The treatment of acne scarring depends on the depth of the scarring. The depth of acne scarring varies and therefore the treatment of acne scarring varies. There is no one single fix-all treatment for acne scarring. Or any type of scarring, for that matter. Acne scarring is mostly a combination of actual scarring (collagen deposition) and volume loss due to tissue destruction.
Acne scarring can be divided into superficial, mid and deep acne scarring. This division corresponds approximately to upper dermis to mid dermis scarring, mid to deep dermis scarring and deep dermis to subcutaneous fat scarring. A single person with acne scarring will most often have more than one type of acne scarring and will therefore require more than one type of treatment.
The treatments below are arranged from superficial to deep treatments. Whatever the treatment options for a given patient, multiple treatments are almost always required.
Upper dermis to mid dermis scarring/volume loss treatments:
Creams and lasers that affect brown and red spots (in cases where there is no volume loss, only color change)
Needling or Percutaneous induction of collagen
Fraxionated Co2 laser (especially of skin laxity is a problem, as in older people)
Mid to deep dermis scarring / volume loss treatments:
Subcision – fewer lesions
Hyaloronic acid fillers – multiple lesions
Deep dermis to subcutaneous fat scarring / volume loss treatments:
CROSS technique – smaller lesions
Punch excision and elevation – smaller lesions
Hyaloronic acid fillers – larger lesions
Excision – larger lesions
Fat fillers – larger lesions