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                          Acne Scars overview & treatments

Acne is the 8th most common disease in the world affecting about 80-90% of teenagers and young adults and affects almost at some point in life. These are raised bumps in the skin and some of them can be large and pus-filled and painful; usually involving the face.

Acne will resolve after a certain period of time but leaves behind scars. Hence acne should be treated in an early stage. If not, the acne gets infected and damage most of the skin after healing, leaving behind a permanent scar which is visible from 10 meters distance.

What is Acne Scarring?

The term scarring refers to a fibrous process in which new collagen is formed, following a full-thickness injury. It affects 30% of those with moderate to severe acne. It is particularly common in severe acne such as nodulocystic or acne conglobata or fulminans Acne scars are formed after healing moderate and severe pimples. Abnormal healing and dermal inflammation create the scar.

There are various modalities used to treat acne scars effectively. The treatment has to be tailored to the individual patient based on the skin type or color, scar type, and the patient’s economic capacity. 

Before treating the acne scar, it’s important to know the prevention of acne scars and different types of acne scars as each type responds to treatment differently. 

How to prevent Acne Scar? Prevention is better than cure; you must have heard this saying from someone. This is true in the case of acne scars also. Treating acne scars can be very difficult than to prevent acne scarring. So the best way to prevent acne scars from occurring is to prevent acne abrasions from occurring. To prevent acne and acne scars from occurring, one needs to understand in detail the causes of acne and acne scars and their right treatments.                                                                         

                                  What are the types of Acne Scars?

There are different types of acne scars. The appearance of hideous acne scars is probably the most distressing thing a lot of people face. In fact, acne scarring has become one of the discussed and searched skincare issues across the world. 

Depending on the width, depth, and 3-dimensional architecture, acne scars are basically classified into three basic types; few authors classify under six variants. 

1.Depressed or Atrophic scars 

Depressed or atrophic scars are shallow dents or pits on the skin due to the loss of tissue. The loss of collagen prevents the skin from repairing the indentation.

Usually, they are divided into three main types such as ice-pick scars, boxcar scars, and rolling scars. Some authors classify atrophic scar under this as a separate variant. 

Ice-pick scar: is the most common acne scars and are narrow and deep into the skin and resembles as large pores. Ice pick scars look as it has been pierced by a sharp instrument and look like a small, thin and deep hole into the skin. These acne scars usually occur after constant acne or after an irritating blemish or cyst.

Boxcar scar: These scars are round to oval depressions or wide box-shaped, with sharply demarcated vertical edges develop on cheeks and temple. They are wider than Ice pick scars and give the skin an uneven pitted appearance.

Rolling scar: These scars look like wide depressions that typically have rounded edges and an irregular rolling appearance and develop because of the fibrous band between the skin and the underlying subcutaneous tissue. Rolling scars differ from Boxcar scars in that they aren’t sharply defined and the skin itself looks uneven and craggy. 

Atrophic scars are thin flat or shallow depressions that heal below the top layer of skin.

2.Raised scars 

Raised scars are formed after healing of inflammatory acne, and appear as bumps on the skin surface. Hence, raised scars are formed due to excess scar tissue formation on the skin.

Papular scars are 3 to 4mm skin-colored cobblestone or soft elevated lesions are commonly seen on nose, chin, and trunk. They result from the destruction of collagen and elastin fibers in the dermal tissues around the hair follicles after acne inflammation. These papular scars are an unrecognized variant of acne scarring and most difficult to treat.

Hypertrophic/Keloid Scars: 

Such types of acne scars are raised, firm and red and usually occur after any skin injury or acne. Hypertrophic scars, Keloids are caused because of the overproduction of collagen. 

Acne Scars Treatment:

Though you must have tried many home remedies, used numerous over-the-counter medicines, and tried various medical procedures for treating acne scars, how effective these remedies and medicines have been? Home remedies and medications do not guarantee any permanent results to treat acne scars. A lot of clinics claim to provide 100% results in treating acne scars, but most of the time they fail to fulfill their promise.

