Why do I Scar from Acne? Can you Help?

before and after skin rejuvenation
Before and after energy based device and injectable treatments for skin rejuvenation and acne scarring treatment

Acne is a common, problematic, emotional journey for most. And the cause can be a variety of factors, but it is mostly inherited, developed from environmental or internal factors – and can start to develop around puberty when your hormone levels rise and can continue all the way into your 40s and 50s.

Acne cause

It is classified as a disorder of the hair follicle and sebaceous glands. Your sebaceous glands have a primary job of secreting oil (sebum) to keep your skin moist and protected… they do this by producing sebum and then sending it through the connected hair follicle and hair before draining onto the skin through the pore.

Skin cells that line the follicle called keratinocytes, usually shed once a month and the process continues with new skin cells but with acne, the sebum and keratinocytes stick to the hair inside the pore – this prevents the skin cells from shedding and the sebum from reaching the surface of the skin. In addition, the bacteria which is called ‘Propionibacterium’ that usually lives on our skin migrates into the trapped hair follicle and causes redness, pain, and inflammation and when the skin wall breaks down naturally or by squeezing and picking – it erupts the contents like a volcano onto surrounding skin creating pimples and then the cycle continues.

Types of Acne

There are many different types of acne you may be familiar with, whiteheads, blackheads, pustules, papules, nodules, and cysts. These guys most often appear where you have high concentration of sebaceous glands like your face, chest and back, shoulders and neck.

Scar formation

Acne that contributes mostly to scar formation are the inflamed, painful acnes such as cystic and nodular acne because they tend to penetrate deeper into the skin which causes damage to tissue and capillaries

Also, an individual that picks and squeezes, or delays treatments when they have inflammation are at much greater risk of scarring. As mentioned above, genetics can also be a predictor in who will scar.

Before scarring develops, acne stimulates the wound healing process from the injury which triggers a cascade of very complex biological processes which can be consolidated into 3 stages: inflammation, granulation tissue formation and matrix remodelling.

Scarring occurs when the skin is damaged during these 3 phases. Individuals that are prone to scarring have a slower inflammation response – but when the process starts, it is more severe and lasts
longer.

During the granulation tissue formation, the damaged tissue and capillaries are
repaired with all sorts of wonderful cells and growth factors which contribute to collagen
formation.
In the matrix remodelling stage, enzymes work away at the architecture of the injured site. During the remodelling, if there is an imbalance of these enzymes it results in the development of scars. If there is an inadequate response – there is less collagen formation and atrophic scars are formed. Whereas if the response is too excited – a raised nodule
forms a hypertrophic scar or keloid scar.

Scar Types

Atrophic scars are more common than hypertrophic scars and can be subclassified into 3
types:

  • Rolling scars,
  • Ice pick and
  • Boxcar.

Ice pick are the most common of the 3 and are narrow, deep and extend to the deep dermis and hypodermis – think of an ice cream cone sitting in your skin. They can vary in severity and can sometimes be referred on for punch excision.

Rolling scars are wider and shallower that have abnormal fibrous anchoring of the dermis which gives the appearance of a ‘small pond’ that creates a shadow on your skin and can be hard to treat because they can tether and are anchored. These also may need surgical methods. Dermal filler and skinbooster work well with these.

Box scars can be quite overwhelming to have with sharp demarcated vertical edges that run wide and can be shallow or deep and do not taper to a point like ice pick scars… think of a ‘plunge pool’ and expect laser interventions and injectables.


Hypertrophic scars are typically pink, firm and raised… they are usually predisposed in skin ypes III-V and are like dermal scars.

All these scars are graded from macular to severe which gives us an indication on whether we can help treat them.

So, what scars can be treated?

First it needs to be mentioned that prevention is the absolute main step in avoiding scars. If you know you’re prone to acne or are suffering from it, seeking guidance from a trained professional you trust is very important – you basically need to reduce the inflammation asap to avoid post acne scarring.

When the scar has formed it causes a therapeutic challenge and a long journey to minimise its appearance, which is why I can’t stress enough on prevention and the persistent management of acne vulgaris.

Everyone will have their own scar paradigm so no, not one size fits all.

What is the consultation process

Expect a face-to-face consultation followed by combined strategies for your treatment plan

Your practitioner will conduct a thorough examination of your scars by first identifying the scar types and their severity. Some individuals may have a combination of subtypes. They will then put you under indirect or angled lighting… this confirms where the deficits are, the depth and helps classifies the scar type – this is the most accurate way to diagnose as opposed to looking at your scars in direct lighting.

They will then discuss with you their scope of what they can offer you and what they can’t. It is important for you to understand their scope and when a referral is appreciated.

Complications from acne scar treatments from untrained professionals or incapable technicians can be traumatising and irreversible which is why we recommend consulting with a skilled practitioner.
From the consultation a treatment plan will be made. The following is a brief outline that gives you some guidance on what may be offered in combination with , and dermal therapy treatments like chemical peels.

Treatment options

Prescription Medications

Skincare products

Chemical peels

Radio Frequency needling

RF MIcroneedling delivers a vertical stamp with insulated needles to scars, breaking up the scar tissue into the dermis,. This is one of the best treatments for most acne scars, especially rolling scars. Because the device uses a stamping technique, it doesn’t cause as much trauma to the epidermis and, there is less collateral damage to the surrounding healthy skin.

It is great on all types and is unlikely to cause post inflammatory hyperpigmentation. A minimum of 3 treatments are needed but more treatments will achieve better results.

Erbium ablative laser

This treatment targets water in the skin and vaporises the tissue in a controlled manner. It heats up the tissue and causes a wound healing process which results in skin resurfacing and increased skin thickness from neocollagenesis. Erbium is exceptional for mild to severe acne scars of all subtypes because it enables your practitioner to first plane down the scar and then blend surrounding skin to give it an even texture.

A consultation is the first step to having this treatment to first diagnose your acne scars, prep your skin with certain products and if necessary perform a patch test to see if erbium is suitable for you.

There is downtime with this laser- up to 2 weeks and the number of treatments is based around your results after each treatment.

Your practitioner may use fractionated erbium or CO2 or full field Erbium or CO2

Dermal filler and skin boosters

This is great for atrophic scars – superficial rolling and tethered scars that have lost collagen. The filler raises the scar up and stimulates collagen production and hydration Sometimes your practitioner will also perform subcision before or while they are performing this treatment.

Subcision

Subcision helps free up the bonds that are causing anchoring and depressions in the skin.

The results from this combination treatment of injectables and subcision are seen immediately and improve over 2 – 4 weeks. It can be combined with RF needling and usually 3 treatments 4 weeks apart are recommended.

TCA cross

Powder Filler

Powder filler is a great treatment, particularly for those with acne scarring whose scarring is becoming worsened by the volume loss that’s associated with ageing.

PRP

Platelet Rich Plasma is another injectable option for scarring treatment.

BIoremodeller

Bioremodeller can be used for skin repair and is useful in acne scarring.

For an appointment to assess your acne scarring, please call our clinic on 93315005.

THE MANSE