Unwanted scars can be a devastating result of cystic acne, leaving one with a dimpled, irregular skin surface.  Avoiding these scars before they occur is the most desirable course of action, but sometimes it is too late.  Treatments can alleviate the visibility of these irregularities.  The specific treatment options vary and should target the type of scar present.  Sometimes a combination of scar types are seen on an individual. 

A key point is to realize that acne scar treatments do not often eliminate acne scars, they can reduce their visibility.  Reduced shadowing and scar depth is the goal of treatment, but signs of the scars are often still seen.  In certain cases, the skin can look exceptionally smooth after treatment, but this is not true for all patients.  

Above is a diagram of acne scar types.  The deepest, ice-pick scars are the most difficult to treat.  Chemical peels (using the CROSS method with TCA) and laser resurfacing may be of the most benefit in ice-pick scars.  Other techniques for deep scars include skin punches and floating punch grafts.

Box-car and rolling scar types often respond better than ice-pick scars.  These are best treated with laser resurfacing and dermal fillers.  The Fraxel laser has an excellent track record when it comes to acne scarring.  Fraxel Restore uses fractional photothermolysis with an erbium laser to build collagen in the dermis.  Fractional CO2 lasers such as ActiveFX and DeepFX and Fraxel Repair are also excellent for these types of acne scars.  Fillers used to improve acne scars include hyaluronic acid (HA) products (Juvederm, Restylane, Perlane). In Michigan, HA fillers are the most popular form of wrinkle and injectable acne scar treatments, especially when performed in conjunction with laser resurfacing. 

Platelet- rich plasma has earned considerable attention in aesthetic medicine in recent years. It is a treatment derived from your own blood cells, namely the platelets and growth factors that aid in repair. Intuitively it makes sense to use the body’s innate system of growth factors to enhance and modulate cell activity in a targeted manner.

Many aesthetic physicians are using PRP to improve cosmetic procedures, such as fat transfer, facelifts, and laser resurfacing.  The "vampire facelift", also called Selphyl actually uses PRP injections to rejuvenate the face.

There has been published evidence that PRP does improve the recovery after laser resurfacing.  Below, a patient is shown before and 5 days after ActiveFX fractional skin resurfacing with PRP.  The benefits seem to include faster skin regrowth and less redness. 

Read more about PRP treatments with laser resurfacing on a PRP treatment blog post by Dr. Kotlus here. 

A new laser treatment for eyelid wrinkles was published by Dr. Kotlus in the latest issue of Dermatologic Surgery, a peer-reviewed journal.  He describes a "dual-depth" laser treatment using the fractional CO2 laser on the eyelid skin.  The laser is also called ActiveFX and DeepFX, two applications of the laser that treat different levels of the skin.  By treating superficial and deep skin layers at the same time, Dr. Kotlus has been able to improve surface sun damage, brown spots, and deep wrinkles in one treatment. 

Shown here is a patient who received the dual-depth laser treatment at the same time as a lower eyelid lift to shift bulging fat, reducing the appearance of lower eyelid bags. The laser enhances the lower eyelid lift by firming the eyelid skin and creating a smoother appearance. Patients should expect about a week of redness after the laser, although swelling can last longer than a week.