Multi-Lift Acne Scar Reconstruction

New Jersey MediSpa Services – Acne Scar Reconstruction & Skin Enhancement Procedures at The Dermatology Center at Old Bridge

What are Acne Scars?

Acne scars are caused by the body’s inflammatory response to acne lesions. In the case of acne, injury is caused by the body’s inflammatory response to sebum, bacteria and dead cells in the plugged sebaceous follicle. Two types of true scars exist: (1) depressed areas such as ice-pick scars, and (2) raised thickened tissue such as keloids.

When tissue suffers an injury, the body rushes its repair kit to the injury site. Among the elements of the repair kit are white blood cells and an array of inflammatory molecules that have the task of repairing tissue and fighting infection. However, when their job is done they may leave a somewhat messy repair site in the form of fibrous scar tissue, or eroded tissue.

White blood cells and inflammatory molecules may remain at the site of an active acne lesion for days or even weeks. In people who are susceptible to scarring, the result may be an acne scar. The occurrence and incidence of scarring is still not well understood, however. There is considerable variation in scarring between one person and another, indicating that some people are more prone to scarring than others. Scarring frequently results from severe inflammatory nodulocystic acne that occurs deep in the skin. But, scarring also may arise from more superficial inflamed lesions.

A few scattered freckles on the face might be considered cute, but when years of sun damage begin to add up, the results are anything but. Most pigmented lesions can be directly attributed to overexposure to the sun's damaging ultraviolet rays. Preventative measures should always be taken by using sunscreen and avoiding the sun. This won't correct any damage already done, but it can help keep pigment problems from getting any worse.

Prevention of Acne Scars

Since the occurrence of scarring is different in different people, it is difficult to predict who will scar, how extensive or deep scars will be, and how long scars will persist. It is also difficult to predict how successfully scars can be prevented by effective acne treatment.

The only sure method of preventing or limiting the extent of scars is to treat acne early in its course, and as long as necessary. The more that inflammation can be prevented or moderated, the more likely it is that scars can be prevented. It is important that anyone with acne who has a known tendency to scar should be under the care of a dermatologist.

Types of Acne Scars

There are two general types of acne scars, defined by tissue response to inflammation:

Scars Caused by Increased Tissue Formation
The scars caused by increased tissue formation are called keloids or hypertrophic scars. The word hypertrophy means "enlargement" or "overgrowth." Both hypertrophic and keloid scars are associated with excessive amounts of the cell substance collagen. Overproduction of collagen is a response of skin cells to injury. The excess collagen becomes piled up in fibrous masses, resulting in a characteristic firm, smooth, usually irregularly-shaped scar.

The typical keloid or hypertrophic scar is 1 to 2 millimeters in diameter, but some may be 1 centimeter or larger. Keloid scars tend to "run in families"—that is, abnormal growth of scar tissue is more likely to occur in susceptible people, who often are people with relatives who have similar types of scars.

Hypertrophic and keloid scars persist for years, but may diminish in size over time.
Scars Caused by Loss of Tissue
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’t fully develop. This condition is sometimes also called "perifollicular elastolysis." The lesions may persist for months to years.

How Are Acne Scars Treated?

Since acne scars come in various sizes and shapes, individualizing treatments becomes necessary to maximize the results. At the consultation, Dr. Rapaport chooses one or a number of different methods that are customized to patient’s needs. For example, subcision (undermining), the TCA CROS Method, Fraxel resurfacing, CO2 or Erbium Laser Resurfacing, and the use of filler substances are appropriate for different types of lesions.

Smooth-Walled (Rolling) Depressed Scars: For smooth-walled (rolling) depressed scars, Dr. Rapaport usually treats the scars with subcision and the NLite laser. During a subcision session, Dr. Rapaport uses a specialized needle to break up scar tissue underneath the depression. The ensuing wound repair process results in the production of collagen in the treated area, causing the depression to slowly fill in from underneath. NLite treatments are recommended within a few days of subcision to bring about a more dramatic collagen production response.

"Box Car" Depressions: For "box car" depressions and certain types of sharper edged scars, subcision in combination with the Fraxel laser has been highly effective. The Fraxel has proven to be an excellent tool to smooth out sharper borders non-ablatively with results that are superior to those resulting from more invasive resurfacing technologies (i.e. CO2). In fact, if the scars being treated are superficial, subcision can probably be circumvented altogether. Additionally, patients being treated with the Fraxel benefit from the laser’s inherent ability to reduce the visibility of pores, a common problem for people plagued with acne.

Pitted Scars: For certain kinds of pitted scars, Dr. Rapaport will often recommend the TCA localized Peeling (also called the TCA CROSS Method). During such treatment, a high concentration of Trichlorocetic acid is introduced just inside the scar. The resurfacing response that occurs inside the depression stimulates collagen production that, over multiple sessions, causes the scar to rise up and close in on itself.

Excision is recommended to treat pitted scars that are not amenable to the CROS Method. As a general rule, for those patients requiring multiple excisions, at least a localized laser resurfacing is done afterwards to smooth over the remaining stitch marks.

Other Conditions: Many types of elevated scars can also be treated by flattening or leveling with laser resurfacing or Radio Frequency surgery.

Full face chemical peels are often recommended for discoloration caused by acne. However, such treatments are not effective on depressed scar tissue.

Schedule a consultation to discuss our Acne Scar Treatment

Request More Information about our Acne Scar Treatment