Cosmetic Services - Acne Scars
Many people consider acne to be a rite of passage, yet it can leave permanent scars on the face and body that cause significant distress. We have been treating acne scars and acne scarring in Denver for over fifteen years. It's a great feeling when patients with acne scars can finally look themselves in the mirror without feeling self-conscious about their appearance.
Types of Acne Scars
Acne scars are classified into distinct types: ice pick scar, box car scar, or rolling scar. These distinctions are important because each type of scar requires a different treatment. Ice pick scars consist of small, deep holes which can have the appearance of enlarged pores. Box car scars are skin indentations or craters and can be shallow or deep. Rolling scars consist of broader indentations or valleys that are due to atrophy or loss of the underlying collagen or fat. Rolling scars tend to be distensible which means that they look better when the skin is stretched tight. It is very common for a given patient to have more than one type of acne scar on their face.
Treatment of Acne Scars
Dr. Ort prefers to treat ice pick scars with CROSS (chemical reconstruction of skin scars). CROSS is performed by applying 100% trichloracetic acid (TCA) directly into each scar using a small wooden applicator. A small injury is produced which leaves a small scab for about a week. Over time, the healing process fills in and smooths the scar. Most patients benefit from repeat treatments done about every six weeks for a total of five or six sessions.
Chemical peels using TCA, Jessner’s peel, salicylic acid, or glycolic acid have a long history of safe and effective use in dermatology. They can be used to help smooth milder scars and can also improve any active acne. Chemical peels can be a great choice for those patients with hyperpigmentation or dark discoloration from their acne.
Lasers have been a mainstay in the treatment of boxcar and rolling acne scars for many years. Most lasers used for acne scars are fractional, meaning that thousands of tiny laser wounds are created in the skin, but the skin in between the laser wounds remains intact (picture a lawn that’s been aerated). This results in faster healing, less downtime, and less risk for side effects. We utilize two distinct fractional lasers. The more gentle Affirm laser utilizes two wavelengths (1440 nm and 1320 nm) to remodel acne scars without downtime. The SmartSkin CO2 laser is an ablative laser, which creates more visible but controlled thermal micro-injuries in the skin. A few days of downtime and peeling will reveal refreshed, rejuvenated skin with smoothing of acne scars and tightening of skin. Most people with acne scars do best with a series of laser treatments done over time. We also frequently use the non-invasive Cynergy pulsed dye laser to improve the appearance of red or purple acne scars.
Microneedling has become one of our most popular treatments for boxcar and rolling acne scars. This technique uses either a skin roller or a pen-like device to create thousands of tiny needle injuries in the skin. We currently perform microneedling with the SkinPen®, which allows us to vary the depth of the needles and allows for treatment of the full face. Microneedling has minimal downtime and patients can resume their normal lives quickly. We usually recommend a series of five treatments for best results. Our patients have been impressed with the results from the SkinPen and we consider it a breakthrough treatment for acne scars.
Rolling scars which are sunken in usually need to be lifted from below. Dr. Ort has advanced training and experience in subcision, which stands for "subcutaneous incision." This technique utilizes a special needle, which is worked under the scar to break up scar tissue and provide visible lifting. The skin is numbed with local anesthetic first to ensure patient comfort. Improvement after subcision can be dramatic. Patients can experience some bruising and swelling after subcision and we typically recommend that patients plan to take a few days off afterwards.
Fillers such as Juvederm®, Voluma®, Restylane®, or Lyft® are a popular, non-invasive treatment method for acne scars. Fillers work best for rolling, distensible acne scars. Injections provide an immediate lift to the skin to help restore a more normal contour. These fillers are safe, long-lasting, and have minimal downtime. Results can last one year or longer and treatment can be repeated over time. Bellafill® is an interesting new filler for acne scars which can provide long-lasting or even permanent results. Dr. Ort has advanced training and expertise in the use of fillers and can help choose the filler that is right for you.
There are many effective treatments for acne scars in Denver. The right treatment depends on many factors, including the type of acne scar, your skin type, and your tolerance for downtime. Dr. Ort and staff specialize in many different treatments for acne scars and will help select a treatment that is best for you!