Getting rid of acne scars?

Originally Published: February 24, 1995 - Last Updated / Reviewed On: July 5, 2013
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Dear Alice,

What can be done about acne scars?

-Defacing

Dear Defacing,

They say beauty is only skin deep, but if you are prone to serious acne the resulting pock marks can be a source of real embarrassment. Some people ignore their scars, or wear them with pride, but if you want a smoother complexion there are a variety of ways to lessen the appearance of long lasting acne scars. A dermatologist can help you weigh the risks of different treatments and help you choose one that will produce the best effects for your skin.  

There are two types of acne scarring — early acne scars and long lasting scars. The first kind, which appears as a reddish blemish, is actually not a scar, but a sign of the normal healing process. These red marks usually fade away in six to 12 months. Allowing early acne scars to heal properly can lessen the chance of permanent scarring. Most importantly, wear sunscreen to avoid sun damage and resist the temptation to pick at the offending zits. Medicated creams containing tretinoin (like Retin-A), alpha-hydroxy acids (AHAs), or beta-hydroxy acid (BHA) can also promote healing. Acne sufferers should avoid using creams with vitamin E, which actually does more harm than good.

Lessening or removing permanent acne scars requires a more intensive plan of attack. One option is laser resurfacing. An intense ray of light energy (the laser) is used to "heat and treat" the affected skin. Essentially, the laser burns off the top layer (epidermis) of damaged skin while also warming the dermis layer underneath. The heat sparks the growth of new collagen fibers, resulting in smoother tighter skin. Depending on the amount of skin being treated, the dermatologist will give you a local anesthetic to numb a small area, a sedative to help you relax, or general anesthesia so you will be unconscious during the treatment. The whole procedure will last a few minutes or up to two hours. Recovery time also depends on the extent of treatment.

Despite its magical appeal, laser resurfacing is a surgical procedure with potential risks. The most common side effect is lightening or darkening of your natural skin color, more common in people with darker skin tones. During the healing process, you may notice:

  • Redness
  • Mild swelling and discomfort
  • Itching
  • Sunburn-like sensation

Less common but more serious risks of laser resurfacing include:

  • Infection
  • Acne break-outs
  • Dermatitis (skin inflammation)
  • Scarring

Another option to treat severe acne scarring is dermabrasion. Similar to laser resurfacing, dermabrasion involves removing the surface layer of skin through high speed sanding to reduce pitted acne scars, or to improve the appearance of raised scars. The skin is numbed with a local anesthetic and a revolving abrasive wheel removes the surface layer. After the procedure, the healing process lasts two weeks. This technique should not be used on skin with active acne.

A third option is minor reconstructive surgery, which also requires anesthesia. Depending on the size and shape of the scarring, a dermatologist can use different techniques to pinch together a deep pin-like scar or shave off an area of rough uneven skin. A skin graft can also be used to replace scarring with healthy skin from another area of the body.

Lastly, collagen or similar products can be injected into the skin to fill in or smooth out acne scars. However, these so-called "dermal fillers" are not permanent, so you will need to have repeated injections to maintain the effect.

To help you weigh all of the options, you may want to consult with a dermatologist who can assess the severity of your scarring and help you choose an appropriate treatment. The dermatologist can also explain the limits and results you can expect from each procedure. If you don't see a dermatologist already, ask your health care provider for a referral. Columbia students may want to begin by making an appointment with a health care provider at Medical Services (Morningside) or the Student Health Service (CUMC).

Given the cost and potential complications, removing acne scars may be more trouble than it's worth. On the other hand, if you're really set on sleeker skin, a trip to the dermatologist may help you put your best face forward.

Alice