In this article I hope to give you some ideas about how to get rid of pimple scars based on what sort of scars you are experiencing and the kind of skin that you have. Pimples can be emotionally as well as physically scarring. In this series of articles, I’ll try to help you deal with all aspects of this unfortunate condition.

OK, there’s an upside and a downside. First, let’s do the downside: Acne scars look terrible, and they can last your entire life. Now on to the upside: Not only can you sometimes stop acne from scarring, but if you already have scars, you may be able to get rid of them.

Some of the treatments that I’m going to be talking about here are heavily invasive and surgical in nature –don’t try this at home!

Your acne scars are simply a natural response of your body to the inflammation caused by your pimples. Nodular acne is the kind that occurs deeper than the skin, and this is the sort that most often causes scarring. Other kinds of acne can also scar, but this is a less common condition, and usually not as severe.

So what are your scars anyway? Well scars are produced by a healing process in which a protein called collagen is laid down by skin cells. Your pimples scars may have a number of different looks to the eye. Sometimes they are flat, sometimes they bulge out and look like lumps on your skin, and where there has been a loss of skin tissue replaced by a smaller amount of collagen, they can be lower than the surrounding skin. Scars from pimples can also have different colors – they can be white, red or the same shade as your own skin color only darker.

If you have pimples that have healed, sometimes they leave a blemish or blotch on the skin. Usually these are not scarring, but only a temporary condition. We won’t refer to these marks as acne scars because no permanent color change exists. Those of us with darker skin can sometimes have post inflammatory pigment changes. This is just an effect from your pimple healing itself. These color changes will usually fade with time.

Tissue loss scarring

Scars that are caused by an actual loss of skin tissue are called pits. The actual medical name would be pit scars or cratariform scars. These happen when the acne is severe enough to have actually destroyed tissue, and they look a lot like chickenpox scars. Part of the reason is that the scar tissue tends to pull back into itself and pull skin tissue with it. This combined with the destruction of tissue in the first place, results in a pit. The pits can have a variety of different appearances, so let’s take a look at the most common names and descriptions for these types:

• Boxcar scars often form on your cheeks and temples. These can be small or large, and look like chicken pox.

• Ice pick scars: the most common kind of pit type pimple scars they are usually found on the cheeks in the upper half of the face. They vary in size, but are usually quite small and have steep sides hence the name ice pick scars.

• Fibrotic scars: scars that are created by fibrous scar tissue pulling in and down. They can be quite large with sharp and clearly defined edges and quite a bit of depth.

• Hill and valley scars: they can give the skin a wavy look. The edges are sloped and they merge into the normal skin surrounding them.

Pimple scars caused by an excess of tissue

Sometimes during the healing process, your body will produce excess collagen in an attempt to repair the damage to itself. Not only will these scars not leave a pit, but they will actually jut out of the normal skin surrounding them and leave a bump. Scars of this type are normally divided into two categories:

• Hypertrophic pimple scars: these look like lumps or bumps, as if something was trapped under your skin.

• Keloids: a keloid is a greatly exaggerated healing response, and is usually far out of proportion to the level of the injury and experienced.

If you’re darker skinned like me, you’re much more likely to get these kinds of scars. They also have a genetic component – if mom or dad had these, you’re much more likely to get them as well. Although they can diminish or fade over time, these acne scars can last for years. They are difficult to work with and completely eliminating them is a hopeless task. To add to the punishment, often the scars return after treatment.

Often the first course of treatment for keloids and hypertrophic scars is cortisone injections straight into this scar. Sometimes this will help to shrink the thickened tissue so that it more completely blends with surrounding normal skin. Surgery is a last resort here, because if you have a tendency to form these kinds of scars from acne damage, you may form a larger scar from surgery.

Pretty much the only pimple scars treatment that has a chance of alleviating the suffering from these would be certain kinds of lasers. Long-term studies are underway to determine how effective these may be.

Regardless of what you’ve been doing to treat your acne itself, don’t expect it to have much effect on the scarring the results from your pimples. But don’t despair yet –you may have to go beyond what your dermatologist can offer, and see a plastic surgeon, but you do have choices here. You are going to have to take a number of things into account though when deciding what course of treatment will be best for you:

• How bad is your scarring? Is it disfiguring or simply a minor annoyance?

• How big of an effect does it have on your life? Does it impact your social or romantic life?

• How much are you willing to spend to diminish or eliminate your scarring? More important, how much do you have to spend?

• What kind of scars do you have, and what are the chances of a successful outcome?

• What about your personal situation – age, health and medical history?

• Maybe you should ask your doctor what she thinks? If you are not satisfied with the answer, don’t be afraid to seek a second opinion.

Just know going in that this is a difficult condition, and you’re probably going to end up participating in multiple courses of treatment and using multiple techniques. It can become very expensive.

Number one on the hit list is not to do anything until you’re absolutely sure your acne is absolutely eradicated and, in the opinion of your Physician, not returning. There is absolutely no point in going through all of the trouble and expense of getting your pimple scars removed if you’re simply going to get more acne, and more scars, and have to do it all again.

Maybe the only good thing about acne scars is that there are a fairly wide variety of techniques and treatments that you can use in your quest to eliminate them.

