Skin and Beauty

Types and Techniques of Acne Scar Revision Surgery

Written by Dr. Suvash Sahu and medically reviewed by iCliniq medical review team.

 
Image: Types and Techniques of Acne Scar Revision Surgery

Acne scars and wrinkles have always a challenge for treatment. Surgery in acne is indicated usually either for acne scars or post-inflammatory hyperpigmentation. Pitted facial scars, although commonly caused by acne, also result from a variety of conditions such as chicken pox, herpes zoster, etc. They are deep with well-defined margins, which cast a shadow, thus making them cosmetically more conspicuous. These deep pitted scars are either crateriform or ice pick shaped with depressed fibrotic base and with firm, indurate, rolling or slopping edges.

Types of Acne Scars:

Acne scars are of three types:

  1. Ice pick scars.
  2. Rolling scars.
  3. Boxcar scars.

Ice pick scars are narrow, less than 2 mm deep, sharply marginated with vertical extents to the deeper layers of skin.

Rolling scars occur when scars are adherent to dermis with relatively normal looking skin. They are wider than 4 mm to 5 mm. The abnormal adherence of scars to dermis leads to superficial shadowing and rolling or undulating appearance of the overlying skin. In this type of scars, subcision is essential for successful treatment.

Boxcar scars are round or oval depressions with sharply demarcated vertical edges. They may be shallow or deep and are commonly up to 0.5 mm or deep, more than 0.5 mm and most often 1.5 mm to 4 mm in diameter. These types of scars respond well to punch excision or punch elevation treatment.

Various Techniques to Treat Acne Scars:

  • Subcision - A technique of uplifting the scars by cutting the underlying fibrous band with the help of hypodermic needles.
  • Punch excision and closure - A kind of circular blade is attached to a pencil like handle. In this method, the scar tissue will get cut and sutured back.
  • Punch incision and elevation - In this method, the scar tissue will just get incised with punch and uplifted to the level of surrounding skin by elevation techniques. This procedure is useful for deep boxcar scars.
  • Punch excision and graft replacement - In this type, pitted scars of up to 4 mm diameter are first excised with the help of punch and immediately replaced with a skin graft taken from other parts of the body.

Factors That Decide Which Technique Has to Be Followed:

1) Number of Scars:

If plenty of closely placed scars are present, then subcision should be a preferred method. If scars are less in number, then other techniques can be done subsequent to subcision for a better result.

2) Orientation Along RSTL:

Scar lying along or parallel to RSTL (relaxed skin tension line) should be punch excised and closed primarily for best results.

3) Scar Surface:

When few scars are present, not along the RSTL, then two alternatives are available. Punch incision and elevation is performed for scars with normal surface texture and punch excision with graft replacement for those with atrophic surface and irregular skin texture.

4) Size of Scar:

The excision with grafting should be avoided for scars more than 4 mm to prevent poor esthetic results. In these types of scars, elliptical excision and suturing can be done.

5) Shape of Scar:

Linear scars are best excised and closed primarily. Circular scars probably require punch float.

Complications:

The complications of scar revision surgery are hematoma, infection, wound dehiscence, graft rejection, allergic reaction to dressing and scarring.

Are you worried about acne scars? Consult an acne scar removal specialist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist/acne-scar-removal

Last reviewed at: 07.Sep.2018

RATING

42
 


Do you have a question on Cosmetic Procedure or Acne?
 
* guaranteed answer within 4 hours.
 

Related Questions & Answers


How to remove hyperpigmented scar?
Query: Hi doctor, I am a 30 year old male. I have a disfigured nose tip with the hyperpigmented scar as a result of a Hydroquinone reaction (Melalite 15 cream). I have undergone several treatments including dermabrasion, subcision and chemical peel. Currently, I am taking Limcee (vitamin c) tablets and co...  Read Full »
Dr. Suvash Sahu
Dermatologist

Answer: Hi, Welcome to icliniq.com. Since you already undergone all possible treatments, the last nonsurgical option, but a very good option is ND:YAG laser (neodymium-doped yttrium aluminium garnet laser) along with the daily night application of Clearz daily cream (Kojic acid and vitamin C) during night. ...  Read Full »
 
Acne: Skin Care Tips and Treatment Options
Article Overview: Acne is the most common problem faced by teenagers which has a social as well as psychological impact. It is said that about 90 to 95 % of the world population would have suffered from acne at some point in their life. Acne is very common during 13 to 30 years of age. After 30 years of age, acne is considered as 'adult acne' which has strong hormonal influence.  Read Article »
Dr. Ashwini V Swamy
Dermatologist

How Does One Develop Acne? Acne is a disorder of pilosebaceous unit, pilo meaning hair, and sebaceous meaning oil-producing gland. These pilosebaceous glands are densely distributed over the face, neck, chest, back, shoulder, and arms. It also has a genetic component, meaning the appearance/ severi ...  Read Article »
 
Are sunken eyes reversible?
Query: Hello doctor, I delivered my baby three years back. After a year, I started suffering from sunken eyes due to lack of sleep, high stress and improper nutrition. For the last six months, I am taking good care of myself and my eyes have slightly improved. I want to know if sunken eyes are reversible. ...  Read Full »
Dr. Bharat Patodiya
Internal Medicine Physician

Answer: Hi, Welcome to icliniq.com. You have explained your problem well. The sunken eyes are definitely reversible, especially when you have started taking good care of yourself. Ask someone who has not met you for a while to compare old picture and now to tell you how much difference is there in your eyes...  Read Full »
 
Acne - Causes, Types, Home Remedies and Treatment Strategy
Article Overview: Acne is a very common condition encountered among teens and adults. To decide the protocol for the treatment of acne, it is important for us to know the causes, conditions associated, sites of acne, the cause of acne and factors affecting the onset of acne. Many home remedies are helpful in treating acne. Mild and moderate acne can be treated with medication and severe acne with other treatment procedures. Prevention is more important than cure.  Read Article »
Dr. Archana
Dermatologist

Acne is a very common skin condition. It commonly starts during puberty but can occur at any age. Although it is not a dangerous condition, acne can leave scars on the skin. Acne appears in different parts of the body like face, chest, and back. Acne affects almost all teenagers in different severit ...  Read Article »
 
Do children with soft cleft palate also need multiple surgeries to fix the issue?
Query: Hello doctor, I am having one doubt in my mind. Previously, I read that all cleft palate children usually undergo multiple surgeries. Is this statement valid for the soft cleft palate as well? Children with soft cleft palate also need to undergo multiple surgeries? My child was having only soft cl...  Read Full »
Dr. Priyanka Aggarwal
Audiologist

Answer: Hello, Welcome to icliniq.com. Multiple surgeries in cleft palate children depend upon the extent of the cleft and the age of the child at the time of operation. Only cleft soft palate rarely need another surgery. But, it is quite often that there is an underlying defect of the hard pal...  Read Full »
 
I have lot of acne scars on my face that make me look ugly. Please suggest me treatment for the same.
Query: Hello Doctor,    I am 19 years old. I have lot of acne scars on my face and it looks ugly. Doctor advised me to use contractubex but it is of no use. Please suggest some other treatment.  Read Full »
Dr. Meha Malhotra
Dermatologist

Answer: Hi, Welcome to icliniq.com. Contractubex gel is topically applied to reduce scars. It is very effective on various types of scars. Other modes of treating scars include: Fractional laser treatment - a non-invasive technique to remove scars. It is the best option but is slightly expensive. ...  Read Full »
 

Ask a Doctor Online

* guaranteed answer within 4 hours

Related Tags