Acne scars can be more distressful than the pimples and cysts that cause them. Before answering the question posed, it's necessary to discuss the different types of scars.
Most acne scars are not true scars and aren't permanent. Post-pimple marks are pink, red or brown spots that will fade with time and can be covered by makeup. Pink or red marks should fade in 3 to 4 months.
Dark brown marks can last 6 months to a year or longer. These are caused by the melanin pigment in the dermis found in cells called melanophages. These scavenger-like cells remain behind to clean up the pus and mess caused by papules and pustules. The challenge in treating these medically is penetration to the depth of the upper dermis, where melanophages reside. The darker your skin, the darker the spots will be. They can be treated painlessly with skin lighteners containing hydroquinone, which does not affect the normal skin color.
Superficial scarring, such as small, shallow depressions, can be improved with topical retinoids, available over-the-counter and in prescription medications. If caught early, these depressed, shallow scars may respond to microdermabrasion, which helps stimulate collagen production. There are over-the-counter microdermabrasion products, or you can have it done professionally. At minimum, 6 to 8 treatments performed on a weekly basis is necessary to see any results.
Treatment of more serious acne scars
Shallow, sunken depressions in the skin with fairly smooth edges, and sunken depressions with ragged, uneven edges are known as Dell scars. Several treatments with microdermabrasion can soften the ragged-edge scars a bit. Laser resurfacing with a CO2 laser or radiofrequency treatments have shown promising results for long-term improvement of these scars. Areas of sunken depression may be filled with materials such as bovine (cow) or human collagen. For deep depressions, there are permanent fillers which serve as something like Bondo does on dents in a car. If you decide on this option, discuss it with the doctor and make sure you understand the pros and cons - if the filler fails, it can leave an even bigger depression and larger scar than you had originally.
The scars usually found on the cheeks are called ice-pick scars, because of their appearance - they look like someone has taken an ice pick to the skin. They're small, deep holes with jagged edges and steep sides. These can evolve over time into depressed fibrotic scars, which also have sharp edges and steep sides, but are larger and firmer at their base than ice-pick scars. These scars are difficult to treat, unfortunately. They require surgery, either cutting out the hole and sewing the sides together, or transplanting skin from behind the ear to fill in the hole, then lasering the entire area so it blends in with the surrounding skin.
Severe cystic acne scarring can result in sinus tracts, leaving spaghetti-like tunnels under the skin that connect one sebaceous gland to another. These pull down and tether the skin. Extensive surgery to remove these tracts may lead to further scarring and increase the likelihood that new cysts will form in these damaged areas. If you have this type of scarring, seek out an accomplished specialist with references for performing surgery on these types of scars.
You can see from the above that scarring can be difficult to remove, which is why the primary goal of most dermatologists is to prevent scarring. If your acne is progressing to the severe stage and home remedies and over-the-counter treatments aren't working for you, see a dermatologist immediately.
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