Laser Treatment for Acne Scars: Different Types of Acne Scars and The Treatments For Them

At some point in our lives, acne has become a major bother and for some, acne breakouts can have lasting effects in the form of acne scars. The prominent buzz for acne scar removal is laser treatments. While lasers have shown tremendous effectiveness on acne removal and a lot of dermatological studies have backed them up, this question still remains:

Do you really need laser treatment for acne scar removal?

Before jumping into the laser for acne scar removal craze, it is first proper to understand the different types of acne scars that can develop on the face. Yes, you read it right! There are different types of acne scars and most of the time, a mix of these acne scar types can appear on the different parts of your face.

How do acne scars form?

When the acne heals, the skin on the affected area repairs itself. However, during the healing process, the skin does not produce enough collagen and the repaired skin layer is not as flawless as the natural skin. This can leave behind depressions of varying depths on the skin surface. Sometimes the opposite can happen where the skin can overproduce collagen in an attempt to repair the damaged skin tissues forming elevated acne scars.

Types of Acne Scars

1. Rolling Scars

Characterized by extensive depressions with sloping edges that appear to be “rolling” on the skin surface.  This type of acne scarring usually reaches the deep layers of the skin tissues called the superficial muscular aponeurotic system (SMAS).

2. Ice Pick Scars

As the name suggests, ice pick scars look like deep, narrow, pitted scars that make the skin look like it has been pierced by an ice pick.  Given that these scars are very deep and narrow, doctors say that it is one of the toughest acne to treat and may take several treatment sessions to observe significant improvements.

3. Boxcar Scars

These scars have a characteristic broad depression and appear “boxier” in shape, hence the name. Like rolling and ice pick scars, boxcar scars are a result of too little production of collagen during acne wound healing. These scars can also be deep-rooted in the deeper skin tissue layers or SMAS.

4. Hypertrophic or Keloid Scars

These are elevated bumps on the skin as a result of the overproduction of collagen during the acne healing process. This excessive collagen settles on the spot where the acne inflammation has been.

5. Papular Scars

These are soft, elevated scars that resemble the color of the natural skin and usually appear on the chin. When the elastin fibers and dermal tissues around the hair follicles become damaged due to acne, popular scars are formed.

6. Post Inflammatory Erythema (PIE)

Following an inflammation from acne, localized redness can be observed on the acne spot and these are called post-inflammatory erythema and can oftentimes lead to acne scarring.

Do I really need a laser for acne scar removal?

The most established laser for acne scar removal is the fractional laser treatment is used technology. It works by creating a ’fraction’ of the skin with uneven skin texture (depressions and elevations) by stimulating the skin’s natural healing process. The most common fractional lasers used for acne scar removal are:

• Fractional CO2 Laser (ablative)
• Non-ablative Fractional Erbium Glass
• Fractional Picosecond Laser (Discovery Pico Plus)

Although fractional lasers have been proven effective and usually the top choice for acne scar removal, there are also other non-laser treatments that may be enough to do the job. With the right assessment from your doctor, alternatives other than a laser can be employed to yield significant results. In some cases, a laser can be used in combination with other non-laser treatments to achieve the best outcomes.

Non-laser alternatives for acne scar removal

According to Dr. Wan Chee Kwang from 1Aesthetics, non-laser treatments can yield great results for acne scar removal. Depending on the extent of scarring, your skin type, and how your skin reacts to the treatment, these procedures can work effectively and can also be used in combination with laser treatments.

1. Radiofrequency Technology

Radiofrequency technology delivers heat energy into the skin in a safer way compared to ablative lasers so there is less downtime, increased safety, and delivers great high efficacy. Two types of radiofrequency technologies are:

• Fractional Bipolar Radiofrequency (produces a pyramidal thermal injury zone)
• Fractional Microneedle Radiofrequency (uses insulated microneedles to penetrate the skin and deliver heat energy to the deeper skin layers)

Best used for: rolling scars, post-inflammatory erythema (PIE), and post-inflammatory hyperpigmentation

2. Subcision and Filler

For this procedure, a subdermal incision (subcision) is made by small needles to release tethered skin scars in the deep layers of the skin. To prevent the skin layers from sticking back together, dermal fillers are injected after a subcision.

Best used for: rolling scars, boxcar scars

3. Scar Excision

Through excision, the scar is removed in the deeper layers of the skin and the skin closed off with a skin graft or sutures.

Best used for: deep, isolated ice pick scars and narrow boxcar scars

4. Intralesional steroid injections

Injection of corticosteroids into the skin reduces over-active inflammation and controls collagen production.

Best used for keloid or hypertrophic scars

5.  Intense Pulsed Light

Intense Pulsed Light or IPL is a light-based acne scar removal that uses wavelengths of light emitted from a high-output light (usually a very bright flashbulb). This energy is then directed toward the target areas on the skin to initiate tissue healing. Compared to lasers and radiofrequency, IPL is usually less powerful and requires more sessions to achieve significant improvements.

Best used for Light and very narrow acne scarring

6. CROSS for Acne Scar removal

This treatment uses highly concentrated chemical peel (such as Trichloroacetic Acid) to lift the base of the acne scarring and resurface the outer skin layer.

Best used for: ice pick scars, small boxcar scars

Proper assessment is vital

Each patient is unique and therefore experience and outcomes for acne scar removal are different for everyone. For some, non-laser treatments may be enough but for others, more advanced treatments may be required. The first step is to effective acne scar removal is through a proper dialogue and assessment with your doctor. Depending on the extent and type of scarring, your doctor will tailor the right acne scar removal for you.