Patients are often interested in treating depressed, ice-pick, and rolling scars resulting from facial acne. Once the acne is appropriately treated and under good control, there are several available treatment options. In general, a multimodality approach produces the best results. Some of these approaches include subcision procedures, punch elevations/ grafts, local acid application (trichloroacetic acid in the "CROSS" technique), filler injections, dermabrasion, and fractional laser resurfacing procedures. All of these techniques and technologies are available at the Pennsylvania Centre for Dermatology.

Traditional (ablative)Laser resurfacing: Traditional ablative laser resurfacing procedures (such as carbon dioxide laser or erbium lasers) physically destroy or remove the superficial layers of the skin. The wound recovery process generally results in skin that is smoother and more regular in texture. However, these approaches generally require anesthesia, significant down-time, and potential risk of permanent discoloration. Additionally, patients with darker skin tones are not good candidates for this procedure.

Fractional Resurfacing Lasers: Unlike tradiational resurfacing lasers, new Fractional Laser devices, allow treatments without the need for general anesthesia, limited to no down-time, and without the risk of permanent facial discoloration. Additionally, this procedure is safe in all skin types including patients with dark skin tones. Fractional Laser Therapy delivers thousands of deep, microscopic columns of laser energy to your skin. These microthermal treatment zones leave the surrounding skin unaffected. The treatment promotes the skin’s natural healing process by producing new collagen and replacing damaged cells. The repaired skin appears healthier, tighter, and with fewer surface imperfections. Each treatment targets between 20 and 25 percent of the skin's surface. Consequently, an effective treatment regimen typically requires 3 to 5 sessions, spaced at 2- to 4-week intervals. Results are immediate and progressive. Optimal improvement is usually visible in about 2 to 3 months.

Dermabrasion: With this somewhat aggressive procedure, a physician will physically strip the top layers of the skin using a machine with a quickly rotating diamond-edged wheel (similar to a Dremel tool). This procedure is extremely user-dependent and should only be performed by physicians with ample experience. There is typically significant down-time and is only recommended for patients with light skin tones. Given the destructive nature of this procedure, some form of anesthesia is required. Scabbing and crusting generally last for a few days to a week. The skin often appears red and inflamed for several weeks after the procedure. This procedure should not be confused with "microdermabrasion" which is a very gentle procedure that has little or no effect on facial acne scars.

Punch Techniques: There are three types of punch procedures that are often utilized to correct deep, ice-pick type scars. All punch procedures involve utilizing an instrument somewhat like a cookie-cutter, but more in line with the size of a pencil eraser. With punch elevation procedures, a punch is used to free the depressed scar from underlying tissue and the column of skin is simply lifted and left and secured in place. With punch removal procedures, the core of skin is removed and the wound is closed with a stitch or alternate method (steri-strip or cyanoacrylate glue). With punch graft procedures, the core of skin is removed and replaced with skin typically removed from an inconspicuous location such as behind the ear. Typically, punch techniques will require some form of follow-up procedure such as dermasanding or superficial resurfacing to smooth out the resulting scars. Punch procedures typically take one to several weeks to fully heal.

Subcision: This procedure involves utilizing a thin sharp instrument (such as the tip of a hypodermic needle) to free up adherent scar tissue under a retracted scar. A small amount of blood will accumulate under the scar and result in wound healing and collagen formation that may help elevate the depression. Typically, several treatments are required and are usually combined with some form of resurfacing or fractional laser procedure. Bruising and swelling can persist for one to two weeks.

Filler Injections / Augmentation: With these procedures, a material is typically injected under a depressed scar to bring make the surface of the skin more uniform in appearance. Most filler materials (such as Restylane) are temporary in nature and can last from as little to four months to as long as 9 months. Several materials are available for this procedure. Results are immediate and there is typicaly no down time or recovery period. Filler injections are often combined with subcision procedures to maximize results.

Localized acid application / CROSS technique: a new and promising procedure for depressed acne scars involves the focal application of trichloroacetic acid in high concentrations. This technique is often referred to as " chemical reconstruction of skin scars" (or CROSS) method. Typically, 65% or 100% trichloroactic acid is applied in small quantities into the base of a depressed scar. The procedure is often repeated three to six times at one to three month intervals for optimal results. White frosting, followed by crusting appears in the treated areas. This typically resolves within one week. Redness and minor swelling may persist for 2 to 8 weeks.

Pulsed Dye Lasers: Some patients are interested in treating flat red scars related to more recent acne. Typically, these flat red lesions will resolve on their own, but may take as long as 6 or 9 months. Vascular lasers, such as the pulsed dye laser, can hasten recovery and help fade these unsightly red lesions.

How Can I Set Up An Appointment?
The Pennsylvania Centre for Dermatology is located at Pennsylvania Hospital, on the 10th Floor of the Spruce Building. Call for more information or to schedule a consultation.

Pennsylvania Centre for Dermatology

822 Pine Street, Suite 2A

Philadelphia, PA 19107

267-519-0154