Acne Scar Treatment in New York, NY

What is Acne Scarring?

Acne scarring is an unfortunate inflammatory response to acne lesions that leads most commonly to degraded collagen, but also at times the production of excessive collagen in an atypical morphology.  So many of our patients in NYC suffer emotionally from their acne scarring making its treatment one of our most important areas of focus. 

There are a variety of different types of acne scarring.  
Hypertrohic Scarring
Some acne scarring can be raised.  This is called hypertrophic acne scarring. The worst form of this is keloidal scarring.  The treatment of this type of acne scarring would involve therapy to break down excessive collagen combined with treatments that remodel the overlying skin. 

Atrophic Scarring

Most acne scarring that distresses patients is indented.  This originates from a destructive inflammatory process that degrades collagen in the dermis causing the skin to contract and indent inwards.   There are three types of atrophic acne scars:

• Ice Pick Scars: Ice pick scars are narrow sharply bordered scars less that 2mm in diameter that taper as they go all the way to the deep dermis.
• Box Car Scars: Acne scars that are wider at the top than ice pick scars and do not taper as they go deeper.  These are typically round to oval based dimples
• Rolling Scars: Shallow but wider (>4mm) scars that give an undulating appearance to the surface of the skin.

Additionally both atrophic and hypertrophic scarring can cause both erythema (overlying redness) or hyperpigmentation (overlying darkening) in the skin.

No matter the type of acne scarring, The Dermatology and Laser Group has a variety of options for our patients visiting our NYC office that can be used either on their own or in combination for the treatment of acne scars. 

Acne Scar Treatment at The Dermatology and Laser Group in NYC

The best treatment plan for each individual’s acne scarring will be determined together with the patient at the consultation.  We will discuss the history of your acne, the scarring, your general internal and skin health, and your goals.  Some of our best acne scar improvements are achieved by combining two or more treatments together.  Treatments we use to treat acne scar include:

Fractional Laser Resurfacing

Fractional Laser Resurfacing improves acne scarring by creating tiny channels in the skin with laser energy.  This activates the body’s wound healing pathway producing new collagen to support the elevation of the depressions, and resurfaces the skin to make the skin texture and tone more uniform.  We have a variety of ablative and non-ablative fractional resurfacing lasers in our office.  The most powerful Acupulse CO2 laser for Laser Skin Resurfacing in NYC has the benefit of fewer treatments needed to achieve results because of its high energy, but can cause up to 2 weeks of downtime.   Our fractionated application of a picosecond laser, the PicoWay Resolve will only cause mild redness for a few hours, but would require many more treatments to achieve the same results. A non-ablative fractional resurfacing laser such as ResurFX is a powerful option with 2-4 days of redness following treatment. 

Microneedling

Similar to fractional laser resurfacing, medical microneedling is used to create tiny pokes in the skin to activate the body’s wound healing pathway to generate new collagen and resurface the skin.  With microneedling thousands of tiny wounds are safely created with stainless steel needles that are thinner than a human hair in diameter.  Microneedling has the advantage that it can be used in darker skin tones where laser is not desirable, and it can also be used to microinject into the skin any fluid that can boost results.

To treat acne scars in our NYC office we often combine microneedling with either PRP (platelet rich plasma) or AnteAGE Growth Factor Serum.  Both of these substances introduce growth factors into the skin, further signaling to the body to activate the process of generating collagen.

Radiofrequencey Microneedling

In some cases, patients may benefit from heat, in the form of radiofrequency energy, being delivered under the skin with the microneedles. Potenza NYC is one such treatment we offer.  I find that this technique can be helpful to improve skin texture only in some cases of rolling scars. 

Chemical Peels

Chemical Peels involve the application of an acid to the surface of the skin.  This acid denatures proteins in the skin, starting an inflammatory cascade that leads to collagen remodeling and superficial resurfacing of the skin.  This can not only help with hyperpigmentation on the surface of the skin but it can also help generate collagen to help with atrophic scarring. One particular application of chemical peels is called TCA CROSS (chemical reconstruction of skin scars) where very high concentration of acid is placed in the center of ice pick scars to induce remodeling of collagen in the walls of the scar.

We also use chemical peels for ongoing mild to severe acne treatment.

Plasma Pen

Plasma pens use very high heat to create a wound in deeper acne scars to induce remodeling of collagen from the inside out.  This technology can be useful for isolated deeper scars when used in conjunction with other procedures such as fractional laser resurfacing or medical microneedling.

Punch Microsurgery

Punch microsurgery can be combined with the procedures above to tackle the deepest of acne scars that are unlikely to have satisfactory improvement from collagen remodeling alone. A small device is used to remove the scar surgically and sutures are placed to close the skin.  Once healed the removal sites can be resurfaced along with the rest of the skin.  

Subcision

For certain types of scars we insert a needle under the skin with the purpose of releasing the fibrous tissue tethering the skin down.  As new collagen develops some will develop under the acne scars without reforming a depression. 

Fillers

Dermal Fillers can be injected under scars to elevate them and add a temporary benefit as we wait for more permanent benefits from other treatments. 

Biostimulators

Certain fillers can be diluted and injected under acne scars with the purpose of stimulating collagen synthesis.  Used this way the benefits of fillers are more long lasting or permanent.  In early 2023 we are expected to have new biostimulating agents FDA cleared with the purpose of stimulating collagen synthesis without adding volume, giving us more options to boost our results for acne scarring treatment.

Treatment of Erythema

Redness, or erythema in acne scars is another complicating factor that can make the appearance of acne scars worse.  We have lasers that specifically deal with redness and eliminating the dilated blood vessels associated with some acne scars.

Treatment of Hyperpigmentation

Hyperpigmentation, or darkening of skin, is another complication of acne scarring that can be very distressing for patients.  Hyperpigmentation is typically more common in darker skin tones.  Lasers, microneedling, and chemical peels can all help reverse hyperpigmentation.

Special Considerations for Hypertrophic (raised) Scars:

For raised scars, in addition to the above treatments to improve skin texture we would also inject the scar with triamcinolone to reduce the size and thickness of the lesions. 

The breadth of our treatment options matched with our years of experience allows us to offer the best possible acne scar treatment in NYC.

References

Rivera AE. Acne scarring: a review and current treatment modalities. J Am Acad Dermatol. 2008 Oct;59(4):659-76. doi: 10.1016/j.jaad.2008.05.029. Epub 2008 Jul 26.

Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001 Jul;45(1):109-17. doi: 10.1067/mjd.2001.113451.

Al-Waiz MM, Al-Sharqi AI. Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals. Dermatol Surg. 2002 May;28(5):383-7. doi: 10.1046/j.1524-4725.2002.01081.x.

Tan J, Beissert S, Cook-Bolden F, Chavda R, Harper J, Hebert A, Lain E, Layton A, Rocha M, Weiss J, Dréno B. Evaluation of psychological well-being and social impact of atrophic acne scarring: A multinational, mixed-methods study. JAAD Int. 2021 Dec 23;6:43-50. doi: 10.1016/j.jdin.2021.11.006.