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Acne Scars

Multi-Modality Approach to Acne Scar-Lift

Tucson Cosmetics Offers Acne Scar Reconstruction & Skin Enhancement Procedures


What are Acne Scars?

Acne scars are caused by the body’s inflammatory response to acne lesions. In the case of acne, injury is caused by the body’s inflammatory response to sebum, bacteria and dead cells in the plugged sebaceous follicle. Two types of true scars exist: (1) depressed areas such as ice-pick scars, and (2) raised thickened tissue such as keloids.
In people who are susceptible to scarring, the result may be an acne scar. The occurrence and incidence of scarring is still not well understood, however. Scarring frequently results from severe inflammatory nodulocystic acne that occurs deep in the skin. But, scarring also may arise from more superficial inflamed lesions.

Prevention of Acne Scars

The only sure method of preventing or limiting the extent of scars is to treat acne early in its course, and as long as necessary. The more that inflammation can be prevented or moderated, the more likely it is that scars can be prevented. It is important that anyone with acne who has a known tendency to scar should be seen in the office as soon as a flare-up occurs.

Types of Acne Scars

There are two general types of acne scars, defined by tissue response to inflammation. The scars caused by increased tissue formation are called keloids or hypertrophic scars.

Scars Caused by Loss of Tissue—similar to scars that result from chicken pox—are more common than keloids and are called hypertrophic scars. Scars associated with loss of tissue are:

Ice-pick scars usually occur on the cheek. They are usually small, with a somewhat jagged edge and steep sides—like wounds from an ice pick. Ice-pick scars may be shallow or deep, and may be hard or soft to the touch. Soft scars can be improved by stretching the skin; hard ice-pick scars cannot be stretched out.

Depressed fibrotic scars are usually quite large, with sharp edges and steep sides. The base of these scars is firm to the touch. Ice-pick scars may evolve into depressed fibrotic scars over time.

Soft scars, superficial or deep are soft to the touch. They have gently sloping rolled edges that merge with normal skin. They are usually small, and either circular or linear in shape.

Atrophic macules are usually fairly small when they occur on the face, but may be a centimeter or larger on the body. They are soft, often with a slightly wrinkled base, and may be bluish in appearance due to blood vessels lying just under the scar. Over time, these scars change from bluish to ivory white in color in white-skinned people, and become much less obvious.

Follicular macular atrophy is more likely to occur on the chest or back of a person with acne. These are small, white, soft lesions, often barely raised above the surface of the skin—somewhat like whiteheads that didn’t fully develop. This condition is sometimes also called “perifollicular elastolysis.” The lesions may persist for months to years.

What are the various treatment modalities for acne and acne scarring?

Since acne scars come in various sizes and shapes, individualizing treatments becomes necessary to maximize the results. At the consultation at Glow, the Doctor chooses one or a number of different methods that are customized to patient’s needs. For example, subcision (undermining), the TCA CROS Method, Thermage, Levulan, Deep chemical peels resurfacing, and the use of filler substances are appropriate for different types of lesions.

Thermage can help soften scars by promoting collagen growth at the dermal level and also destroy the P. Acnes bacteria to prevent breakouts for atleast 4-6 months, typically patients need two treatments spaced apart by 1-2 months as determined by the physician. There is also very little downtime with this procedure.

Levulan effectively destroys the overactive sebaceous glands that feed the P. Acnes bacteria and improves the texture of the skin. It also improves scarring. There is down time with this procedure, but the results of treatment are achieved faster than with Thermage. The downtime includes peeling and crusting as well as avoidance of sun exposure for 48 hrs.

Smooth-Walled (Rolling) Depressed Scars: These are usually treated with subcision. During a subcision session, a specialized needle is used to break up scar tissue underneath the depression. The ensuing wound repair process results in the production of collagen in the treated area, causing the depression to slowly fill in from underneath. Thermage treatments are recommended within a few days of subcision to bring about a more dramatic collagen production response.

Pitted Scars: For these, TCA localized Peeling (also called the TCA CROSS Method) is best. During such treatment, a high concentration of Trichlorocetic acid is introduced just inside the scar. The resurfacing response that occurs inside the depression stimulates collagen production that, over multiple sessions, causes the scar to rise up and close in on itself. These scars can also be removed with surgery depending on what the physician recommends

Elevated scars can also be treated by flattening or leveling with laser resurfacing or Thermage.

Microdermabrasion. This new technique is a surface form of dermabrasion. Rather than a high-speed brush, our microdermabrasion uses aluminum oxide crystals or Sodium Bicarbonate crystals passing through a vacuum tube to remove surface skin. Only the very surface cells of the skin are removed, so no additional wound is created. Multiple procedures are often required but deeper scars may not be significantly improved only our doctor can advise you best.

Collagen injection to soften a scar: Collagen, a normal substance of the body, is injected under the skin to “stretch” and “fill out” certain types of superficial and deep soft scars. Collagen treatment usually does not work as well for ice-pick scars and keloids. Cosmetic benefit from collagen injection usually lasts 3 to 6 months. Additional collagen injections to maintain the cosmetic benefit are done at additional cost.

Skin Surgery. Some ice-pick scars may be removed by “punch” excision of each individual scar. In this procedure each scar is excised down to the layer of subcutaneous fat; the resulting hole in the skin may be repaired with sutures or with a small skin graft. Subcision is a technique in which a surgical probe is used to lift the scar tissue away from unscarred skin, thus elevating a depressed scar. This allows collagen to be stimulated and soften the appearance of the scar.


Please come in for a consultation so that we may best determine what the best treatment option for you.

Individual Results may vary and no guarantees can be made.