Facial Scars: Treatment Options

There’s something inherently a little daunting about the idea of getting laser treatments for a skin concern. But, as the landscape of acne scar treatments continues to evolve and expand, lasers remain at the forefront for good reason—even if the idea of them makes you think of something from Dexter’s Lab.

Still, lasers are far from the only option for treating acne scars. So, here’s what you need to know about laser and non-laser treatments for acne scars—and how to pick the best treatment option for your skin.

First off, what kind of scars do you have?

Acne scars come in all kinds of shapes and sizes and some people are more likely to develop some types rather than others, as SELF explained previously.

Your scars may be raised or depressed, widespread or minimal, deep or shallow. Raised scars, which includes keloids, are more likely to appear on the back or chest, the American Academy of Dermatology (AAD) explains. But people of color are more likely to develop raised scars in general, including on the face. Depressed scars, such as the more shallow boxcar and rolling scars as well as the deeper and narrower icepick scars, generally appear only on the face.

The type and severity of the scars you have generally determines which kind of treatment will be most effective for you. For instance, treatments that are designed to stimulate collagen, like microneedling, won’t do much good for those with raised scars that form as a result of an excess of collagen. And treatments that are meant to fill in the area left by depressed scarring won’t really help with raised scars. So, when talking to a dermatologist about your treatment options, the type of scarring you have is one of the first things they’ll want to examine.

For starters, lasers can be ablative or nonablative. Ablative ones create wounds that actually melt or otherwise destroy scar tissue and tighten up the collagen in the skin, while nonablative alternatives promote new collagen production by heating up the skin rather than causing an actual wound. Current thinking holds that ablative lasers are generally more effective for treating all kinds of scars because they’re such an aggressive form of treatment. But they are also undoubtedly harsher and riskier to use in patients of color because the wounds they create also create a greater likelihood of hyperpigmentation during the healing process. In turn, nonablative methods—which can still be incredibly effective—have become more popular.

Lasers can also differ in how they actually treat acne scars. For instance, they either work fractionally or nonfractionally. Nonfractionated lasers take a sort of “scorched earth” approach and affect the entire surface of the skin. Because of that more aggressive approach, they are generally considered to be more effective than fractional lasers. But they’re falling out of favor as gentler, safer and still effective treatments are developed, including different types of fractional treatments. Those fractional procedures treat the skin in a targeted grid, creating smaller “microcolumns of injury” while leaving some areas of the skin untouched, Neelam Vashi, M.D., associate professor of dermatology at Boston University School of Medicine and director of the Boston University Cosmetic and Laser Center, tells SELF. That triggers a healing response in the skin that generates new collagen and rebuilds the skin.

Fractional treatments (commonly known by the brand name Fraxel) can be ablative or nonablative, and even though nonablative options will be less invasive and allow for a quicker recovery time, neither are without their risks.

Laser treatments do usually come with some after-effects, including feelings of sensitivity, swelling, redness, oozing, and crusting, especially in the days immediately following the treatment, Hillary D. Johnson, M.D., Ph.D., FAAD, clinical associate professor of dermatology at the University of Iowa, tells SELF. These side effects are pretty standard across the board for all types of lasers, but may be more severe as your skin heals after more aggressive types of treatments.

After seven-to-10 days, the swelling should go down and you’ll be left looking and feeling like you have a bad sunburn, she says. So you’ll need to be extra careful about sun safety and cut back your skin-care routine to the bare minimum (definitely no exfoliating treatments) while your skin heals, which could take up to two months after treatment.

In addition to the down time, laser treatments are notoriously expensive. They can cost anywhere from $900 to $1600 per treatment, depending on the type of laser, and are generally not covered by insurance. Also, treating acne scars with lasers can require several appointments, and the amount of time it takes to complete treatment will vary from patient to patient, Dr. Vashi says. Luckily, she adds that “each laser treatment will make [the scars] somewhat better.”

So you could start to notice positive changes in your skin after a month, Dr. Johnson says, but you may also need to wait up to six months to see the final results.

Sometimes dermatologists will suggest a laser in addition to other acne scar treatments.

When you’re considering a treatment plan, it’s always important to ask your derm about all of your options to make sure you know what else is out there. And even if you decide on a laser treatment, it’s likely that your doctor will bolster their laser treatments with other, non-laser procedures. It’s actually pretty rare that a treatment plan for acne scars will consist of just one method—it’s more likely to feature some combination of treatments that each address a different type of acne scar, Dr. Johnson says. And Dr. Vashi echoes the importance of a multimodal approach: “There are very few patients I do one thing for.”

Even if that sounds complicated (or, for the laser-shy among us, just plain bad), Dr. Johnson says this tends to yield the best, most visible results, which is your dermatologist’s number-one goal. So don’t be surprised if your derm does, ultimately, recommend including some laser treatments as part of a larger plan.

Still not down for lasers? Here are some other acne scar treatments.

All chemical peels work via the same basic process: Apply a concentrated chemical substance to the skin, which essentially destroys the outer later of skin to remove damage and kickstart the body’s repair process.

Chemical peels can be an effective way to manage acne itself and, when done safely, they can also make subtle changes to very shallow scars, Dr. Vashi says. Light- to medium-depth peels containing an alpha- or beta-hydroxy-acid (such as glycolic acid or salicylic acid) will exfoliate the skin and reduce hyperpigmentation, she says. That can make the skin’s overall pigment and texture look more even.

One type of chemical procedure—which involves the use of trichloroacetic acid (TCA)—has been found to be particularly effective in treating deeper, narrower scars known as “icepick scars.” These tend to be so deep that lasers and needles can’t penetrate far enough to reach their base, so, a tiny dose of TCA is dabbed into the scar to help close it up. But this type of treatment usually takes multiple sessions, lasting up to six months, to see improvements, Dr. Johnson says.

It should be noted that, although most chemical peel options are superficial enough that they won’t increase the risk of hyperpigmentation for people with darker skin, procedures involving TCA might be an exception.

Best for: Treating acne itself and the shallowest scars. To get deeper into the skin, look into TCA treatments, which are especially useful for deep icepick scars.

Before you totally discount laser acne-scar treatments, here’s how they work.

Like basically all other treatment options, lasers cannot completely remove your acne scars. They can only help reduce the appearance of scars and improve your skin’s texture. But still, lasers offer a straightforward, effective way to make a variety of different types of acne scars less noticeable—including raised and depressed scars. And there are actually several different types of laser treatments, with some working more gently than others.

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