I am sorry to break it to you but true acne scars never completely disappear! Before you get all depressed and down about it, there is good news! There are various effective treatments which can improve the appearance of scars and make them less noticeable. But before we get on the treatments, we need to understand what kind of acne scars do we have? Not all scars are created equally? There are two types of acne scars:
Depressed: This scar is what the name implies and that is these scars cause depressions in the skin. Often, these scars are formed on the face. These scars are referred to as "atrophic" which means they occur due to loss of tissue. This happens because of the damage to the collagen, fat or other tissues below the skin. The examples of atrophic scars are Boxcar, Icepick and Rolling.
Boxcar: They can look round or oval depressions with steep vertical sides. They are shallow to medium depressed scars with well defined edges. Most commonly found on the cheeks and temples. These scars can respond well to many treatments due to their shallow depth. Boxcar scars can be superficial to severe depending on the amount of tissue lost. The available treatments are full laser resurfacing, Fractional Resurfacing, Fraxel laser, dermal grafting, Radio Frequency.
Icepick: These scars are deep and very narrow and extend all the way to second layer of the skin called dermis. Due to its depth, the only available procedures are Punch Excision, Punch Grafting or TCA cross. The aim of the treatment is to raise the depth of scarring since it is deep or altogether excise the pick. These procedure give dramatic results. If scars are successfully raised with these procedures, laser resurfacing can further provide additional benefits.
Rolling: These scars are broad depressions that have rounded and sloping edges. If there are several of these type of scars found in one area of the skin, then it gives it a rolling look or appearance as the name suggests. These scars are common in people who had their skin afflicted by long term inflammatory acne. Unfortunately as the skin ages, they become more pronounced due to lose of elasticity in the skin. Due to its sloping edges, there are multiple treatments like Laser resurfacing, chemical peels, microdermabrasion, needling, subcision and red light photo therapy that can give good results. Fillers can also be an option only if it is not a large affected area.
Raised: The second type of acne scar is called hypertrophic or most people would know it by its popular name called Keloid scar. These are raised, dense and thicker than its surrounding skin. In simple words, we can call these thick lumpy scars. These are normally found on jawline, neck, chest and back. Unlike other atrophic scars, these are not caused due to loss of tissue, rather they develop from an overproduction of collagen. When the pocket of inflammation within a pore ruptures and skin tissue get damaged, the body tries to repair the damage by producing collagen. During this healing process, the body overproduces collagen which forms a raised tissue on the surface of the skin. It is unfortunate that these scars can still recur after having a successful treatment. Steroid (cortisone) creams, tapes or corticosteroid injections are used to help them shrink and flatten the scar. Interferon injections can also be used to soften the scar tissue. There is redness found in the scar that can require three to four laser treatments to see the best results.