Acne scarring can be treated and greatly improved. However, no complete resolution is possible in the worst cases. Thus, patients who are upset about the appearance of their skin should be made aware, before they start the process of eliminating their scars, that even the most sophisticated treatment-and the most skilled of plastic surgeons-may not be able to return their skin to its pristine, pre-acne condition.
Finally, before proceeding to describe scarring treatments, we should add three caveats:
1. Before you deal with old scars, make sure your current acne is fully cured.
2. Since collagenase can take a long time to dissolve excess scar tissue, wait at least a year after your last acne attack before doing anything about the remaining scars.
3. Waiting a year is especially important if you are one of the few people forced to take Accutane to eliminate the residual acne left after completion of the Acne Cure program.
Step 1: Bleach
1. A "medium" peel, using either trichloracetic acid, a similar commercial product called jessener's Solution or glycolic acid at a concentration of 50 to 70%. Often physicians recommend that, after they have conducted the glycolic acid peel, the patient complete the procedure at home, using a 20 to 30% glycolic acid gel daily for the next 7 to 14 days.
2. A "deep" phenol peels In general, we believe that when it comes to chemical peels, neither extreme is desirable.
Step 2: Dermabrasion
This involves removing the top layer of the skin down to the upper surface of the dermis. In the past it was done by mechanical means; a small diamond burr was used to scrape off the top layer of skin.
The difficulty with this approach is that it may leave fair skin very red for weeks or even for several months, and it may cause dark skin to darken unevenly; the resulting mottled appearance can become permanent.
Step 3: There are two basic ways in which this can be achieved.
Flat scars can be filled in by injecting collagen under them, thus pushing them up to the same level as the rest of the skin.
1. Rarely, a patient experiences an allergic reaction to collagen injections; in that case, the procedure obviously cannot be used.
2. Ice pick scarring may necessitate a more extreme removal system. Since the scars are anchored to the bottom layer of the skin, in many cases the collagen injections will not push them out, or at least not far enough.