Surgery can improve the appearance of acne scars, but doctors often use a complementary treatment afterward for optimal results. Combining surgery and postsurgery injections is one of the most effective ways to treat raised acne scars.
The American Academy of Dermatology Association (AADA) is the source of the above information.
Surgery is also an option for treating depressed acne scars. Additionally, nonsurgical treatments — such as laser resurfacing and skin tightening — are available.
Treatment for acne scars should commence after resolving the active acne infection. This is because surgical treatments are likely to irritate the skin and may lead to flare-ups in some people. However, a dermatologist can help someone manage this.
There is no best treatment for every person. The choice depends on the type of scars someone has, along with other considerations, such as costs and recovery time.
This article examines acne scars and plastic surgery. It also discusses other treatment choices and factors to consider before undergoing a procedure and answers some frequently asked questions.
Some types of acne can cause a raised scar, known as hypertrophic or keloid scars. Scars can also be indented, known as atrophic scars. Most surgical and nonsurgical treatments can reduce the size and visibility of acne scars.
Learn more about acne scar types.
Dermatologists consider the options safe and effective. A combination of treatments, outlined below, is usually necessary for optimal results.
Surgical acne scar treatments
Surgical removal is one of the treatments for indented and raised acne scars.
Indented acne scars
If a scar is indented, a doctor may surgically lift it closer to the skin surface to make it less noticeable. This is suitable for treating a few depressed scars.
Punch techniques are types of surgery that doctors use for very deeply indented scars. They involve removing, elevating, or replacing the scar tissue with a skin graft.
Raised acne scars
Most people with raised acne scars may experience a recurrence following surgery, so a doctor may recommend a complementary treatment to help prevent or reduce recurrence.
Complementary treatment with surgery can involve injections or radiation. Individuals who receive injections will likely have one per month for several months. The combination of surgery with injections is one of the most effective treatments for raised scars. Injection medications may entail:
- fluorouracil (5-FU) — a chemotherapy agent
- corticosteroids — anti-inflammatory medications
- interferon — a substance that helps the immune system fight infections
Radiation is not a first-line treatment unless other treatments have been unsuccessful. This is likely because it carries some risks, such as the potential for the treated area to heal inadequately.
Nonsurgical acne scar treatments
Nonsurgical treatments include:
Injections
This involves injecting medication directly into the scars to flatten and soften them. A dermatologist usually administers them once every few weeks. Surgery may be necessary if someone does not receive satisfactory results after the fourth treatment. Injections can be a good choice for raised, painful scars.
Subcision
This technique requires inserting a needle below the scar and moving it in a fanning motion to produce a micro-wound. It aims to stimulate collagen production in the skin, which can help improve appearance by elevating a depressed scar.
Dermal fillers
Substances, or fillers, are injected beneath the skin to elevate indented scars. Common fillers include:
- polymethyl-methacrylate fillers
- hyaluronic acid fillers
- poly-L-lactic acid fillers
- calcium hydroxyapatite fillers
Alternatively, a person can use their own fat as a natural filler. Dermal fillers are a treatment for deeper indented scars, and a dermatologist typically combines them with skin treatments that induce collagen production.
Fillers are appropriate for improving the appearance of a few depressed scars but are less helpful for icepick scars, which are usually deep and look like an icepick has punctured the skin. The Food and Drug Administration (FDA) has approved a dermal filler — Bellafill — for acne scars in people over 21 years.
Laser resurfacing
This procedure entails passing light wavelengths across the skin to stimulate the production of more collagen. It reduces the edges of acne scars and makes them less noticeable.
This is an option for treating depressed scars.
Learn more about laser resurfacing.
Microneedling
Another type of collagen-induction therapy is microneedling, which involves passing a device with tiny needles across the skin. The needles cause a micro-injury that triggers the body’s healing response. Most people need 3–6 sessions.
This is an option for treating certain depressed scars, but not icepick scars.
Chemical peels
This entails applying a solution that causes peeling of the outermost skin layer, stimulating new skin growth. It can be helpful for depressed scars.
Cryotherapy
This uses freezing to reduce the appearance of scars. It may be suitable for certain raised scars.
Skin tightening
This is a newer, more affordable procedure that uses radiofrequency to tighten the skin and makes raised scars less visible. Radiofrequency entails the use of an electromagnetic device that produces heat, which triggers collagen production and the formation of new skin cells.
Skin tightening requires a certain amount of at-home care afterward.
A one-size-fits-all best acne scar treatment does not exist, notes the American Board of Facial Cosmetic Surgery.
As the above section indicates, different treatments are more suitable for different types of scars. Side effects can occur with any or all treatments. However, the practitioner performing the procedure should notify a person of these beforehand.
Some factors to consider before undertaking any procedures for acne scars include:
- Costs: Health insurance does not cover acne scar treatment, so costs may be a consideration.
- Time and aftercare involved: Certain treatments require more time and aftercare, which may inconvenience some people. Treatments before and after the scar removal procedures to prep the skin and help counteract the possible side effects of the treatment itself may be necessary. For example, doctors may recommend hydroquinone cream after laser resurfacing.
- Recovery period: As the recovery time differs among treatments, a person with a tight schedule may wish to choose one that involves a shorter period.
- Priority rank: Some individuals experience more distress from acne scars than others, so getting treatment may be a higher priority. People do not always need to seek treatment for acne scars.
- The person performing the procedure: Depending on the treatment or scar severity, this could be a dermatologist, aesthetician, or nurse. A person may wish to consider their expertise and experience regarding acne scar cases.
The following section includes common questions about acne scars:
Do acne scar removal creams work?
Creams and gels are available over the counter. They can help decrease discomfort and itchiness, as well as fade, flatten, or shrink raised scars.
That said, for effectiveness, a person must use these products on an ongoing basis. While acne creams have little potential for causing side effects, continuous use may result in irritated or itchy skin. Even though they help, none are likely to remove a raised scar.
Is acne scar removal permanent?
Scars can recur after surgical removal, but dermatologists may advise complementary treatment to minimize the likelihood.
Is acne laser treatment effective?
Laser therapy for acne scars comes in many varieties. The more intensive types require a longer recovery period, so a person should choose them carefully. However, just one treatment can produce noticeable results for some individuals.
Surgery is one of the treatment options that can reduce the size and visibility of acne scars. To prevent scars from returning, dermatologists often recommend a complementary treatment to follow surgery, such as injections.
Aside from surgery, other treatments are helpful. These include procedures such as laser resurfacing and microneedling. Additionally, acne scar creams may reduce discomfort and help certain types of scars fade, but long-term use may irritate the skin.
The choice of treatment can depend on the characteristics of the scar. Other factors may also be a consideration, such as costs, as health insurance does not cover acne scar procedures.