Fig.1 Facial acne scars
Chemical peeling
Chemical peeling causes injury to the superficial layers of the skin and believed to induce new collagen to form in deeper layers. Alpha-hydroxy acid (AHA) peels may help improve very superficial scars slightly. Treatment is easily tolerated and causes minimal disruption to the patient's work schedule. However, multiple treatments are needed. Deep scars do not improve with chemical peeling.
Laser Resurfacing
Laser resurfacing of the skin is a new treatment for acne scars. There are several laser systems available to re-surface the skin in a controlled manner. The skin heals and repairs itself with some clearance of the scars. In suitable patients, up to 40% improvement may be expected from a single laser treatment. However, there is risk of complications such as prolonged redness, pigmentation and infections. It takes several weeks to recover from the surgery. It is generally much more effective than chemical peels for the treatment of acne scars.
Dermabrasion
Dermabrasion is an older technique for skin resurfacing but the principle is similar to that of laser resurfacing using mechanical sanding to re-surface the skin. It involves a certain degree of blood loss and requires greater skill on the part of the surgeon.
Scar Revision
Very deep, depressed scars will necessitate excision (cutting) and stitching to correct the defect. Elevated scars (keloids) can be flattened by injecting small doses of steroids into the keloids (Fig 2).
Fig.2 Hypertrophic scars