In many cases of acne scarring, surgical intervention offers the best hope for dramatic improvement in the appearance of the skin. Particularly for deep acne scars, such as icepick scars, surgical removal of the damaged tissue is the most direct and effective treatment.
There are several surgical techniques used to correct acne scars. These include: Punch-out excision, subcision, needling and dermal fillers. Each technique is tailored to a specific type of scarring. In general these techniques are moderately invasive and many require anesthesia. Like other surgical procedures, these techniques should only be applied by licensed professionals in a clinical environment.
Punch-Out Excision of Acne Scars
Much like how the name sounds, punch out excision involves surgically removing the damaged area. This technique is used primarily for targeted treatment of narrow and deep scars (e.g. icepick scars). In some cases the excised tissue is replaced by an implant, which is often healthy skin tissue from a different region of the body. Cultured fibroblasts, which are skin cells grown in the laboratory are also sometimes used. In cases where an implant is used, the technique is known as “punch-graft” or “punch-implant”.
This type of surgery can be very effective at improving the condition of some difficult to treat acne scars. It is also fairly invasive, quite painful and usually requires anesthesia.
Subcision of Depressed Acne Scars
Subcision is a less invasive technique then excision, and involves surgically disrupting the fibrous tissue underneath a depressed scar. This fibrous bundle of collagen-rich tissue can serve as an anchor that connects the bottom of the scar to the underlying tissue. It can also inhibit the regrowth of healthy tissue. In the surgical subcision of acne scars, the physician uses a needle to disrupt these fibers. This raises (elevates) the base of the scar, decreasing the depth of the pit and improving the appearance of the skin.
Surgical subcision is often combined with the use of cosmetic fillers, such as collagen, fat or synthetic polymers to further reduce the pitted appearance of the scar.
Cosmetic fillers are commonly used in conjunction with many other acne scar treatments, particularly for deep depression scars. There are several types of cosmetic fillers in use for acne scar treatment, and they range from autologous fat injections (fat tissue from other parts of your body) to synthetic fillers, like Restalyn. The advantage of cosmetic fillers is that they can be very effective at raising depressed scars and are less invasive then other techniques. The disadvantages are that cosmetic fillers are not usually permanent and it is possible that the filler can shift under the skin, exacerbating the original problem.
A common approach with acne scars is to use a primary surgical technique, like subcision, to disrupt the fibrous scar tissue underneath the base of the scar, then use a filler to elevate the pit so that it is even with the surrounding skin.
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References and Sources
Resurfacing the Acne Scarred Face.
Fulton, et al. 1999. For article abstract, click here.
Subcision for Acne Scarring: Technique and Outcomes in 40 Patients.
Alam, et al. 2005. For article abstract, click here.