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The scars left by acne are more than skin deep. Many patients with acne scars say that anxiety about their appearance has dominated their lives, undermined their self-esteem, and caused problems in their personal and professional relationships.

In fact, acne scars do go deep into the skin. This is what makes their appearance so obvious. It is also what makes them difficult to effectively treat. While scars left by acne are either hypertrophic (raised) or atrophic (depressed), atrophic scars are more typical. These scars can range from wide, saucer-like craters to narrow, deep pits that make the skin look as if it has been jabbed with an ice pick.

Over the years, doctors have used a variety of surgical techniques to smooth out atrophic acne scars, including dermabrasion, chemical peels, and injection of filler materials such as silicone, collagen, or fat. In a technique called punch grafting, a little core of skin containing a single scar is cut out with a metal hole punch. A tiny plug of normal skin, usually taken from behind the ear is put in its place to fill in the cavity. Unfortunately, none of these treatment procedures has ever been regarded as totally successful.

Injections with filler agents such as collagen or fat are effective for only a limited period of time. The body eventually absorbs these injected materials, the depression returns, and reinjection is necessary to maintain the desired effect.

Acne pits extend deep into the dermis (one of the inner layers of skin tissue). The atrophic scars commonly extend below the level where skin can be removed easily by dermabrasion or chemical peel resurfacing techniques. Only very deep chemical peels or aggressive dermabrasion has significant effect. Scarring and pigment changes are common complications with both techniques. However, cosmetic surgeons with extensive experience in performing dermabrasion often can provide patients with satisfactory improvement.

The high-energy pulsed carbon dioxide laser is a safer, generally more effective technique for treating atrophic, or depressed, acne scars. (Hypertrophic — or raised — scars are treated with a 585 nm flashlamp-pumped pulsed dye laser.) Precision is the chief advantage of laser treatment over other resurfacing methods. An experienced laser surgeon can usually peel as deeply as needed into the dermis in order to have the maximum possible positive effect without compromising the skin’s ability to regenerate a normal new surface.

Clinical studies have shown that laser resurfacing typically provides a 50 to 80 percent improvement in the appearance of atrophic acne scars. (One hundred percent means that the scars are totally eliminated.) To a great extent, the degree of success depends on the scars. Shallow, soft, saucer-like depressions respond best; tough, fibrous ice-pick scars are the most resistant to treatment.

Patients with extremely deep or extensive scarring may require more than one resurfacing procedure. Repeat treatments should be delayed by at least 9 to 12 months in order to permit the skin time to fully heal after the first procedure. Typically, patients see the most dramatic changes following the first treatment, and more subtle, yet still measurable improvements, after the second treatment.

Deep laser resurfacing to eradicate acne scars results in immediate facial swelling, with raw, sensitive exposed skin. Swelling and discomfort peak in 24 to 48 hours. Within two to three days, the swelling improves, but the skin is still sensitive to the touch. The treated skin remains red for several weeks, with complete recovery requiring a year or more.

Deep laser resurfacing for acne scars is a significant surgical procedure. Recuperation is relatively slow and painful. However, if you are among the multitude of people who have spent their adult lives living with the self-consciousness caused by acne scars, laser resurfacing offers you the potential for significant long-standing cosmetic improvement.

As with any surgical procedure, complications are possible with laser resurfacing. Your physician should explain the possible complications to you. A full understanding of the potential risks and benefits will help you make a better and more informed decision for yourself.

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