You've just finished your battle with acne, expecting your skin to go completely back to normal when you quickly realize that you've been left with a variety of indents, discolorations, lumps, and bumps. It isn't leftover acne or acne beneath the surface just waiting to go away, it's more than likely an acne scar left behind (thanks to that lovely little blemish that’s been residing on your face for the past year). You didn't pick, took care of your spots properly, and didn't pile on too many aggravating products- so what gives?
If you suffer from whiteheads and blackheads, your acne most likely will not leave any scarring behind; the more aggressive and deep forms are those which cause a disturbance in the collagen fibers of your skin. Pustules, nodules, and cystsare the most common types of severe acne which form deep beneath the surface of the skin, leaving behind acne scars.
As these pores fill with pus and bacteria they swell up to an unmanageable size and come to the surface as an inflamed lesion. Because there is not enough room beneath the surface, a deep break occurs in the follicle wall. You can actually physically feel when a cystic spot is beginning to scar by an itching or burning sensation. To repair the damage your skin forms new collagenfibers, which typically don't look the same as your old skin, that my friends are a scar!
FYI, popping and prying your zits is never a good idea and can increase chances of scarring, but no popping doesn’t necessarily mean no scarring. Because nodules, pustules, and cysts form so deep beneath the surface, acne scarring can still occur even if you don't pop (like me). The best thing to do in the case of deep spots is to just let the pimple run its course. Most will go away rather quickly(1-2 weeks)as long as you're not touching and piling on aggravating products!
Identifying the type of acne scarring you suffer from is extremely important because once you are aware which type you have, then you are able to properly tackle it using the correct treatment options.
Acne scars can be divided into two main categories, atrophic, which is a loss of tissue, and hypertrophic, which is excess growth of tissue. Within those two categories are four subcategories, rolling, boxcar, ice pick, and keloid. All scars can be superficial to severe, depending on the amount of skin tissue lost. Each has distinctive qualities as to what constitutes them as that specific type of scar as well as preferred treatments geared towards the individual scar type.
Icepick scars are those which are deep and narrow, sometimes resembling the appearance of an open pore, and can also be large. The skin looks as if it were pricked by an ice pick or by another sharp object, thus the name Ice pick scar.
Ice pick scars from when a cyst or another inflamed spot makes its way to the surface; the skin tissue is destroyed leaving behind a long, deep scar.
Treatment Options: Icepick scars are usually treated with punch grafting, punch out excision, and lasers. Because the scarring is deep and narrow, things like micro-dermabrasion and needling are not often recommended.
Rolling scars look exactly as the name says, they appear like a rolling or wave-like texture. They typically are wide and shallow, with less defined edges. If you suffer from cheek scarring try taking a photograph straight on; if there are large patches with less defined edges that hold the appearance of a wave or rolling motion, you more than likely have rolling scars. Another easy way to tell if you have rolling scars is to puff out your cheeks if the scars disappear then you have rolling scars.
Rolling scars typically occur on people who had long term inflammatory acne. They begin to form as the skin ages and loses its original elasticity.
Rolling scars are often termed the "best" scars to have due to the various treatment options that all work in repairing the skin. Because they have sloping edges you can see noticeable results through laser resurfacing, micro-dermabrasion, chemical peels, needling, and subcision.
Cosmetic fillers are not typically recommended for rolling scars because they tend to take up a larger area of skin.
Boxcar scars again, typically appear as the name states, in a more defined, carved out, box-like texture (but can also be round in shape). These scars are deep and wide with steep defined edges, giving the skin a pitted appearance.
Boxcar scars form when a breakout destroys the collagen and supporting tissue around the skin. The skin is left without any fibers to support where the breakout began, creating a depressed area.
How To Get Rid of Boxcar Scars
Treatment Options: Because boxcar scars cover a smaller area than rolling scars and have defined edges,cosmetic fillersare usually a good option. The steep edges make it harder to smooth out the skin’s surface so it typically takes multiple laser treatments in conjunction with punch out excision and surgical subcisons. More shallow boxcar scars respond well to chemical peels and microdermabrasion but are ineffective for deeper scars.
Keloid scars are the least common type of acne scars. They appear as
a raised mass of tissue, sometimes resembling a cystic spot themselves. Keloid scars usually grow bigger than the breakout and are most commonly found on the body rather than on the face.
Keloid scars are hypertrophic, meaning that they form due to an overproduction of skin tissue and collagen rather than a loss of tissue like the other three types of scarring.
How To Treat Keloid Scars
Treatment Options:Steroid creams and cortisone injections are most commonly the first lines of defense when it comes to the treatment of keloid scars. Because they are raised, Keloid scars are treated much differently in comparison to atrophic scarring; the focus is placed on flattening, shrinking, and softening of the scar tissue.