ACNE SCARRING
Acne scarring is the development of deep pits or broad,
shallow pits. They are particularly noticeable with side lighting since a
depressed scar casts a shadow. Many procedures are available to improve
acne scarring including filling agents, such as collagen from cows or
pigs; your own collagen and fat; cutting and sewing, as well as skin
grafts, and resurfacing or dermabrasion.
Filling agents work by elevating broad and shallow
scars to approximate the surrounding normal skin; thus, decreasing
shadowing which makes the scars less evident. Most filling agents are
temporary, even your own collagen and fat when injected in this area may
or may not survive permanently. Scars can be cut into and collagen grafts
can be taken from other parts of the skin and inserted like a sandwich for
sometimes permanent correction of large crateriform scars. Small icepick
scars are best treated by cutting them out and resewing them or, even
better, cutting them out and replacing them with small skin grafts from
behind the ear - called "punch grafting.".
A more definitive procedure for acne scarring would be
dermabrasion or resurfacing with the ultrapulsed carbon dioxide laser as
described above. This procedure works by filing down or burning down the
surrounding normal skin to the level of the scar to give one a smoother,
more even appearance. The scars are still there, they are just less deep,
thus there is less shadowing. The complications from resurfacing
procedures include scarring which can be thick, red and cordlike,
particularly along the jawline, or more subtle whitish scars, particularly
along the lips and lids. These procedures should be done by experienced
physicians and every patient's result is somewhat different; thus, while
one can give a patient who has suffered the ravages of acne some
significant hope for improvement, none of the surgical procedures are
perfect and the patient certainly will not end up with "normal" skin or
perfectly smooth skin. The goal of acne scar surgery or revision is
improvement in appearance and many patients, particularly women, are more
than satisfied just to be able to put on makeup smoothly without it
catching in the pits. Other patients, however, enter into these kinds of
procedures with the misunderstanding or false impression that they will
end up with smooth or normal-appearing skin. There will always be some
element of scarring.
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