Depressed Acne Scars: Can They Be 100% Eliminated? Effective Treatments and Management

Hello. I am Dr. Lee Sang-ju, a board-certified dermatologist. Depressed acne scars are almost always left behind after severe acne. While depressed acne scars are known to be difficult to treat, they can be sufficiently improved with modern medicine. Today, I would like to answer your questions about depressed acne scars.

The sooner the treatment, the better

It is best to start all scar treatments as early as possible. In particular, treating acne scars that still have redness in the early stages is desirable as it can reduce the possibility of the scars becoming deeply entrenched.

Can acne and scars be treated simultaneously?

If active acne and scars are present together, it is most effective to proceed with acne treatment and scar treatment simultaneously.

Red marks and depressed scars, which should be treated first?

If treated at the red mark stage before the scar is fully established, a scar prevention effect can be expected. Therefore, treating red acne marks first, and then depressed scars afterward, generally poses no significant problem.

Is there an age limit for acne scar treatment?

Since the period when acne occurs is when skin appendages are almost fully developed, treatment is sufficiently possible from high school age. However, since the treatment period can be long, it is advisable to plan the treatment within a scope that does not interfere with studies.

Depressed acne scars vary greatly in shape, size, and depth, making it difficult to satisfy all scars with a single method. They can be broadly divided into laser treatment and procedural treatment.

Laser Treatment: Fraxel DUAL vs. Ultrapulse Encore

• Fraxel DUAL Laser: A representative example of a non-ablative fractional laser, it creates microscopic wounds on the skin to induce regeneration. It is mainly effective for mild acne scars.
• Ultrapulse Encore Laser: An ablative fractional laser that creates deeper wounds than Fraxel DUAL, allowing for a more powerful regenerative effect. Research has reported that it is about 5 times more effective than Fraxel DUAL. It may be more helpful for severe acne scars.
• Laser Dermabrasion: One of the effective methods for deep acne scars.

Procedural Treatments for Various Scars

• Shallow scars: Fractional laser is primarily used.
• Deep acne scars: Laser Dermabrasion can be effective.
• Locally deep scars: If lasers alone may not be effective, methods such as punch excision to elevate the scar, CROSS, or Derma-rolling are considered.
• Rolling scars (uneven scars): Subcision (subdermal incision) or scar fillers may be helpful.

Will Laser Dermabrasion weaken the skin?

The skin has good regenerative power, so Laser Dermabrasion treatment does not weaken the skin. On the contrary, scientific evidence shows that actual skin thickness increases after treatment compared to before, so you don't need to worry too much.

Is it possible to perform Laser Dermabrasion partially on the nose area?

Yes, it is possible to treat only the nose area with Laser Dermabrasion. However, since the nose is an area with many pores, if the pores are too large and deep, the inner pores may become more prominent during Laser Dermabrasion treatment. Therefore, it is advisable to consult with a dermatologist to find the appropriate method.

Post-Treatment Recovery and Care

After Laser Dermabrasion, a moist dressing will be applied for about a week to protect the skin. Daily life is possible after a week, and makeup, face washing, and showering can also be done. Of course, the treated area may appear red, but this gradually improves over time, so you don't need to worry.

If you did not see significant improvement after Fraxel DUAL treatment, it may be because it is effective for shallow scars but less effective for deep scars. In such cases, more powerful treatments such as Ultrapulse Encore Laser or Er:YAG Laser can be considered, and if necessary, even Laser Dermabrasion is advisable.

Keloid scars refer to a predisposition where scars swell up after an injury. Even in such cases, careful treatment generally poses no major problems. However, it is advisable to receive treatment from a specialist with extensive experience in treating keloid skin.

Injecting scar fillers into depressed acne scars to fill the sunken areas is another method. It is effective for soft, depressed acne scars and is observed to last for about 1 year or more.

Many people worry that if the filler is absorbed, the scar will return to its original state. However, as new collagen is generated in the area where the filler was filled, an improved state compared to before can be expected even after the filler is gone.

In modern medicine, the term '100% cure' is not used for scars. However, I can tell you that 100% improvement of acne scars is sufficiently possible with modern medicine.

Treatment duration varies depending on the extent of the patient's scars. For mild scars, one or two treatments may be sufficient, but for deep scars, 5 to 10 treatments may be necessary.

Acne extraction at a dermatology clinic is done to remove sebum clumps that feed acne bacteria. If sebum clumps remain, they can cause inflammation and leave scars, so creating an environment where acne bacteria cannot easily survive helps prevent inflammation and scar formation. If scars have formed due to extraction, it is advisable to visit the clinic for an examination.

In the past, methods of taking skin from other areas and grafting it onto depressed acne scars were considered. However, if taken from the arm, a scar may remain on the arm, and even when using excess skin behind the ear, there is a disadvantage that the grafted area may appear prominent due to the characteristics of Asian skin, so other methods are currently preferred.

Acne scars are a skin condition that can be sufficiently improved through various treatment methods. If you have any questions about your skin, please consult with a dermatologist at any time to create the optimal treatment plan for you.