Acne scarring is a physical, emotional, and a permanent reminder of the uncomfortable skin condition. A number of treatments are available to reduce the appearance of scars.

We at Clear Skin Centre are committed to providing our patients with the best result-oriented treatments for acne scars. So if you are suffering from acne scars, there is nothing to worry about. We proudly say that we are the first and only center in India to provide the most advance, time-tested, FDA approved treatment with different technologies for acne scars. Our skin treatments will help you get rid of acne and or its scars and have acne-free scars, clear skin. 

We at Clear Skin laser Centre provide the following treatments. Treatment options include:

Specific dermatological procedures: Chemical peeling, Microdermabrasion, Photon-microneedle therapy, PRP, and Dermafillers.

Surgical procedures: Subsection, Dermabrasions, Scar Revision, Punch elevation and excision, Punch grafting, Dermal grafts, and Autologous fat transfer.      

Laser treatments or Energy-based devices: Fractional resurfacing laser such Fractional co2, Erbium Yag laser, Erbium glass laser, Fractional sublative RF, Fractional MNRF (Scarlet & Endymed pro), Pico-laser, Pulse Dye laser (PDL) and Enerjet.

Usually, these procedures are done at monthly intervals for at least 4-5 times, they stimulate collagen production in the deeper part of the skin making scars less visible.

However, a number of treatments available to treat the scar, once you develop scar it becomes permanent on your skin. All scars don’t need treatment, only cosmetically undesirable, unpleasant and physically, mentally disturbing scars are to be treated. 

General Medication: Topical creams, ointments or gels, Silicone gels or sheets, and steroid injections and creams. Application of topical creams, a course of injection, and silicone sheet dressings can shrink the scar or appears less visible. Hypertrophic scar and Keloid scar can be well managed by intralesional injection and silicone gel 

Specific dermatological procedures 

Chemical peeling: Chemical peeling is a simple process of inducing a chemical solution in a controlled manner to remove the top layers. Chemical peeling requires multiple sessions in treating scars and best for surface layer scars; by exfoliating the dead superficial layers of the skin, which promotes the development of healthy new top layers of skin, making brighter and smoother. Chemical peels are most commonly used in treating acne and acne scars; include glycolic acid, salicylic acid, Jessner’s solution, resorcinol, and trichloroacetic acid (TCA).

TCA Cross is known as Chemical Reconstruction of skin scars mainly for pitted acne scars.

Cryotherapy: This treatment is mainly used to treat Keloids, liquid Nitrogen is applied on the scar to freeze keloid. In the early stages, Cryotherapy can diminish their growth, for effective results may need to take more sessions at the regular interval period suggested by our dermatologists. And to enhance the results intralesional steroid injection is given.       

Microdermabrasion: is a treatment procedure in which the skin is treated with the help of a special device with a rapidly rotating handpiece to smoothes out the superficial layers of skin and improves tissue regeneration. This procedure is used to treat acne scars, fine lines, and skin discoloration. This treatment helps brighten the skin tone and reveal healthy skin.

Photon microneedle therapy: Microneedling is a simple, cheap modality used commonly for treating acne scarring and for transdermal drug delivery. This treatment consists of a device with numerous needles with uniform length and diameter; which creates tiny punctures in the top layer of the skin and triggers the body to produce new collagen and elastin; resulting in improved texture and firmness by thickening of the epidermis and dermis of the skin.

Photon microneedle therapy combines conventional microneedle with the added benefit of LED light therapy and used to stimulate the biological activity of skin at the cellular level. 

PRP: Platelet-rich plasma is an exciting new method; involves separating the platelets from the whole blood. This concentrated platelet is injected into the scars (especially pitted acne scars) which is rich in growth factors, helps in collagen remodeling, and thereby improves the appearance of the scars. It is a safe and effective treatment as it involves the patient’s own blood. To enhance further results it is combined with fractional lasers.

Dermal fillers: Fillers injections are a temporary way to fill depressed scar(acne) using fillers such as Restylane or Perlane.

