What are Acne Scar?
Acne scars are usually the result of inflamed blemishes caused by skin pores engorged with excess oil, dead skin cells and bacteria. These pore swells, causing a break in the follicle wall. Shallow lesions are usually minor and heal quickly.

But if there is a deep break in the wall of the pore, infected material can spill out into surrounding tissue, creating deeper lesions. The skin attempts to repair these lesions by forming new collagen fibres. Finally the Acne Scars occur as a result of fibrosis of the skin tissue as it heals after pimples subside.

Acne scar Fading and marks on skin depends on certain factors that include size, type of scar, depth of the scar, skin quality and other personal factors as age,diet,skin care, environmental conditions and genetics.

Common Types of scar are listed below:

1. Hypertrophic scar

Hypertrophic scar is a thickened, wide, often raised scar that develops where skin is injured. Scars are common during the wound healing process, but a hypertrophic scar is a result of an abnormal response to a trauma or injury.
In certain people, body cells called myofibroblasts produce too much collagen during healing. This can happen simply as a result of a person’s skin type and healing tendencies. More commonly, overproduction of collagen occurs when a wound is infected or inflamed, under a great deal of tension or motion (such as in injuries over a joint), or left to heal without stitches.
Hypertrophic scars are similar to keloid scars but tend to be milder and don’t grow beyond the boundaries of the original skin injury.

Corticosteroid treatments: Corticosteroid injections are considered a first-line treatment for hypertrophic scars. Injecting a steroid into the scar every six weeks may help flatten and soften the scar.

Laser therapy: Laser therapy is more effective in newly formed scars than in older scars. The lasers work by burning and flattening elevated scars. They also target the red and pink pigments in the scars to lighten them.

Bleomycin: Bleomycin is a metabolite of a strain of soil bacteria. It’s shown promising results when injected directly into a hypertrophic scar. It may help improve the scars appearance and relieve itching and pain. More clinical trials are needed to confirm its efficacy.

Cryotherapy: In cryotherapy, a dermatologist freezes the scar tissue with liquid nitrogen to help flatten it. Cryotherapy has been shown to be successful, safe, nontoxic, and well-tolerated in a number of Research studies.

Surgery: After waiting at least a year, a hypertrophic scar can be excised, or cut out, and closed again with stitches. This treatment tries to re-heal the injury while eliminating the issues that may have caused the scar in the first place, such as infection, inflammation, or tension.

2. Atrophic scar

An atrophic scar is an indented scar that heals below the normal layer of skin tissue. Atrophic scars form when the skin is unable to regenerate tissue. As a result, it leaves behind imbalanced scarring.
Atrophic scars are often the result of severe acne or chickenpox. They can also form after having a mole removed. The indentation can form into one of three types of scarring.
Atrophic scars are the most common type of acne scars. They are subdivided into three main categories: ice pick, boxcar, and rolling scars. Treatment depends on the type of scar you have. Atrophic scars can be difficult to treat and can require multiple procedures that may need to be repeated over a period of time.

3. Ice pick scars

Ice pick scars are a type of acne scar. Due to their depth and narrow impressions, ice pick scars are more severe than boxcar, atrophic, or other types of acne scars.
Although professional treatments may not completely get rid of the scar, you should notice marked improvements in appearance and texture.
Like other types of acne scars, ice pick scars are remnants of a severe acne lesion or outbreak.
Some acne scars are atrophic, meaning they are thin and flat. Both rolling and boxcar scars are wide, but have either sloping or sharp edges.
Ice pick scars are narrower than atrophic acne scars, but are also deeper than all types of scars. They’re characterized by narrow pitted shapes in the skin. These shapes are often more noticeable to the naked eye.
Ice pick scars are usually caused by severe acne, such as cysts and nodules.

4.Rolling scar

Rolling scars are a common type of scarring that can occur as a result of the acne healing process. They appear as indents in the skin and tend to measure a few millimetres wide. They are defined by their sloping edges, giving the skin a wavy, uneven appearance and aren’t always the same size as the original acne lesion that caused them, as the size depends on how the skin heals.
Rolling scars are more common in areas of the face where the skin is thicker, such as the lower cheeks and jaw.
The formation of rolling scars is largely dependent on how your skin heals. If you tend to scar easily then you are more likely to develop acne scars.
Inflammation also plays a key role in development of acne scars. The deeper that inflammation from an acne lesion reaches into the skin the more likely it is to scar upon healing. This is one of the reasons that it is important to treat acne as soon as possible, to lower the risk of deep inflammation.

