So you’ve cleared your acne only to reveal you now have acne scars. Don’t panic! There are solutions.

The first step is to realize that not all acne scars are equal. There are multiple types of acne scars, some are pigmented scars and others are textural. There are actually three types of textural scars that people don't realize. There's box scar, which can look like a chicken pox scar with a shallow depth and a defined edge. Then, there is an ice pick scar, which is when the scar looks almost like a hole. Finally, there’s a rolling scar, which is textural and looks more like a dimpling to the skin.

You also have pigmentation scars: post-inflammatory erythmia (PIE) and post-inflammatory hyperpigmentation (PIH). The type of treatment you do will depend on the type of scarring you’re experiencing.

When we're talking about textural scarring, the idea is that we want to encourage and build collagen within the skin. This helps soften the depths of the scarring, but it also improves the overall texture and tightens up the skin. There are different ways ways we can do that, but the most generalized one that people always go to is microneedling, which, to me, is the gold standard for scar revision and collagen induction. It involves taking a microneedling device, penetrating it up to 1 to 1.5 millimeter depth (depending on the scar), and doing a series of three to six treatments on the skin. The best thing about microneedling is that it's cumulative, so every time you do it, you’re going to see better and better results. Collagen isn't built in a day.

If you need a little more, there is another ramped up version of this called RF microneedling, where the needles are heated. When these needles hit that base layer of dermis, it kind of pulls and tightens and contracts that level of dermal skin and helps rebuilt. Like most treatments, make sure to go to an excellent provider. You can do a lot of damage with RF microneedling if you don’t know what you’re doing.

And if you have very deep textural scarring, I sometimes recommend something called subcision, which is done at a derm’s office. To do it, they use a needle to manually break up the scar tissue under the skin. It's pretty gnarly and can feel terrible even though they usually numb you first.

For a really intense scar, you may have heard about TCA Cross, which uses trichloroacetic acid to treat very deep ice pick and boxcar scars. It's an extremely strong treatment where the provider will apply the chemical to the middle of your scar using a teeny tiny instrument. It creates a wound that then pulls the edges of the scar together to form smooth skin. It can be highly effective, but, again it must be done by an excellent, experienced provider, and it does run the risk of hyperpigmentation. Always speak to your dermatologist before trying TCA Cross or any other intensive treatment.

For pigmented scars, lasers are most effective. In the laser department, CO2 is kind of like the big daddy laser that treats anything — it’s really resurfacing and ablative. And then there's also Erbium laser which also deeply ablative. And then you have things which are lighter and more fractional, like Fraxel and Clear and Brilliant. These can be helpful, but the lighter you go, the more sessions you might need.

At home, make sure you’re exfoliating regularly and encouraging cell turnover with a retinol that suits your skin. (Always work your way up the % ladder slowly for your barrier’s sake.) And, to prevent future dark spots or making your existing spots worse, do not leave the house without sunscreen.

Any questions? You know where to find me.

Xx

Sofie