In the last two decades we’ve seen a number of the innovative procedures, such as skin surfacing remodeling, dermabrasion, surgical removal and surgical treatments used to reduce or eliminate pimple scarring. Each of these techniques has its own group of supporters proclaiming that this is how to remove pimple scars. Unfortunately, results can best be described as ambiguous and are hugely dependent upon your personal situation.

Up until the last few years some practitioners were using chemical peels to try and get rid of the acne scars or discoloration on facial skin. Unfortunately the results have been less than satisfactory, and this has been relegated for the most part to the dustbin of medical history.

The single most promising technique developed recently is the use of lasers which we will discuss in detail now:

Laser skin resurfacing – removing scars with light

There are several different kinds of lasers out there now, and they are used in a number of ways to both help with the acne outbreaks themselves, and to improve the appearance of the resultant scarring.

Laser treatments normally take place on an outpatient basis in your dermatologist’s office. Anywhere from 3 to 5 sessions may be required, and the price can be as much as $10,000.

Sometimes your provider will want to combine laser and surgery. If this is the case, he will usually perform the surgery first to give your skin time to heal before proceeding with the laser treatment.

• Ablative lasers

These lasers actually burn away the outer layers of your skin, including any scar tissue. They will also stimulate your dermis to produce collagen, causing it to tighten and reduce the fibrous bands of your scars. We should note here that this procedure should be considered invasive, and can cause scars all on its own. Because you have actually removed the outer layers of skin you have to be extremely careful to prevent infection and take proper care of your skin. To add insult to injury, your skin could be reddish for months after the procedure.

• Non-Ablative Lasers

These are the latest and the greatest. Non-Ablative lasers are able to promote new tissue growth beneath the epidermis without creating a wound. The machine penetrates into the dermis, or layer of tissue underneath your skin and promotes collagen growth. This can be very effective for treating boxcar scars, and for smoothing and tightening other scars that have been previously treated. It is not effective for deep scarring.

Non-Ablative lasers are a subcategory of lasers with its own members. These include:

• N –lite lasers: primarily used to encourage collagen growth

• Infrared lasers: normally used for remodeling and tightening the dermis, underneath the outer layer of skin

• Sprinkling laser beams (frac ceo laser): set of shooting a single beam of light, this machine produces a pattern of dots. This leaves areas of existing skin in between the treated areas and theoretically allows for much faster healing. Patient pain and discomfort is also greatly reduced.

Scars which have left a hole or depression in your skin can be removed or improved by a technique called an excision. When excising scars, your Physician will cut the scar out of your skin completely, down to the layer of subcutaneous fat. The resulting hole can either be filled in with a skin graft, or simply closed with stitches. Excision techniques include:

• Punch excision: Your dermatologist has a tool similar to a hole punch that simply removes the small portion of scored tissue. He then sutures the hole closed.

• Punch replacing: Again, the scar is removed but this time your Physician will have a piece of fresh skin from elsewhere on your body to fill the hole.

• Punch elevation: In this technique, the scar is punched out but then it is moved up to match the level of the surrounding skin.

Depending on what is done, and the amount and type of the aftercare needed, these procedures can run anywhere from $100 to several $1000 dollars.

Subcising acne scars

Subcision is a technique where the fibrous tissue creating tension between the surface skin and the dermis is broken down. It also helps to encourage the growth of collagen. This can be useful for hill and valley scars that are a result of the underlying scar tissue remodeling the surface skin. This is a very delicate procedure and should only be performed by highly qualified professionals. Make no doubt about it, this is true surgery and a scalpel or sharpened needle will be used to lift scar tissue away from skin, creating a wound. The hope is that once the infusions are broken apart the healing process will create more elastic and smoother skin.

Tissue augmentation

In this procedure a number of different materials, ranging from synthetic to your body’s own fat are ejected into depressed scar areas. The goal here is to bring the depressed area up to the level of the skin surrounding it. Normally, this procedure is only used as an add on after other treatments have been tried. It does not provide a satisfactory appearance, unless the scars have soft rounded edges. This will not be the direction you want to go if you have ice pick scarring.

Dermabrasion

As you might have gathered from the name, dermabrasion essentially sandpapers off the scars, along with the top layer of skin. In fact, in the olden times it was actually sandpaper that was used perform the procedure. Certain types of scars may actually become more prominent if the scarring is worse under the outer layer of skin and that it is on the surface. Many dermatologists no longer perform dermabrasion especially on darker skinned patients, as it can actually worsen hypertrophic scarring or keloids.

Micro-dermabrasion

In this procedure, aluminum oxide crystals are blasted on to your face and then vacuumed away along with the resultant dislocated skin. This is a very gentle surface only treatment, and its primary use is in reducing the lines around the eyes and age spots. It is not particularly effective for acne scar treatment.

And there you have it. As you can see you have any number of effective (and some not so effective) arrows in your quiver for getting rid of your pimple scars. If all of these seem too invasive or expensive two you, you may want to start by looking at some of the acne scar creams available on the open market, or other home remedies for pimple scars.

In a future article, I will cover these in depth, as well as more exotic natural healing methods.