Atrophic acne scars can present as diverts or depressions on the skin, and most frequently occur on the cheeks. These types of acne scars are secondary to a loss of collagen and respond well to a variety of scar treatments.
If the scar is tethered, subscision can help release and improve scarring. Laser treatment with deep fractional/ Fraxel laser can also stimulate collagen production.
Collagen can also be replaced with dermal fillers and a process called dermal grafting.
My last treatment as part of the Synergy Program for my scars was a tiny bit of dermal filler. Results were instant, and 90% of my scars are gone. Can’t be happier with the whole process.
Box Car Scars
Mixed Acne Scars
Rolling & Depressed Acne Scars
There are many forms of acne scars, however atrophic scars do best will fillers. Atrophic scars are scars that are depressed or hollow, and are secondary to a loss of collagen, fat or extracellular matrix. This loss of collagen occurs in the deeper layers of the skin. By replacing loss volume, scars can ‘fill up’.
There are two ways to ‘fill up’ a scar.
- Firstly, deep fractional laser can stimulate collagen-producing cells to start laying more collagen. Often several treatments are needed to obtain an improvement.
2. The second method is to actually place collagen or a collagen replacement into the area.
Temporary fillers are best, for small depressions we use a very ‘liquid’ form of filler, however for volume loss, a thicker filler is preferable. Fillers work by replenishing lost volume in the dermal layers of the skin, and each filler type is suited for different applications and locations. We will advise you as to which dermal filler is best for your scars.
Most fillers contain Lidocaine, a local anaesthetic that is mixed in with the filler. This can significantly reduce the amount of pain during the filling process.
Fillers last between 4-18 months depending on the type of filler used. More ‘fluid’ fillers last 4-6 months whilst fillers such as Juvaderm last between 12-18 months.
Permanent filler have a greater rate of complications such as lumps, and also infections, and as a rule we do not recommend them our clinic.
Our approach to atrophic scars is to provide patients with a realistic expectations and goals. If you are in a hurry to fill up scars, then dermal fillers is the first choice- instant filling, with minimal down time. The flip side is that you may require a top up every 12-24 months.
If you are not in a hurry to get your scars filled, a more permanent solution that can reduce scars by 50-70% is a series of fractional laser treatments. Fractional laser stimulates your own collagen producing cells to make collagen. In another words - you make your own collagen. This process takes time, as most patient will require 3-4 Fractional laser treatments to their acne scars. In some cases, filler can then be used to fill up the remaining scars. This process is probably the best, as less filler will need to be used compared to filler alone.
Another method of using permanent filling is a process called Dermal Grafting- here we use your own collagen harvested from the back of your ear to fill up the atrophic scars. Dermal grafting has its advantages and disadvantages.
Dermal fillers are only recommended for certain types of acne scars, including atrophic and rolling scars. They are not recommended ice-pick scarring.
Dermal fillers form part of The Synergy Approach to acne scar treatment- most patients will have different types of scars, and a multi-treatment approach is best.
Yes. Dermal fillers are compatible will all skin types, and can be an ideal treatment for atrophic scars in darker skin patients. As dermal fillers target the loss of collagen deep in the skin layer, it spares any epidermal damage and reduces the chance of post treatment darkening of the skin.
Absolutely! In face this is how we recommend acne scar treatment is approached. This method of scar treatment is called The Synergy Approach - that is we combine multiple modalities to treat scarring.
As a guide, we advocate either RF (RadioFrequency) or Fractional laser to stimulate your own collagen before fillers. This process can be slow, as collagen stimulation takes months to achieve, however if successful, it can reduce the volume of filler needed.
If scars are tethered, we use subscision to free up bound-down collagen. If you have ice pick scars, TCA crossis the preferred method of scar revision. As emphasised, a combination of treatments is preferred, as most patients will have a combination of acne scar types.
The great advantage of dermal fillers over procedures such as Fraxel or Fractional laser is that fillers are associated with very little downtime. Patients can go to work immediately after filler treatment. In some patients, bruising may occur, however this is usually mild and will dissipate over a few days.
Dermal fillers can be that ‘lunch time fix’ of acne scars everyone is wanting.
This is one of the most well tolerated procedures in acne scar revision! We use many special techniques to ensure that pain is minimal, including the use of a special numbing cream prior to filler. Most fillers also contain local anaesthetic. Filling can take less than 30 seconds to complete, depending on the number of acne scars.
Dermal grafting is an old procedure that can be effective in managing atrophic scars, especially if scars are very small. This process replaces atrophic scars with your own collagen.
The process of Dermal Grafting is as follows -
- A small area from the back of your ear is harvested
- The top layer of harvested skin is stripped with a CO2 Laser
- The dermal layer is then ‘harvested’ and processed
- A tiny incision is made on the top of your atrophic scar
- A tiny bit of ‘harvested collagen’ is placed into the scar
- One or two stiches closes up the incision
- Stitches are taken out 4-5 days later
- Scars can be improved by 50-70% after one graft
- Incision line of the graft site can be resurfaced with laser 3-6 months later
- Any atrophic scars can then be finely corrected with filler after laser
The advantage of dermal grafting is that you use your own collagen and not a synthetic variety. In good hands, this can be a very effective method in treating atrophic acne scars.
There are several disadvantages to dermal grafting -
- Multiple incision will be made, resulting in multiple ‘nick’ ie. Trading a scar for another scar.
- These incision lines can be reduced with laser, but that involves another procedure down the line.
- In 10-15% of cases, a granuloma can form- this is due to a tiny bit of skin called epidermis from the donor site being transplanted to the scar site. This usually settles down with very dilute steroid injections, but in some cases may require excision.
In reality, even though dermal grafting has been very successful in the past, the combination of fractional laser and dermal fillers have largely replaced this method of acne scar revision. With modern technology, the process of treating atrophic scars is simpler, but importantly safer for patients.
Dermal filler vary in price depending on how much is needed. This depends on many factors most importantly on the extent of scarring- depth and area.
As a guide, fillers start from $280 for a few small areas, and can range to $2500. This price variation is dependent on how much filler we use. A through assessment with your Specialist will be needed prior to knowing how much filler to use.
Payment plans are available for acne scar revision.
Dr Davin S. Lim
Acne Specialist Clinics
Westside Laser Dermatology
Without doubt, atrophic scars can respond well to dermal fillers. Fillers have a clear and distinct advantage in that they provide ‘instant’ collagen to hollows, dents and diverts in the skin. Downtime for the patient is minimal, and the process takes only a few minutes to perform. The procedure is well tolerated as we combine a local anaesthetic together with the filler. Most patients will get between 12-24 months with temporary fillers.
I usually combine filling with other forms of collagen stimulation as part of my Synergy Approach. Treatments such as RF Fractional RadioFrequency, and Fractional laser treatments can stimulate the patient’s innate collagen laying process. The distinct advantage of laser treatment is that once collagen is stimulated, it’s yours to keep! Lasers and fractional methods can awaken your own collagen forming process, and I use fillers to ‘top’ up what is needed. In this common scenario, I leave dermal fillers as last line treatment, as a significant percentage of acne scars fill up with fractional laser treatment.
As I keep reinforcing, the Synergy Approach of scar revision is paramount for the best results - multiple treatment methods for different types of scars!