Surgical treatments or procedures: this includes 

Subsicion: This is a minor surgical process used for treating deep rolling (acne) scars; it is performed to undermine the scar with a fine hypodermic needle. This breaks the fibrous strands in the affected area by separating the skin tissue from deeper scar tissue. This allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area.                      

RF subsicion is a modification of conventional technique where a blunt cannula is inserted below the scars and subsequently delivering the radiofrequency energy.

Dermabrasion: This process involves rotating electrical machines, which penetrates more deeply and can completely remove surface scars and significantly improve the look of deep acne scars; done under local or general anesthesia. Dermabrasion, on the other hand, is a minimally invasive procedure for acne scar reduction

Scar revision is surgery to improve or reduce the appearance of scars and blends in with the surrounding skin. It also restores function and corrects skin changes disfigurement caused by injury or previous surgery or wound poor healing.

Punch excision/elevation: are usually done in ice pick and punch (boxcars) out acne scars In the punch excision, the acne scar is surgically removed through a punch matching the size of the scar and the skin edges are sutured together. Punch excision is ideal for deep ice pick scars and narrow, deep scars. Punch elevation is utilized for depressed scars like chickenpox scars or boxcar scars.

Punch grafting: is a simple effective treatment done for depressed acne scars. In this process a small punch tool is used to punch a hole in the skin, removing the scar and replace it with a plug of new skin. The new plugged skin inserted into the area, are usually removed from behind the ear lobe. The grafts held in place with sutures or surgical glue.

Autologous Fat Transfer/Dermal Grafts as a natural filler for treating depressed scar and recently been used.

Laser treatment or Energy-based devices:

Nowadays, laser scar removal is one of the most popular and most demanded scar removing techniques, the reason being non-surgical, non-invasive technique, most effective results without any discomfort and downtime of surgery. This treatment uses high-energy beams to break hard scar tissues and remove the damaged and older skin tissue and rebuilds it with fresh, new collagen without harming the surrounding skin tissues and leaving behind less visible scars, most attractive and smoother skin.

Laser Scar Removal is the simple, easy, tolerable, and out-patient procedure with minimum downtime allowing you to continue your routine activities along with the treatment and deliver quick results. But like any other procedure, laser scar removal also has some side effects associated with it that every potential candidate should be aware of before committing to the procedure.

Fractional laser skin resurfacing: treats microscopic columns of skin. It is a non-invasive treatment that uses a device to deliver a laser beam that targets a fraction of the skin at a time. These are called microthermal treatment zones (MTZs). Within each MTZ old epidermal pigmented cells are expelled and the collagen in the dermis is penetrated causing a reaction that leads to collagen remodeling and new collagen formation. This evens out the depressions in the skin.

There are plenty of fractional laser resurfacing technologies, among them the few mentioned below classified as ablative and non-ablative, which are the most commonly used are:

Fractional Co2 laser: produces a specific wavelength of light in the mid-infrared spectrum (10600 nm) and new versions have a super or ultra pulsed mode. It allows its laser energy is selectively absorbed by tissue water.

Fractional Erbium YAG laser: is a solid-state laser and emits a wavelength of 2940nm and its chromophore is water. This wavelength is closer to the peak spectrum of water and therefore has an absorption coefficient 12-16times higher than the CO2 laser. It is also a versatile laser and can be used in different modes such as ablative or non-ablative.

Fractional Erbium glass laser: Fractional Erbium glass is one of the most advanced lasers, used for skin resurfacing and rejuvenation. It is a non-invasive and non-ablative laser that works at 1550 nm wavelength.

Fractional non-ablative lasers produce a gentler effect on the skin, keep the epidermis intact, the laser energy heats the deeper dermis tissue in a controlled manner, and specifically activates fibroblast to stimulate neocollagenesis and dermal remodeling. This does not cause the water in the tissue to evaporate.

Fractional Micro-Skin resurfacing RF: [FSR]

This is also fractional skin resurfacing treatment done with a radiofrequency device and also called as fractional sublative RF. Hence it is not a laser, it can be used in a patient having laser phobia; for treating any atrophic or acne scar.

