As anyone with acne knows, it’s not just pimples we have to worry about. Acne can be bad enough on its own, but it is often followed up by noticeable acne scars. Since individual scars can sometimes take years to fully heal, they can seem worse than the acne, and serve as a constant reminder of acne-prone skin. Modern research and technology have led to the development of a variety of techniques to minimize the appearance of scars, including microdermabrasion, dermabrasion, chemical peels, and laser skin resurfacing. Surgical scar revision is another type of acne scar treatment, and this article will explain the basics of these procedures. First, however, let’s do a quick review on acne and the formation of scars.
Acne develops when pores in the skin become blocked, trapping sebum inside the pore along with natural skin bacteria. There are a variety of reasons that pores may become blocked, including being plugged by excess sebum or by dead skin cells that weren’t sloughed off when they should have been. Sebum itself isn’t necessarily acne causing, and moreover, it is necessary for healthy skin, as it has many moisturizing and protective qualities. However, when sebum and bacteria are trapped together in a pore, the end result is generally multiplication of the bacteria triggering an immune system response, leading to inflammation and redness characteristic of acne.
During acne breakouts, scars may form in response to injury of the dermis, the deep connective tissue layer of the skin. These scars are actually composed of collagen, and are intended to seal the wound shut while it heals and the skin rebuilds itself. Even the smoothest scars are generally visible to some degree, since they lack the porosity of regular skin. However, some scars are fundamentally more noticeable, and this is due to the amount of collagen left over the wound. Once the would is healed, an enzyme called collagenase breaks down the collagen so that only a very thin layer is left. If too much collagen is removed, the scar may appear sunken compared to the surrounding skin. However, if too much collagen was created to begin with, an excess of collagen will be left behind, it may actually stick out above the skin level. Those formed from too little collagen are called atrophic scars, and ones from excess collagen are called hypertrophic scars.
Scar revision surgery is one type of cosmetic procedure to help even out such scars. When used for hypertrophic scars, the surgery removes extra scar tissue and places the scar back in such a way that it is smooth with the surrounding skin. This is called scar excision. One type of excision called punch excision is for deep acne scars. This process removes the scar altogether, and the surgeon sutures the wound edges back together in order to create a fine, uniform scar.
Subcision is a process created for atrophic scars, using fat and other substances to fill up the depression under the scar so that it becomes level. Subcision can also involve the separation of skin tissue from the scar tissue to allow blood to pool, eventually forming connective tissue and raising the scar up. Both these processes are always done by licensed professionals, and the patient may be under either local or general anesthesia, on an outpatient basis.
Effects of surgical scar revision include swelling and bruising, and patients may take up to a week or two to recover, depending on the procedure, size and depth of treatment, and on the patient themselves.
The results can be very good, although the effects from some fillers injected to the scar may not be permanent. Potential side-effects include infection, numbness, and reactions to anesthesia.
There are so many procedures for minimizing acne scars that consultation with a dermatologist or plastic surgeon is a necessary first step. Many practices are specifically tailored towards a single type of scar, and could have no effect at all on another type. For instance, excision is generally useless for deep acne scars, where punch excision has excellent results. Another thing to remember about procedures like surgical scar revision is to keep expectations realistic. This can be a useful tool to minimize the appearance of scars, but it is impossible to eliminate scars altogether. Excision and subcision are often most effective when used in combination with other scar revision techniques.