Chicken pox, caused by the varicella-zoster virus, often leaves visible reminders on the skin. These facial scars frequently manifest as small depressions or “holes,” which can be a source of long-term self-consciousness. Scar revision aims to elevate the depressed tissue and smooth the skin’s surface, and this article explores the options available, from topical treatments to advanced clinical procedures.
Understanding Atrophic Chicken Pox Scars
The indentations left by the varicella virus are classified as atrophic scars, meaning they form below the surrounding skin tissue. This depression occurs due to a localized loss of collagen and subcutaneous fat following the inflammation caused by the chicken pox lesion. The body fails to produce sufficient collagen to fully reconstruct the damaged dermal layer during the repair process. Chicken pox scars typically present as two types: ice pick scars, which are narrow, V-shaped indentations; and boxcar scars, which are wider, round depressions with sharply defined, vertical edges.
Topical and At-Home Scar Management
Initial attempts to improve minor scarring often involve over-the-counter topical treatments and at-home care. Silicone gels and sheets are recommended non-invasive options, working by creating a semi-occlusive layer over the scar. This barrier helps hydrate the skin and regulate collagen production, which softens scar tissue and minimizes redness over time. Products containing onion extract are also used, but these topical methods are primarily suited for improving surface texture and color, not filling deep atrophic scars. Mild exfoliation using alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs) can also help by promoting cell turnover, making shallow scars less noticeable.
Advanced Clinical Scar Revision Procedures
For deep, long-standing atrophic chicken pox scars, professional dermatological procedures are necessary to achieve meaningful correction. These clinical methods are designed to either resurface the skin or stimulate new collagen production within the scar depression. The choice of procedure depends on the scar type, its depth, and the patient’s skin type.
Laser Resurfacing
Laser resurfacing uses focused light energy to improve skin texture and stimulate new tissue growth. Ablative lasers, such as Carbon Dioxide (\(\text{CO}_2\)) or Erbium (\(\text{Er:YAG}\)) lasers, vaporize the outermost layers of the skin, forcing the body to produce a new, smoother surface. This method offers the most dramatic results but requires significant downtime, often ranging from one to three weeks. Non-ablative or fractional lasers target the deeper dermis without removing the surface layer, leading to less downtime but requiring more treatment sessions.
Microneedling
Microneedling, also known as Collagen Induction Therapy (CIT), involves using a device with fine needles to create controlled micro-injuries in the skin. This process triggers the body’s natural wound-healing response, stimulating the production of new collagen and elastin beneath the scar. For enhanced results, the procedure can be combined with Radiofrequency (RF) energy, where the needles deliver heat into the dermis, further tightening tissue and boosting collagen synthesis.
Chemical Peels (Deep Peels)
Concentrated chemical peels can be used to treat specific, localized depressions, though superficial peels are not effective for deep atrophic scars. The Trichloroacetic Acid (TCA) CROSS technique involves applying a high concentration of TCA directly into the base of deep ice pick or boxcar scars. This controlled chemical burn causes localized inflammation and subsequent collagen remodeling, which helps to elevate the depression.
Dermal Fillers
Dermal fillers, often composed of hyaluronic acid, provide an immediate, temporary solution by lifting depressed scars to the level of the surrounding skin. A small amount of filler is injected directly beneath the atrophic scar to restore lost volume. This method is effective for boxcar scars and can also stimulate the skin’s own fibroblasts to produce collagen. Since the filler material is eventually metabolized by the body, treatment must be repeated, usually every six to eighteen months, to maintain the correction.
Subcision
Subcision is a technique designed to treat tethered or “pulled-down” scars, which are common with long-standing chicken pox marks. The procedure involves inserting a needle horizontally beneath the scar to mechanically break the fibrous bands that anchor the scar tissue to the underlying fat. Releasing these tethers allows the skin to rise, and the resulting blood clot under the scar encourages the formation of new connective tissue to hold the scar in its elevated position.
Managing Expectations and Long-Term Skin Care
It is important to approach scar revision with the understanding that the goal is significant reduction and improvement, not complete elimination of the scar. Most atrophic scars can be made substantially less noticeable, but results from collagen-stimulating procedures are not immediate, often taking several months to fully develop. Long-term skin maintenance is a necessary part of the scar revision process, especially following any resurfacing treatment. Strict sun protection is mandatory, as ultraviolet (UV) radiation can cause treated skin to hyperpigment, leading to dark marks. Consulting a board-certified dermatologist is the best first step to creating a personalized treatment plan that addresses the specific characteristics of your scars.