FSR produces volumetric heating into the deep dermis which helps in collagen remodeling & formation of new collagen beneath the scar tissue. As it is a Fractional process, it leaves the healthy skin in between the ablated area which allows faster healing with lesser downtime. FSR technology is useful in treating textural irregularities of the skin, wrinkles, and acne scars.

Fractional Microneedle RF: the microneedles are driven directly into the skin at a certain depth, and radiofrequency energy is then released; generating heat throughout the dermis. It results in volumetric tightening, collagen remodeling, and collagen production.

Fractional MNRF treatments are the latest innovations in the field of cosmetic dermatology. It is considered safer than fractional laser treatment and can be used on all types of skin without any major adverse effects.

Fractional MNRF delivers the energy deeper into the dermis; provides fractional ablation, creates microthermal zones, and leaves the healthy skin around, for rapid healing.

Fractional MNRF treatments are minimally invasive, minimum procedure time and downtime and the risks such as post-inflammatory hyperpigmentation and scarring are lower. 

Pico laser: Pico Laser (or picosecond laser) is a laser device that uses very short pulse duration < 1 nanosecond which predominantly causes photoacoustic damage ( pulses of the light measured by changes in pressure ie sound waves) 

The picosecond laser is mainly used for pigmentation removal, acne scars, skin rejuvenation and brightening, and tattoo removal. 

Pico laser works creating a laser-induced optical breakdown or micro subsicion; which promotes collagen and elastin production. Pico laser can penetrate several layers into the skin. The laser energy once delivered causes tiny globules of air or bubble; and these bubbles are filled up with collagen from deep within and raise indentations and depression caused by scars.

PDL: Pulsed dye laser are basically designed to rid patients of benign vascular lesions; they can also be used to treat scars especially red acne scars or fresh scars, hypertrophic, and keloid scars. The laser delivers an intense burst of yellow light to the skin; which is specifically absorbed by the blood vessels in the dermis. These blood vessels are coagulated and then reabsorbed by the body during the natural healing process; helps in collagen remodeling and hence scar correction.


Enerjet is synergetic innovation technology based on microtrauma and the effect of the healing compound. No needles, no risks of burns, no tissue necrosis. It is just safe with long-lasting results.

Enerjet uses Jet Volumetric Remodeling (JVR) technology – a high-pressure jet technology to laterally introduce healing agents deep into the dermal layer of the skin for a wide range of aesthetic indications. This single, innovative, non-thermal, and non-surgical solution is suitable for all skin types and all areas of the body. Enerjet is ideal for kinetic facelifts, scar repair, and dermal thickening. Enerjet solutions are proven to deliver superior, immediate, and long-lasting clinical results.

Advantages over lasers and surgery:

Safe, effective and simple

No needles

No thermal heating

Non-surgical, immediate results

Minimal downtime 

Enerjet works for both atrophic/depressed scars and in hypertrophic/ keloid scars and stretch marks. 

How does Enerjet work? 

A healing compound is administered deeply into the dermis using powerful jet technology. The healing compound, combined with kinetic energy, creates a controlled microtrauma, stimulating the body’s natural healing response. The jet disperses into the target zone to cover 100 times the area of a single 32G needle entry point, leaving virtually no signs on the skins outer layer (only 200 microns).      

Enerjet in Acne scars: It uses pneumatic energy to first break up the tight scar tissue underneath the skin after which microdroplets of high molecular weight hyaluronic acid are delivered. The skin then responds to microtrauma by stimulating elastin and collagen production resulting in an improvement of the scars. The continued remodeling effects of the treatment improve the results over time

Depending on scar’s shape minor procedures are advised as mentioned above. The outcome is always better when we combine different modalities depending on the nature of the scar. No scar can ever be completely removed; always leaves a trace, but their visibility can be lessened by the above-mentioned means.

We at Clear Skin Centre are committed to providing our patients with the best result-oriented treatments for acne scars. So if you are suffering from acne scars, there is nothing to worry about. We proudly say that at present we are the first and only center in India at present to provide the most advance, time-tested, FDA approved treatment with different technologies for acne scars. Our skin treatments will help you get rid of acne and or its scars and have acne-free scars, clear skin. 


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