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Acne Scars: Why they form & how to get rid of them



Acne scars can be more frustrating than actual acne. Scarring can be difficult to conceal, even with make-up, and it’s visible long after the original acne outbreak has subsided.


So, why do some pimples cause scars?

Acne is a result of a sebum-clogged follicle that gets infected with acne bacteria. Acne scars, however, are caused by inflammation. Inflammation can result from a superficial acne papule (or pustule) or from a deeper nodule or cyst. A good rule of thumb: the deeper the inflammation, the greater the risk of scarring.


Generally, a small acne papule causes little damage to the skin and heals quickly. These may leave a reddish-pink mark that fades with time. These marks are not considered scars.


However, prolonged acne inflammation can destroy healthy tissue and leave a void. To heal, the skin reacts by producing collagen fibres. The collagen fibres can repair and fill the gaps, but the appearance of the skin may not be as smooth as before.


What do acne scars look like?

Acne scars are commonly atrophic scars, or depressed scars. There are four main types:
• Ice pick scars are tiny, deep holes in the skin. This type of scar gets its name from the fact that the skin looks like it’s been hacked by a tiny ice pick.
• Boxcar scars are crater-like depressions with defined edges. They are deeper and wider than ice pick scars.
• Rolling scars appear wavy with shallow depressions and smooth edges.


Ice pick scars Boxed or boxcar scars Rolling scars


Another type of scar, albeit rarer, is hypertrophic or keloidal scarring. This happens when the body’s healing mechanisms overcompensate by producing too much collagen, creating a mass of raised tissue over the wound. Keloids may appear as pinkish-reddish-brownish lumps and are commonly flattened with steroid injections. Once the scar is flat, the reddish tones of the scar may be treated with a series of laser treatments.


How are acne scars treated?

Treatment of acne scars depends on the type of scar. Ice pick scars are typically the hardest to conservatively treat, as their tiny sizes make them almost impossible to fully reach with lasers or fillers. These are treated using punch excision – literally cutting the scars out and suturing the gaps together.


Boxcar scars and rolling scars are treated through a combination of subcision, Revlite or BB Laser, and/or Rejuran Healer (DNA injections). These scars are tethered to the underlying skin tissue by fibrous bands. In subcision, a special needle is used to break these tethered fibres in order to restore the contour of the skin. Some degree of bruising is expected. The resulting healing from the inflammation helps the scar to fill back in.



When subcision is combined with BB Laser or Rejuran Healer (DNA injections), results are more visible. BB Laser performed immediately after subcision can stimulate the skin to generate more collagen, and this helps to lift the released depressions even further. Similarly, Rejuran Healer injections done after subcision, can help the skin to heal, as it stimulates production of collagen and elastin to increase the skin’s thickness and elasticity, hence filling in depressed scars. Both BB Laser and Rejuran Healer have the added benefit of treating the entire face and improving overall skin quality. As a DNA injection, Rejuran Healer can stimulate cell growth for healthier and less inflamed skin. Whether to choose B.B Laser or Rejuran Healer injections after subcision depends on an individual’s tolerance to injectables and downtime. BB Laser may leave a sheen of veneer-like micro-crust, that sloughs off with routine washing in 3-7 days, while Rejuran Healer makes the skin bumpy and dotty for 1-2 days.


Read more about BB Laser here.

Read more about Rejuran Healer injections here.