Does anything actually work for acne scars?
Treatment for acne scars can be effective, however no treatment removes acne scars. What treatment achieves is to render them less noticeable.
Where treatment disappoints, the explanation is often that the treatment did not match the scar. Laser resurfacing performed upon tethered rolling scars smooths the surface of a depression and leaves the depression. Dermal filler injected into a scar held down by fibrous bands cannot release the bands. Another reason for treatment failure is treating scars while acne remains active, so that new scars form as quickly as the existing ones are treated. I will always advise to gain effective control of acne through medical treatments if required prior to treating acne scars.
Matching the procedure to the problem and sequencing it correctly can achieve improvements. Subcision addresses scars tethered to deeper tissue, particularly rolling scars. TCA CROSS addresses narrow deep ice pick scars and deeper boxcar scars. Punch excision addresses a small number of very deep scars. Fractional laser resurfacing addresses surface irregularity once the contour has been corrected. Most patients require more than one of these, in that order.
A full course generally takes twelve to eighteen months across several procedures, with collagen continuing to remodel for months after each one. It is a project rather than an appointment.
Anyone promising removal should be treated with suspicion, and so should the conclusion that nothing works, which is usually reached after one inappropriate treatment assessed too early. The realistic position lies between the two and is worth having: scars that are shallower, cast less shadow and are no longer the first thing seen.
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