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Skin reflects life experience. Every surface evolves with each smile, frown, and gesture. But when impurities settle into the skin, they can obscure the appearance you wish to project.

Acne is caused by blocked pores and excess sebum (oils). When breakouts are pronounced, they can leave scars that may require medical attention. Before you decide how to address your unique pattern of scarring, let’s assess the four major types of tissue that result from acne.

Hypertrophic vs. Atrophic

There are two main categories of acne scars: atrophic and hypertrophic. The depletion of collagen leads to tissue loss, which is the source of atrophic scars. Atrophic marks often appear as divots or craters in the surface of the skin.

On the other end of the spectrum, too much tissue in a given area is the hallmark of a hypertrophic scar. Raised marks and discoloration can disrupt your natural attractiveness, making hypertrophic scarring quite problematic.

Keloids are an even more severe type of scar than the regular hypertrophic variety. Hypertrophic scars rise above the skin’s surface, but keloids go one step further: they extend beyond the border of the original abrasion. Keloid scars can cause discomfort as they stretch the skin and expand the site of a wound.

Treating Hypertrophic and Keloid Scars

The key to keloid and hypertrophic scar treatment is minimization. Collagen has already accumulated to patch the skin, but it has left a bulky, unsightly blotch in its place. Your doctor can reduce this phenomenon by applying silicone gel sheets to the affected area. A gel will flatten and soften the skin, making it blend more aesthetically with its surroundings. 

In certain situations, your cosmetic care team may recommend laser treatments to ablate the raised portion of a scar and even the proverbial playing field. The exact approach to fixing a keloid or hypertrophic scar depends on the nature of the tissue, the skin tone of the patient, and the desired goal of the procedure. 

Types of Atrophic Scars

As our bodies age, we produce less and less collagen. Collagen is the most prevalent protein in the human body, and it is instrumental in the maintenance and regeneration of the skin.

When the surface of the skin is broken, collagen rushes to the area. This could result in the hypertrophic scar patterns described above, or the collagen surge may be insufficient to patch the wound properly. In the latter case, atrophic scars occur.

But not all atrophic scars are created equal. They manifest in three different ways: ice pick, rolling and boxcar. The main characteristic of ice pick scars is the wedge shape that slices its way through the epidermis and into the dermis. 

On the other hand, a rolling scar gets its name from the irregular, undefined nature of its appearance. The contours of rolling scars are nebulous, stretching beyond the parameters of the original breakout. As collagen filters to the area to heal the patchwork quilt of acne, it forms blotchy, uneven protrusions, like rolling hills.

The third type of atrophic scar pattern is the boxcar variety. When acne leaves pitted, deep punches in the skin, are known as boxcar scars. The sides of a boxcar scar are parallel, delving deep into the dermis. Unlike ice pick scars, they require more attention to adequately fill in the gaps left behind by acne breakouts.

How to Treat Atrophic Scarring

The treatment you require for a loss of tissue due to acne will depend on the type of atrophic scars you are experiencing. 

If a boxcar mark is especially severe, you may need to fill in the area. This can be achieved in various ways, but the correct procedure will depend upon your physiology and complexion. Your doctor may suggest fat grafting to patch a boxcar scar. This process begins with a gentle removal of excess fat from elsewhere on your body. Once the lipids are purified, they are ready for transfer to the area depleted by acne. Boxcar divots can be patched and raised until they are level with the surrounding skin.

Ice pick scars are easier to address since they require more minor corrections than boxcar scarring issues. Your physician can administer a simple course of Botox to ease the tension along the edges of an ice pick scar. This allows your skin to naturally relax and adhere to a more even, flattened appearance. If you need a bit more volume underneath the surface, your doctor can also inject a facial filler at the root of an atrophic scar. Fillers round out the area like you are adding air to a balloon. The surface enjoys a renewed vigor for months at a time, depending on which injectable (or combination of injectables) you use.

Rolling scars are often more difficult to correct than the ice pick or boxcar phenomena described above. Due to the irregular formation of rolling scars, a surgeon may wish to disrupt the abnormality according to its shape.

For example, if the edges of a scar are stretching in opposite or diagonal directions, a Z-plasty procedure can guide the skin into a more pleasing declination. Z-plasty acne treatment begins with a skillful, small series of incisions in the shape of a Z (hence the name). The ridges of this incision are gently sutured together, allowing the skin to heal appropriately and beautifully.

Pamper Your Skin

Just as each case of acne is different, so too are their potential treatments. To determine the right approach for your skin, you should visit a knowledgeable leader in the field of aesthetic enhancement.

Dr. Binder can analyze your acne scarring issues and advise you on the best path back to your ideal look. Contact us today and be ready to be ravishing!