Treatments for Acne Scars

The objective of scar treatment is to give the skin a more acceptable physical appearance. Total restoration of the skin, to the way it looked before you had acne, is often not possible, but scar treatment does usually improve the appearance of your skin.

A number of treatments are available. The type of treatment selected should be the one that is best for you in terms of your type of skin, the cost, what you want the treatment to accomplish, and the possibility that some types of treatment may result in more scarring if you are very susceptible to scar formation.

It is essential for you to have a frank discussion with the dermatologist. The dermatologist needs to conduct a full examination and determine whether treatment can, or should, be undertaken.

The scar treatments that are currently available include:
• Chemical peel
• Dermabrasion
• MicroDermabrasion
• Laser or resurfacing of scars
• Soft-tissue augmentation
• Intralesional steroid injection (keloids)
• Excisional surgery in selected cases


Chemical peels can improve small, depressed scars and some larger scars. Peeling may also be effective in treating any remaining acne by removing comedones (blackheads and whiteheads). Ice-pick scars and deep fibrotic scars are not treated effectively by chemical peels. Keloids are usually not treated by chemical peels. Repeated and/or deep peels may be necessary to improve deep or extensive scarring.

Dermabrasion was thought to be the most effective treatment for acne scars, and is still a procedure commonly used for that purpose. Under local anesthetic, a high-speed brush or fraise used to remove surface skin and alter the contour of scars. Superficial scars may be removed altogether, and deeper scars may be reduced in depth. Dermabrasion does not work for all kinds of scars; for example, it may make ice-pick scars more noticeable if the scars are wider under the skin than at the surface. Today a combination of dermabrasion and "punch" excision of scar tissue make many ice-pick scars treatable by dermabrasion. In darker-skinned people, dermabrasion may cause changes in pigmentation that require additional treatment.

Microdermabrasion. This new technique is a surface form of dermabrasion. Rather than a high-speed brush, microdermabrasion uses aluminum oxide crystals passing through a vacuum tube to remove surface skin. Only the very surface cells of the skin are removed, so no additional wound is created. Multiple procedures are often required but scars may not be significantly improved.

Laser treatment of acne scars is a newer technology but one that can be very effective in selected patients. The various energy and tissue-penetrating power of different lasers may be used to treat complex scars. For example, the deep tissue penetration of a YAG laser may be used to "sculpt" irregular scarring and the infrared beam of the carbon dioxide laser may be used to tighten collagen fibers in the skin and elevate depressed scars.

Soft-tissue augmentation can correct some atrophic (loss of tissue) scars. Injections of subcutaneous fat or collagen under the scars elevates them to bring the surface of the scars even with the surface of surrounding skin. The procedure may have to be repeated from time to time.

Injection of steroids directly into keloid scars can sometimes result in scar improvement. An intralesional injection can be combined with surgery to reduce the size of scars in carefully selected patients. Keloid surgery should be performed only by a dermatologic surgeon.

In summary, 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. Dermatologic surgery treatments should be discussed with a dermatologist