if you think that acne only affects adolescents going through puberty, think again. singapore’s public national skin centre reports that almost 60% of patients experience acne only in adulthood.
while mild acne will often be home remedied without complications, severe and chronic acne may leave behind scars and pigmentation. this, in turn, may induce feelings of insecurity and perhaps even cause psychological issues. unfortunately, scarring occurs easily and very early on. to make matters worse, acne scars often become more apparent and noticeable as we age due to collagen breakdown.
understanding the type of acne scars you have is crucial in devising an effective treatment plan that targets the problem at its root. dermatologists may recommend a combination of acne scar removal treatments for the best results.
understanding the types of acne scars
depressed or atrophic scars
one of the most common scars on the face are formed when not enough collagen is made when the acne wound is healing.
1. icepick
icepick scars are narrow and v-shaped scars (less than 2mm) that taper towards a point deep within the dermis tissue. these are most common at the cheeks and are formed when a cyst or other inflamed tissue finds its way to the surface of the skin.
2. rolling
rolling scars have gentle shallow, sloping features and can be often found clustering around one another. this causes a rolling or wave-like appearance on the skin surface. the scar opening is around 4-5mm wide and usually varies in size. it is caused by damage under the surface of the skin where fibrous strands are tethered to the deep subcutaneous tissue layer.
3. boxcar
boxcar scars resemble scars left behind by chickenpox. they are usually angular and u-shaped with a 1-4mm opening and are often 0.1-0.5mm deep. the shallower they are, the better they respond to treatments.
treatment types for depressed scars
resurfacing
suitable for people who wish to lighten the appearance of widespread shallow scars, resurfacing helps by removing the top layers of skin, promoting new skin cell growth. some procedures include:
● dermabrasion
● microdermabrasions
● chemical peels
● laser resurfacing
used for boxcar and rolling scars. may help to level deeper icepick scars as well.
Fillers
fillers are used to plump up depressed scars usually using collagen, the patient’s own fat or other synthetic substances. there are temporary and permanent fillers, each with its own set of pros and cons.
used for a small number of boxcar and rolling scars.
skin tightening using radiofrequency
this is a relatively new treatment method that utilises radiofrequency to tighten the skin. by doing that, it flattens and smooths out depressed scars. patients will have to return for monthly appointments. aftercare is also needed to help soothe a slight burning sensation. dermatologists might recommend sunscreen application during the day and moisturisers during the night for a week.
used for boxcar and deep icepick scars.
Microneedling
microneedling uses a microneedle-studded pen or roller to puncture the numbed skin briefly. this stimulates collagen production, which effectively fills in depressed scars. microneedling is an extended process requiring several trips to see the effect. the duration may vary from three to six treatments every two to six weeks. side effects like swelling and slight bruising may be present and patients are required to do aftercare.
used for widespread depressed acne scars.
subcision
subcision is done by inserting a needle to break the fibrotic tether holding the depressed scar to the subcutaneous tissue.
used for depressed scars.
raised or hypertrophic scars
these scars are usually elevated above the skin layer and may feel like bumps across the skin. they are the result of too much collagen forming during the healing process.
1. hypertrophic scars
these raised scars are typically found in males, especially around the chin area and the back. generally the result of severe acne and cysts under the skin, these are expected to decrease in size over time.
2. keloidal
these can be found on the back and chest area of males which developed as a result of acne lesions.
treatment types for raised scars
injections
dermatologists inject certain chemicals into the skin such as fluorouracil, corticosteroids and interferon which help to smooth and flatten scars. patients are required to return every two to six weeks.
used for raised scars.
acne scar surgery (followed by injections)
acne scar surgery is one of the most effective treatments for raised scars when combined with other methods like injections.
used as a complementary method for severe raised scars
laser therapy
pulsed dye laser (pdl) and intense pulsed light (ipl) can help soothe itchy and painful scars while lightening the colour of pigmented scars and flattening a raised scar.
used for all types of acne scars
cryosurgery
cryosurgery uses sub-zero temperatures to freeze raised scars, causing them to fall out. this method is often combined with injections for better results. it is, however, not recommended for people with darker skin as it may cause light spots to form.
used for raised scars but are not recommended for people with darker skin
