If you have scars from healed acne, chances are that you want to get rid of them and you want to get rid of them for good. Your dermatologist, however, may have a different perspective on the subject. Chances are that your skin doctor will regard the task of treating acne scars as a matter of concealing a scar that will always be there, making it invisible but not even trying to remove it.
Understanding the doctor’s perspective on scar treatment helps you establish reasonable expectations of acne scar treatment. And if you have a good grip on the likely outcomes of a medical procedure, you can make an informed choice between medical treatments, cosmetic coverups, or even accepting acne scars as part of your face’s life story.
Skin That Heals Easily and Skin That Does Not
Acne scars heal in different ways in different places on the body. In the unlikely event you were to get a pimple right on top of your lip or almost on your eyelid, it would probably be very uncomfortable until it healed but you are not likely to have a lasting scar. On the other hand, acne on the chest often leaves scars, as do skin infections on the lower legs.
There are also skin types that tend to form noticeable, raised, pink hypertrophic scars as acne heals. The ethnic group most commonly afflicted with this unfavorable genetics of scarring is Irish. Men of African or Hispanic descent often develop this kind of scar when they have acne keloidalis nuchae, which forms around ingrown hairs.
Favorable Scars and Unfavorable Scars
Doctors also assess the potential for a good cosmetic result from dermabrasion or laser ablation on the basis of favorability and unfavorability of scars. What makes a scar favorable or unfavorable?
- Flat scars are more easily concealed with makeup and are considered to be favorable. Raised scars leave a shadow even when they are covered by makeup and are considered to be unfavorable.
- Scars in the lines and creases between facial features are easier to conceal and are considered to be favorable. Scars on the cheeks and forehead are readily visible and are considered to be unfavorable.
- Scars are less visible on loose or relaxed skin. Scars are more visible on tight skin.
- Irregular scars are less visible than regular scars. The rounder the acne scar, the more unfavorable it is for treatment.
- Older scars are less visible than newer scars. Redness fades with time, unless excessive sun exposure and sunburn keep reactivating the inflammatory process. Older scars are more favorable for revision than newer scars.
The more favorable characteristics the dermatologist can see in the scar, the more likely you are to receive a recommendation for treatment. But don’t just take your dermatologist’s word on whether an acne scar is easily or not-so-easily healed. It can take up to a year to recover form the procedures doctors use to treat acne scars. If you know you have a wedding or another important event coming up, you will want to let your dermatologist know so you and your doctor can assess whether acne scar treatment will still be in the healing stage when you need to look your best. The doctor usually can change a scar from “less favorable” to “more favorable” but that requires scalpel-and-suture surgery, not laser ablation or dermabrasion or a chemical peel.
Getting Good Results from Surgery on Acne Scars
Surgery can work wonders on acne scars, but the dermatologist’s work can be wasted if you are not extremely careful with follow-up care at home. When the doctor cuts out a scar and stitches your skin shut, the sutures will be placed below the skin to keep the wound shut. Any visible stitches are there to hold your skin together so it can grow evenly, not to keep the wound from opening. And to encourage the skin to grow back together, it is your job to follow your doctor’s directions and apply layered, tensionless bandages over the area of treated skin.
Basically, it’s very, very important to change bandages just as often as you are instructed, and to place them in right spot each and every time. If you move a bandage a little closer to or a little farther away from the treated scar, you create pressure on healing skin. Wounds that are kept under pressure develop new scar tissue—usually an outward facing pink scar where you have an indented, colorless acne scar. To prevent this result, you absolutely, positively must be meticulous about taking care of your surgical wound after you are sent home from the dermatologist’s office.
After the surgical wound begins to heal, your doctor may ask you to use silicone sheets or silicone gels to keep an outward-facing, pink scar from developing where you had the acne scar removed. Silicone sheets can be worn 24 hours a day or just at night. Silicone gel is applied to the skin and allied to dry to “pucker” over the scar and keep scar tissue from rising. It may be necessary to use silicone sheets or silicone gel for several months to keep scars from rising.
And just because you get surgery doesn’t mean your dermatologist won’t also want to use laser acne scar treatment. Pulsed dye lasers are used to treat red, raised scars. Non-ablative lasers, that is, lasers that do not remove layers of skin, such as Fraxel, are used to smooth out the edges of scars to make them less noticeable. And dermabrasion also is used to treat the skin surrounding a scar to make the scar less noticeable.
Surgical treatment for acne scars is not an option you will read a lot about, but it is often the very best treatment for improving your complexion. Just be sure to go into the procedure with realistic expectations about your results, and be absolutely sure to follow all of your doctor’s recommendations for post-surgical care.
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