) raised scars

3. Scar Creams - An at-home alternative to lasers that can reduce itchiness, size, color, and raised texture of a scar. For best results, these need to be used continuously.

4. Ablative Fractional Laser Resurfacing - On raised scars, this laser treament targets the topmost and lower layers of the skin to lessen texture.

Best for: Hypertrophic scars on the nose or rhinophyma

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