Pitted acne scars are very common consequences after getting pimples (also known as acne). This is especially common if the pimple outbreak was serious or if the pimples were big.
It is important to know the differences between flat acne marks and pitted acne scars because the treatments are different.
Treating scars and acne marks is as much a science as it is an art. It requires accurate diagnosis followed by precise treatment to deliver optimal improvements and results.
What are Pitted Acne Scars?
Pitted acne scars are scars that are atrophic scars. They look like depressions or “holes” in your skin. There are 3 types of pitted scars: ice pick scars, boxcar scars and rolling scars.
Before treating pitted acne scars, you need to have a consult to understand the exact type of acne scarring that you have.
These are examples:
Ice Pick Scars
Ice pick scars are deep scars with narrow width.
Boxcar scars are deep scars with “punched out” and squarish edges.
Rolling scars are shallow scars that have sloping edges.
Do Pitted Scars go away over time?
Unfortunately, pitted scars do not go away over time. In fact, atrophic acne scars slowly worsen over years and decades due to aging-related collagen loss in your skin.
How To Treat Pitted Scars?
In order to treat scars effectively, it is also important to identify the types of acne scars first followed by instituting the appropriate treatment for the type of scar.
For example, box-car scars will require subcision and filler followed by fractional laser whereas icepick scars can be treated slightly differently with TCA chemical peel and fractional lasers.
Everyone is unique. The most suitable treatments for your scar and skin will differ amongst individuals depending on your skin type, hydration, pain tolerance and ability to handle downtime.
Scar treatments should also be flexible to accommodate how your skin changes during the course of treatment.
• Chemical Peels
Chemical peels can treat acne scars. For mild pitted acne scarring, chemical peel can help to reduce acne inflammation (increased white blood cells), help with fighting acne and treat mild depressed scars. Examples include azelaic acid, salicylic acid, glycolic acid and exfoliating hydroxy acids.
More aggressive chemical peels like TCA cross can be used for ice-pick scars.
Fractional laser resurfacing helps to resurface your skin for deep pitted scars remodelling. After fractional laser resurfacing for treating acne scars, your skin heals with new skin cells and more even toned skin underneath. This treatment also helps to rejuvenate surrounding skin around the pitted scarring and scarred tissue.
Fractional laser can be combined with other treatments like Infini and Subcision to achieve better scarring improvement results. This is why it is important to see a doctor who has a wide range of treatment options to offer you.
Topical anaesthesia is used before the treatment to reduce discomfort. Strict aftercare of sun avoidance by wearing sunscreen is recommended to minimise post inflammatory hyperpigmentation.
Fractional micro needling radiofrequency treatments like INFINI can help the healing process by reducing inflammation and reducing blood flow so that the redness improves.
This treatment also stimulates collagen production in the deep dermis layer over several treatments to achieve smooth skin.
Subcision works best for tethered scars, stubborn scar tissue and deep pitted scars.
Subcision is performed using a needle to gently free up the scar tissue under the skin. It is a laborious process but the results obtained are often unparalleled. Not many doctors in Singapore offer this treatment.
Subcision works best with dermal fillers to support scar recovery and remodelling.
• Dermal Fillers
Dermal fillers are often used together with subcision of acne scars to enhance scar remodelling and recovery.
There are several type of fillers for deeper scars, ranging from hyaluronic acid fillers to collagen stimulators like Rejuran, Profhilo and Ellanse. Each has its own strengths and weaknesses.
Collagen stimulators in particular can stimulate new skin collagen production and elastin production by helping your body to produce new collagen fibers. While your scarring may not disappear completely, the deep indentations will look shallower and less obvious
This is a highly technical treatment for pitted acne scar and also one of the most effective treatments that requires dexterity and experience.
Apart from effectiveness of the treatment for deep pitted acne scars, the other key considerations that you should have include: recovery time/ wound healing, risk and price.
Other treatments that used to be popular amongst board certified dermatologist include punch excision. However, it has risks of new scar, takes quite a while to heal, post-inflammatory hyperpigmentation and risk of hypertrophic scars/ keloid scars.
If in doubt, please speak to a scar expert or board certified dermatologist for advice as there’s no “one size fits all” treatment options in cosmetic dermatology.
How To Prevent Pitted Acne Scars
The best way to prevent deep pitted acne scars is to prevent active acne lesions from forming. This can be done using good skin care, early acne treatments and avoid squeezing the pimples that form. However, do note that genetics also play a role in determining how easily you scar after active acne.
Apart from early acne treatment, knowing the difference between active acne and acne scars is also important. Remember to treat acne immediately so that less scars form. This is especially important for patients who have dark skin (darker skin types).
Let us help you to achieve blemish free skin!
Dr Justin Boey uses specialised acne scar treatments that will smooth your skin texture and improve the appearance of acne scars.
We have one of the widest range of Acne Scar Lasers, Microneedling Radiofrequency devices, Subcision technology and Chemical Peels in Singapore.
Whether you’re looking for laser treatments or other forms of pitted acne scarring removal solutions in Singapore, we have you covered.