Atrophic Scars

Atrophic scars refer to the pitted scar-like marks on a person’s skin. They originate when the skin fails to regenerate the tissue naturally, therefore leaving imbalanced scarring. This therapeutic challenge is a permanent result of acne vulgaris. The most common types of atrophic scars are:

• Ice pick
• Boxcar
• Rolling

What causes atrophic scars?

Atrophic scars result from the loss of collagen during the skin’s inflammatory healing process. The localized degradation of collagen and subcutaneous fat causes the affected area to dip below the level of healthy skin tissue. The type of atrophic scar that tends to form varies for each person. Here are the most common causes of atrophic scarring:

Icepick Scars

Ice pick scars are characterized as narrow indentations in the skin that usually result from severe cystic or papular acne burrowing deep in the skin. Among the three, ice pick scars are the most severe due to their tiny diameter and depth of penetration. They often appear on the forehead, cheekbones, and nose.

Among the three, ice pick scars are the most difficult acne scar treatment because of their narrowness and depth of penetration. In general, we have found that ice pick scars respond well to phenol CROSS, our frontline treatment method. However, patients with more severe ice pick scars may benefit more from punch excision, a process in which a small “cookie-cutter” tool is used to punch out the ice pick scar. In this manner, we ensure that the scar is removed in its entirety, as opposed to other treatments that merely treat the surface.

Boxcar Scars

Boxcar scars have sharp defined boundaries with more geometric indentations in the skin.Boxcar scars result from collagen depletion caused by acne breakouts, leaving a visible depression behind on the skin. Boxcars are typically shallower and wider than ice pick scars, and have vertical walls with an even, flat base.

Although boxcar scars can be treated with a variety of procedures, many of them, including laser, dermabrasion, and microneedling, work superficially and are ineffective for deeper scars.At our clinic, subcision, punch excision, and collagen stimulators are the most effective and long-lasting treatment options available. We will perform a thorough evaluation of each of your boxcar scars to customize your treatment plan.

Rolling Scars

Rolling scars develop when fibrous tissue tethers the epidermis to the underlying subcutaneous tissue, creating sloping and wave-like indentations in the skin. Rolling scars are shallow and soft depressions that become more noticeable when skin ages and loses its elasticity. Rolling scars can disappear over time but may require intervention depending on their severity.

Because rolling scars are the softest among the different scar types, they respond the best to subcision followed by collagen stimulation. We will perform a thorough evaluation of your rolling scars to assess their severity and depth to determine what layers will need to be subcised. It is important to manually sever the fibrotic tethers in multiple layers to completely remodel the skin. Any treatments that do not target these tethers will not solve the root cause of rolling scars.

Hypertrophic Scars

A hypertrophic scar is a thick raised scar developed on areas of high skin tension. It is an abnormal wound healing response that commonly occurs following diseases, burns, surgical incisions, and other forms of skin trauma. Although they aren’t life threatening, they can be a bit itchy and painful if left untreated.

Trauma to the skin can sometimes leave behind raised, rubbery scars called hypertrophic scars. Unlike atrophic acne scars, hypertrophic scars result from overproduction of collagen as opposed to the depletion of collagen. Like rolling scars, hypertrophic scars usually resolve over time but do require treatment depending on their severity. Hypertrophic scars have the following characteristics:

• Shiny luster
• Rubbery texture
• Raised
• Hairless
• Stays within border