5.Boxcar scars

Boxcar scars are a type of acne scar. Specifically, they are a type of atrophic scar, which is the most common type of acne scar. Boxcar scars make up about 20 to 30 % of atrophic scars. The other types of atrophic scars are ice pick scars and rolling scars.
Boxcar scars look like a round or oval depression or crater in your skin. They typically have sharp vertical edges, and are wider than ice pick scars but not as wide as rolling scars. Shallow ones may respond well to treatment, but deeper scars may be harder to get rid of.
Treatment for boxcar scars depends on several factors, such as how red the scars are, how deep they are, the location of the scarring, and your skin type.
Shallow scars may be easier to treat than deep scars. In many cases, combining treatments is best for reducing the appearance of boxcar scars.

Various Treatment Options for Atrophic Scars:

i. Chemical peels

Chemical peels are a common treatment method. The peeling process involves destroying the damaged layer of skin by applying chemicals to its surface. The chemical solution causes your skin to peel, producing a fresh layer underneath.
This regeneration decreases the appearance of atrophic scars. Peels can take days to weeks to show improvement. In some cases, your skin requires substantial time to heal.
Different chemical agents are used depending on the severity of your scarring. They range from mild chemicals used in everyday skin care products — such as glycolic acid — to chemicals used in deeper peels — such as phenol — that require sedation before being applied to the skin.

ii. Fillers

Soft-tissue fillers are a common treatment specifically for rolling atrophic acne scars. They are used to level or raise the indented scars to match the normal layer of skin. Hyaluronic acid fillers are injected under the scar and provide almost immediate results. Over time, the soft tissue fillers improve skin volume and decrease scarring appearance.

iii. Skin needling

Skin needling or microneedling therapy is a method that punctures the skin to regenerate a healthier layer. The microneedling procedure involves rolling a group of needles over skin in various directions. These needles create hundreds of punctures on your skin and cause new collagen to form.
This therapy method triggers your skin to regenerate and increase collagen, a protein necessary to maintain skin elasticity and health.

iv. Punch excision

Punch excision treatments are another common method for treating and eliminating atrophic acne scars, specifically ice pick scars. In this procedure, dermatologist uses a needle the size of your scar to cut out the scar tissue. Then, your doctor closes the wound with stitches. If your scars are more severe, your doctor will take a small skin graft from behind your ear to fill the wound.
The punch excision and replacement graft methods may result in an uneven skin pigmentation and marks from the stitching.

v. Subcision

Subcision is an inexpensive surgical procedure best used to treat rolling atrophic scars. While effective as a solo procedure, subcision is often combined with other treatments including microneedling and chemical peels.
The subcision method loosens the area around the indented scar and creates a new wound that can heal properly and match your normal layer of skin.
During this procedure, a needle is inserted under the skin repeatedly in various directions around the scar tissue, using a fanning motion. After the procedure, pressure and ice should be applied to the affected site to prevent bleeding. Subcision may be repeated if your scar is more severe.

Punch Elavation

This is where the centre of the rolling scar is removed and then reattached at an elevated level, bringing it up to match the height of the skin’s surface so that the scar appears flat. Punch Grafting This is where the scar is removed and the wound is filled with skin taken from another part of the body, such as the back of the ear.

Microneedling

This treatment is sometimes known as collagen induction therapy. It works by using a special tool to create several, tiny injuries within a scar. These injuries usually heal within two days and new collagen is formed inside of the scar. Collagen is a protein that help gives our skin strength and elasticity. As the new collagen forms it reduces the scar’s depth. Multiple treatments tend to be required every four to six weeks to gain maximum benefits. You should also be aware that the depth of needling has an effect on how successful the treatment is, with deeper needles often providing better results.

TCA CROSS (Chemical Reconstruction of Skin Scars)

In this treatment, an acid known as trichloroacetic acid (TCA) is inserted into scars in high concentrations of 70%-100%. The acid generates a small inflammatory response in the skin and results in new collagen being formed, which reduces the depth of the scar. Multiple treatments tend to be required every to gain maximum benefits.

Subcision

In subcision, a needle is put under your skin and moved in multiple directions to separate the top layer of skin from the scar tissue below.
The resulting healing process causes collagen to form and push the scar up.
This is not as effective a treatment for boxcar scars as the above treatments are. However, it only has minor, short-term side effects, such as bruising and pain during the procedure

Punch grafting

According to an article published in The Journal of Clinical and Aesthetic Dermatology, punch grafting is the best treatment for ice pick scars. This treatment involves taking out the scar and replacing it with a skin graft (usually from behind your ear).
Punch grafting is guaranteed to fill in deep, narrow ice pick scars. The downside is that you will need multiple grafts — sometimes up to 20 — for a single scar. Sometimes, the resulting area is slightly more elevated than the surrounding area of skin.

