Acne Scars

Not to be confused with microdermabrasion, or "power peel", "Parisian peel", or "lunchtime peel" which will do little for acne scarring and are primarily for fine lines and complexion rejuvenation.

Dermabrasion has been around for many decades. Initially, sandpaper was used to remove damaged skin and allow new skin to grow in its place, but now machines with quickly rotating diamond edged wheels are normally used. Depending on how coarse the wheel is, your doctor will achieve a less or more substantial effect. The procedure usually takes about a half an hour to an hour, and the skin is either frozen or numbed first.

Dermabrasion is best for light skinned or very dark patients, and not as good for those in between.

Laser resurfacing is challenging Dermabrasion for supremacy in the "resurfacing" field. Enough studies comparing the two are not yet available, so it is unclear which is better.

For a few days following the procedure, your skin will look scraped, and then a scab will form. Swelling occurs usually as well.

After the scabbing has fallen off, your skin will be reddish for several weeks. Most people can return to work after two weeks or so.

Laser resurfacing involves the use of a laser to remove skin so new skin can form in its place. This is a new procedure and few studies have been done. Laser resurfacing is promising because the penetration depth into the skin is more easily controlled with a laser than with other methods. Some practitioners claim very good results, some less so. The procedure can take just a few minutes for small areas or an hour or more for large areas.

Right now you and your doctor can choose between the CO2 laser and the erbium (YAG) laser. Again, not a lot of research has been done to compare the two.

Laser resurfacing can cause uneven skin tones in people with darker skin.

After treatment you will probably experience redness and swelling. Your doctor will most likely give you ointment to apply to the skin during healing. Your doctor may or may not apply a bandage to your skin. If he/she does, it will probably be on for a week or so, and be changed periodically.

Redness from laser resurfacing can last several weeks. Your skin may maintain a pinkish coloration for months afterward.

Application of different types of acid to the skin in order to remove the top layer so that a smoother layer can surface.

The procedure takes about 15 minutes or so. Peels are often repeated for best results.

Chemical peels are unlikely to produce results in people with severe scarring, and is designed only for the lightest of cases. It is the least likely method of treatment to improve acne scars.

Some redness and swelling is common following treatment. Also, flakiness and dryness can be expected as the top layer of skin sluffs off. Depending upon the acid used, recovery can take from one day to several weeks.

There are 3 techniques:

1. Punch replacement: removal of the pitted scar with a hair-transplant type punch which is then replaced with a skin graft, usually from behind the ear. This is usually the most successful method for deep scars.

2. Punch excision: removal of a pitted scar. The wound is then closed and allowed to heal.

3. Punch elevation: the scar is cut loose from the bottom, but not discarded. It is allowed to float up to the level of surrounding skin.


Punch techniques may be combined with resurfacing (dermabrasion or laser) to produce better results.

Punches may take several weeks or longer to heal.

Detaching the scar from deeper tissue, which allows a pool of blood to form under the scar. The blood clot helps form connective tissue under the scar, leveling it with the surface.

Usually 1-3 treatments are necessary. Subcision is often combined with resurfacing (dermabrasion or laser).

Injecting material under the scar to bring it to surface level (may follow subcision). Collagen is often used. One's own fat is also sometimes used, and other materials are being studied for use in augmentation.

Collagen injections are temporary, and last about 6 months give or take a few months.

Whereas many acne scar treatments are temporary, augmentation may prove to be a more permanent solution in the future, and the search for the best material for the job continues.

There is usually no recovery time. You can go back to your normal schedule right away.