Acne is normally a condition that many of us contend with during our adolescent years at around the onset of puberty, which eventually disappears as our hormones stabilize. However, due to a variety of reasons, acne has a tendency to leave permanent disfiguring marks on our skin, which cannot be treated through topical applications such as creams and ointments. Any discoloration or defect that lasts longer than one year qualifies to be considered a permanent acne scar. Most acne scarring of this nature can only be removed or lessened through cosmetic procedures of differing invasiveness and intensity.

If the scarring is not deep and mostly affects the skin surface, doctors will usually recommend some form of dermabrasion, a technique where the upper layers of skin are removed to allow new skin to regenerate without the defects. Dermabrasion used to be rather painful, utilizing a sterile electric sander and requiring the patient to be sedated while undergoing the procedure. Moreover, the patient usually needed several months to heal as his raw skin slowly grew back.

Modern methods, however, are reducing the need to resort to this agonizing technique. Microdermabrasion, a form of the procedure that uses abrasive crystals or an exfoliating machine, is used for minor scars and produces adequate results without the associated pain. Laser dermabrasion is also becoming more common, utilizing tiny pulses of laser light to puncture the affected skin area, allowing it to regenerate from the damage gradually as fresh, unscarred skin tissue in a relatively short period of time.

Any of the aforementioned treatments may require several sessions if the scarred area is rather large, or to further reduce the scar remnants if some faded traces remain.

More severe and deeper scarring cannot be treated with conventional skin resurfacing methods. Icepick scars, for example, are so named because they give the impression that the skin has been stabbed with an icepick. These deep scars require a technique called punch excision, whereby the affected skin area is sliced out with a device resembling a cookie cutter tool, and the skin edges are sutured together. Sometimes, a skin graft may be necessary to replace the removed skin, and this is normally taken from behind the ear. These two methods produce minor scarring from the wounds, but are more susceptible to treatment with typical resurfacing.

A third punch treatment involves using the same tools, but instead of excising the scar, its base is merely dislodged from the skin and elevated to the surface, where it can be smoothed out. This method is called punch elevation.

Other types of deep or complex scars are boxcar scars, so named because the scar looks like a tiny compartment lodged in the skin, and rolling scars, which are caused when surface skin tethers itself to the subcutaneous tissue beneath, giving the skin a wave-like appearance. Boxcar scars may be treated in the same manner as icepick scars. Rolling scars, however, are more responsive to a process known as subcutaneous incision, whereby a needle is inserted and retracted in a piston-like movement under the skin. This procedure severs the bonds between the skin and the subcutaneous tissue, allowing it to be stretched and settled. Subcutaneous incision causes bruising that disappears in about a week, and may involve the injection of corticosteroids in the affected area to prevent the formation of nodules.

Since skin defects are rarely uniform or isolated to one type, it is normal to expect doctors to mix different procedures to completely treat one person. Regardless of the methods utilized, it is important to remember to care for one’s skin afterwards to prevent new scar formation or incomplete healing of the treated areas, by cleansing it properly, using various topical medicines, and limiting exposure to the sun.