What Causes Acne Scarring

Top Acne Treatment

Happily, acne scars are not truly hopeless. But they do present a difficult challenge to the surgeon’s skills because they are as destructive to the physical structure of the skin as their appearance is to the psyche. So what does cause acne scarring?

The skin is made up of three layers. At the surface is the epidermis. The dermis, which lies just below, consists of a meshwork of protein strands (collagen and elastin) that look very much like the threads that make up woven cloth. The bottom layer is the subcutis, or fatty layer.

Acne scars are caused by inflamed lesions that destroy a portion of the dermis and its collagen, creating a raised, or hypertrophic scar. More commonly, the collagen grows back only partially or not at all, leaving a depressed, or atrophic, scar.

Depending on the severity and extent of the inflammatory destruction, atrophic acne scars range in contour from shallow undulating, depressions and saucer like indentations, to deep pits and jagged edged craters that make the skin look as if it has been jabbed with an ice pick or other sharp instrument. Some, called full thickness scars, extend all the way through the dermis into the fatty subcutis.

Frequently, atrophic scars are bound down, tethered like a balloon held to earth by ropes, to the tissues below them with bands of collagen that run straight into the subcutaneous tissue. These scars tend to become increasingly evident as a person ages and gradually loses subcutaneous fat. The skin sags, but parts of it remain hitched to the underlying tissues by the fibrous bands.

Few acne scars can be completely eliminated by any means, which is why experienced doctors typically speak in terms of revising them or reducing their appearance, rather than erasing or eradicating them. The most common approach is to resurface the skin, by such techniques as laser ablation, chemical peels, or dermabrasion. But most acne scars penetrate far below the level where skin can safely be removed. Only the most minor, superficial scars can actually be expunged. Most can only be reduced in size and depth.

Some doctors say you can expect to get up to 80 percent improvement in acne scars with resurfacing, but others seem to think it’s just in the 50 percent range or less. They feel it’s not likely that you can get 80 percent improvement with resurfacing alone. Especially if the scars are big or if they are full thickness, 50 percent is about the best you can hope for.

For optimum results, depressed acne scars generally require both resurfacing and additional treatment, often by injecting or implanting cosmetic filler material such as collagen beneath the depression to raise it up. That’s when you can possible get 80 percent improvement. When you both resurface and use some sort of filler.

You can get a rough idea of what type of treatment your own scars may need in any given location by using your fingers to stretch the skin there and see how the scars react. Pulling the skin taut will make shallow or soft-sided scars almost or totally disappear; those scars generally can be corrected with resurfacing and fillers. Scars that you can’t stretch out by pulling on the skin generally require surgical excision.