Atrophic scars, depressions in the skin, result from various conditions or injuries, leading to uneven texture. This article explores professional treatments and how they improve skin appearance.
What Are Atrophic Scars?
Atrophic scars are characterized by their sunken or depressed appearance, forming below the surrounding skin surface. They develop when the skin’s healing process after an injury or inflammation involves insufficient production of collagen or loss of underlying tissue.
Common types include icepick scars, which are deep and narrow, resembling a puncture mark. Boxcar scars are wider with defined, angular edges, similar to chickenpox scars. Rolling scars create a wave-like or undulating appearance due to tethering of the skin to the subcutaneous tissue.
Professional Treatment Approaches
Professional treatments for atrophic scars aim to stimulate collagen production, resurface the skin, or add volume to depressed areas. Laser resurfacing techniques utilize concentrated light beams to improve skin texture and tone. Ablative lasers, such as CO2 or Erbium:YAG, vaporize the outer layers of damaged skin, stimulating new collagen formation as the skin heals. Non-ablative lasers, in contrast, heat the underlying skin tissue without removing the surface, promoting collagen remodeling with less downtime.
Microneedling involves using a device with fine needles to create controlled micro-injuries in the skin. These tiny punctures stimulate the body’s natural wound healing process, leading to the production of new collagen and elastin. When combined with radiofrequency (RF) energy, the needles deliver heat into the deeper layers of the skin, enhancing collagen contraction and further stimulating its synthesis. This dual action can lead to more significant improvements in scar depth and texture.
Chemical peels involve applying a chemical solution to the skin, which exfoliates the outer layers and promotes cellular turnover. For atrophic scars, medium to deep peels, often containing trichloroacetic acid (TCA), are used to encourage collagen regeneration and improve skin texture. The controlled removal of damaged skin layers allows healthier, smoother skin to emerge.
Dermal fillers are injectable substances used to add volume beneath depressed scars, lifting them to the level of the surrounding skin. Common fillers include hyaluronic acid, which temporarily plumps the skin and can also stimulate some collagen production. Other options include poly-L-lactic acid or calcium hydroxylapatite, which provide longer-lasting results by encouraging the body’s own collagen synthesis over time. This approach is particularly effective for rolling scars that have significant volume loss.
Subcision is a procedure where a needle is inserted under the scar to break up fibrous bands that pull the skin downwards. These bands, often formed during the healing process, contribute to the depressed appearance of rolling and some boxcar scars. By releasing these tethers, the skin can rise, and the resulting space fills with new collagen and blood, improving the scar’s contour.
Punch excision involves surgically removing individual icepick or small boxcar scars. The resulting small wound is then either sutured closed. This method directly removes atrophic scars.
Important Considerations for Treatment
Consulting with a qualified dermatologist or plastic surgeon is an important first step when considering treatment for atrophic scars. These specialists can accurately assess the type and severity of scars, recommending the most appropriate treatment plan tailored to individual needs.
While professional treatments can significantly improve the appearance of atrophic scars, complete removal is often not achievable. The goal is to achieve a noticeable improvement in texture and depth, making the scars less prominent. Patients should anticipate that multiple treatment sessions will likely be necessary to achieve desired outcomes, due to gradual collagen regeneration and skin remodeling.
Potential side effects vary depending on the treatment but can include temporary redness, swelling, bruising, or discomfort. Downtime also differs greatly between procedures. Patients should discuss these aspects with their provider. Costs vary widely based on the chosen procedure, number of sessions, and practitioner’s fees. Post-treatment care, such as sun protection and proper wound care, is also important for optimizing results and minimizing complications.