Punch excision

A punch excision is a method that involves cutting out the ice pick scar. After the excision process, your skin is closed up from all sides.
Punch excision is one of the most effective treatments for ice pick scars. However, you’ll still be left with a thin scar in its place.
Although punch excision helps treat texture problems, it doesn’t get rid of any surrounding skin discoloration. You may need to complement this one-time surgical method with a resurfacing treatment.

Laser resurfacing
What type of treatments options are available for Acne Laser ?

Fractional Co2 :
Fractional CO2 laser to repair acne scars and help deliver an even-toned complexion to our Acne scar treatment patients. The fractional CO2 laser works by poking microscopic holes into the deep layers of the skin, which regenerates collagen growth and evens out pitted acne scars.
The fractional CO2 laser treats only a fraction of the skin’s surface at a time, while leaving the adjacent skin untouched. Patients enjoy 30-70 percent improvement of their acne scarring after just one fractional CO2 laser treatment.
The most effective treatment now available is Fractional CO2 Laser. It is a new type of laser that will resurface only a part of the affected skin (hence the name “fractional), without affecting the surrounding area. This reduces the possibility of side effects and speeds up healing in acne scars and other skin treatments.
CO-2 Fractional Laser Resurfacing also removes layers of skin tissue in a fractionated method (columns of skin are removed, leaving the skin surrounding each column intact to aid in healing) to help reduce “age-spots” (also called sun freckles and liver spots,), fine lines, wrinkles, scarring, uneven coloration, skin laxity, textural irregularities, dull tone, and a thinned collagen layer of the face, neck, and chest.

Keloidal scars

When skin is injured, fibrous tissue called scar tissue forms over the wound to repair and protect the injury. In some cases, extra scar tissue grows, forming smooth, hard growths called keloids.
Keloids can be much larger than the original wound. They’re most commonly found on the chest, shoulders, earlobes, and cheeks. However, keloids can affect any part of the body.
Although keloids aren’t harmful to your health, they may create cosmetic concerns.
Keloids come from the overgrowth of scar tissue. Keloid scars tend to be larger than the original wound itself. They may take weeks or months to develop fully.

The symptoms of a keloid can include:

• a localized area that is flesh-colored, pink, or red
• a lumpy or ridged area of skin that’s usually raised
• an area that continues to grow larger with scar tissue over time
• an itchy patch of skin

While keloid scars may be itchy, they’re usually not harmful to your health. You may experience discomfort, tenderness, or possible irritation from your clothing or other forms of friction.
Keloid scarring can form on large areas of your body, but this is generally rare. When it happens, the hardened, tight scar tissue may restrict movement.
Keloids are often more of a cosmetic concern than a health one. You may feel self-conscious if the keloid is very large or in a highly visible location, such as on an earlobe or the face

Scar revision with surgery

Scar revision surgery will attempt to minimize a scar so that it is less conspicuous and blends in with the surrounding skin tone and texture.
Scars are visible signs that remain after a wound has healed. They are the unavoidable results of injury or surgery, and their development can be unpredictable. Poor healing may contribute to scars that are obvious, unsightly or disfiguring. Even a wound that heals well can result in a scar that affects your appearance. Scars may be noticeable due to their size, shape or location; they can also be raised or depressed, and may differ in color or texture from the surrounding healthy tissue.
Your treatment options may vary based on the type and degree of scarring and can include:

• Simple topical treatments
• Minimally invasive procedures
• Surgical revision with advanced techniques in wound closure

Although scar revision can provide a more pleasing cosmetic result or improve a scar that has healed poorly, a scar cannot be completely erased.

Do’s and Don’ts of Acne Scar Treatment

Do’s

Stay out of the sun: Overexposure to the sun can darken scars and make them look more prominent.

Use proper skin care lotions and medications adviced by the Dermatologist

Use luke warm water for face wash

Avoid applying high PH based cosmetics or Makeup for Face

Maintain proper sleep and healthy diet especially rich foods which has antioxidants

Don’ts

Irritate inflamed skin.

Over washing or scrubbing scarred areas can further reduce skin elasticity and heighten the appearance of the scar.

Pick at scars. Bacteria from unwashed fingers and nails increase the risk of additional cysts forming, leading to the development of a larger scar.

Give up on acne scars.

For Best treatment options and services with Amazing results consult at Elements of Aesthetics Clinic under Dr.Stuti Khare Shukla. All the treatments are FDA approved.