We all have our battle scars—some emotional, some... well, right there on your skin. If acne left its mark in the form of pesky ice pick, rolling, or box scars, don’t worry! Your skin’s story isn’t over yet. Let’s break down how these scars form, the treatments you’ve probably already Googled, and my go-to strategies for turning your complexion from bumpy road to smooth highway.
What’s the Deal with Atrophic Scars?
Atrophic scars are like that one friend who shows up uninvited and overstays their welcome. They’re the indents and depressions left behind, often after acne, and they love hanging around because your skin didn’t produce enough collagen while trying to heal.
Now, let’s put on our science hats for a second. These scars form due to an inflammatory process that leads to reduced collagen production and poor matrix regeneration. And here’s the kicker—fibrotic bands form at the dermal-subcutaneous junction, pulling your skin down like a taut rubber band, creating those annoying dips and divots. It’s kind of like your skin’s natural scaffolding went a little wonky. But hey, nothing we can’t fix!
Image source: Vempati, A. et al. (2023) ‘Subcision for atrophic acne scarring: A comprehensive review of surgical instruments and combinatorial treatments’, Clinical, Cosmetic and Investigational Dermatology, Volume 16, pp. 125–134. doi:10.2147/ccid.s397888.
The Endless Chase for Clear Skin
Scar treatments—there are so many out there. It’s like chasing after the Holy Grail of skincare. You’ve got your lasers, your peels, your needles, and that trendy new thing your friend swears by (but isn’t quite sure what it does). It’s easy to feel overwhelmed, but don’t worry—your skin can be saved, and it all starts with prepping it properly.
Before jumping into any resurfacing treatment, it’s super important to prepare your skin. Hydration is your skin’s best friend, and if you’ve got active acne, that needs to be treated first. You wouldn’t want to build a house on a shaky foundation, right? The same goes for your skin—clear it up, hydrate, and make sure it’s ready to recover from the main event.
The Perfect Match: Tailoring Treatment to Your Scar Type
Here’s the lowdown on which treatment works best for your type of scar. Let’s break it down based on the scar’s characteristics.
Image source: Vempati, A. et al. (2023) ‘Subcision for atrophic acne scarring: A comprehensive review of surgical instruments and combinatorial treatments’, Clinical, Cosmetic and Investigational Dermatology, Volume 16, pp. 125–134. doi:10.2147/ccid.s397888
A: Ice-pick scar; B: Box scar; C: Rolling scar
Ice Pick Scars
Scar shape: Often mistaken as large pores, these are conical depressions with borders converging into a single point deep in the dermis or subcutaneous tissue.
- TCA (Trichloroacetic Acid) Cross: Sounds fancy because it is. This high-strength chemical peel goes right into the scar to promote collagen production, helping those deep little craters fill in.
- Polynucleotide Therapy: It’s like hitting the refresh button for your skin cells. It boosts cellular repair and healing, softening the appearance of scars.
- Hyaluronic Acid Skin Boosters: Think of it as a big gulp of water for your skin. It plumps things up, making the skin look fuller and smoother.
- Fotona StarWalker PQX Fractional Rejuvenation: Lasers—because, of course! This one targets deep into the skin, creating a micro-channel of controlled energy, promoting collagen growth right where it’s needed.
Rolling Scars
Combination of rolling and box scars
Scar shape: Depressed, distensible scars with gentle, sloping edges.
- Microneedling with Radiofrequency: This is a power duo. Tiny needles create controlled injuries, while radiofrequency works deeper through innovative thermal gradients to stimulate collagen production like a boss.
- Subcision with PRF: We’re talking precision here. This technique breaks up the fibrotic bands under the skin, while PRF (your own blood’s growth factors!) helps the healing process.
- Polynucleotide and Recombinant Human Polypeptide Alpha 1 Chain: A mouthful, sure, but it’s a magic combo that speeds up skin regeneration. Polynucleotides stimulate skin repair by promoting collagen production, while recombinant human polypeptide alpha 1 chain provides the essential building blocks for the triple-helix structure of collagen. Together, they enhance skin regeneration and strengthen the skin’s structure, effectively reducing scars.
- Fotona SP Dynamis Nx Line Resurfacing Laser: Another laser? Absolutely. This one resurfaces the skin, targeting uneven texture and promoting healing from the inside out, allowing for more accurate and precise control.
- HIFU (High-Intensity Focused Ultrasound): HIFU tightens the skin by targeting the SMAS layer, not only reducing the surface area of your scars but also lightening the load on your skin’s repair system. By shrinking the scar tissue, HIFU makes it easier for your skin to regenerate, speeding up the healing process while enhancing the overall appearance.
Box Scars
Scar shape: Shallow or deep, punched-out, ‘U’-shaped scars that may be round, polygonal, or linear.
- Similar treatments as with rolling scars (Microneedling with RF, Subcision with PRF, Polynucleotide & Recombinant Human Polypeptide Alpha 1 Chain, Fotona SP Dynamis Nx Line, HIFU).
- Calcium Hydroxyapatite: Calcium Hydroxyapatite (CaHA) not only stimulates collagen but also adds immediate volume, helping to fill in boxcar and rolling scars. It works by replacing dermal and subcutaneous volume, which is particularly effective for larger rolling and superficial boxcar scars. Over time, CaHA promotes collagen production, providing both immediate and long-term scar improvement.
Progress Takes Time—And That’s Okay!
Here’s the truth bomb: acne scar treatment isn’t an overnight miracle. It takes time, patience, and sometimes a bit of trial and error. Progress varies from person to person, so don’t be discouraged if it takes a few sessions to see results. The key is in getting a treatment plan tailored just for you.
Now that you’re armed with the knowledge, it’s time to take the next step. Ready to say goodbye to those scars? Book a consultation with me at Dream Clinic, and let’s work together to get your skin looking fresh, smooth, and flawless!
References
Antonino, A. and Francesco, A. (2020) ‘Prospective and randomized comparative study of calcium hydroxylapatite vs calcium hydroxylapatite plus hifu in treatment of moderate‐to‐severe acne scars’, Journal of Cosmetic Dermatology, 20(1), pp. 53–61. doi:10.1111/jocd.13472.
Clementoni, M.T. and Azzopardi, E. (2020) ‘Specific attention areas in scar management: Management of atrophic scars’, Textbook on Scar Management, pp. 353–362. doi:10.1007/978-3-030-44766-3_41.
Goldberg, D.J., Amin, S. and Hussain, M. (2006) ‘Acne scar correction using calcium hydroxylapatite in a carrier‐based gel’, Journal of Cosmetic and Laser Therapy, 8(3), pp. 134–136. doi:10.1080/14764170600891632.
Vempati, A. et al. (2023) ‘Subcision for atrophic acne scarring: A comprehensive review of surgical instruments and combinatorial treatments’, Clinical, Cosmetic and Investigational Dermatology, Volume 16, pp. 125–134. doi:10.2147/ccid.s397888.
Xiao, A. (2022) Laser revision of scars, StatPearls [Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK539686/ (Accessed: 12 October 2024).