Stretch Marks + Scars

Acne scars are caused by the body’s inflammatory response to acne lesions. The best way to prevent scars is to treat acne early, and as long as necessary. If scars form, a number of effective treatments are available.

Scars form at the site of an injury to tissue. Two types of true scars exist, as discussed later: (1) depressed areas such as ice-pick scars, and (2) raised thickened tissue such as keloids.

Acne scars associated with loss of tissue – similar to scars that result from chicken pox – are more common than keloids and hypertrophic scars.

Scars associated with loss of tissue are:

  • Ice-pick scars usually occur on the cheek. They are usually small, with a somewhat jagged edge and steep sides – like wounds from an ice pick. Ice-pick scars may be shallow or deep, and may be hard or soft to the touch. Soft scars can be improved by stretching the skin; hard ice-pick scars cannot be stretched out.
  • Depressed fibrotic scars are usually quite large, with sharp edges and steep sides. The base of these scars is firm to the touch. Ice-pick scars may evolve into depressed fibrotic scars over time.
  • Soft scars, superficial or deep are soft to the touch. They have gently sloping rolled edges that merge with normal skin. They are usually small, and either circular or linear in shape.
  • Atrophic macules are usually fairly small when they occur on the face, but may be a centimeter or larger on the body. They are soft, often with a slightly wrinkled base, and may be bluish in appearance due to blood vessels lying just under the scar. Over time, these scars change from bluish to ivory-white in color in white-skinned people, and become much less obvious.
  • Follicular macular atrophy is more likely to occur on the chest or back of a person with acne. These are small, white, soft lesions, often barely raised above the surface of the skin – somewhat like whiteheads that didn’t fully develop. This condition is sometimes also called “perifollicular elastolysis.” The lesions may persist for months to years.

Thanks to the refinement of a number of dermatologic surgical techniques, scars can be treated with a variety of safe, effective procedures that improve the appearance of a patient’s skin and boost the patient’s self-esteem. The following are common techniques and procedures used to improve scarring:

Dermabrasion: The dermatologist removes or “abrades” the skin with a rotary instrument. The skin undergoes a “remodeling” process as it heals, resulting in a smoother and fresher appearance. This procedure is avoided in darker skinned individuals because of the risk of hyperpigmentation.

Punch Excision or Replacement Graft: Punch excision of each individual scar is a technique for ice pick scars. In this procedure, each scar is excised down to the layer of subcutaneous fat; the resulting hole in the skin may be repaired with the punched skin glued or sutured at skin level, or the resulting hole may simply be closed with a suture or with a small skin graft.

Subcision: A technique in which a surgical probe is used to lift the scar tissue away from unscarred skin, thus elevating a depressed scar. Occasionally, a filler substance can be placed to elevate the depressed scar after subcision.

Soft Tissue Fillers: Collagen-related fillers are injected in small quantities below the surface of the skin to elevate depressed scars. This is often coupled with subcision which lifts the scar and allows a space for the filler to occupy.

Chemical Peeling: By applying a chemical solution to the skin, mild scarring and certain types of acne may be treated. Chemical peeling enables new, regenerated skin to appear, improving the appearance of the condition.

Your dermatologist will choose the technique or combination of treatment approaches based upon the nature of the scarring, the patient’s medical history.