The #1 Doctor Recommended Scar Gel.
THE DEFINITIVE GUIDE TO ACNE SCAR TREATMENT & REMOVAL
By Dr. Aarons
Acne alone is difficult, but the resulting scars created by acne can be downright frustrating. Accepting and loving yourself for who you are is critical to mental health, but with today's advances in medical technology there's no reason you have to live with acne scars.
Many people are under the misguided impression that acne scar treatment needs to be expensive and complicated. They look at the high cost of laser scar removal or scar revision surgery and decide that treatment is out of their budget.
That may have been the case in the past, but it isn't the reality that we live in today.
Our goal with this guide is to give you an understanding of what acne scars are, how and why they form, what the 5 different types of acne scars are, and what the best treatment option is based on your type of acne scar and your budget.
By the end of this guide you'll know which of the 5 types of acne scar you have and what the best treatment option is based on your budget. The best part? It only takes about 20 minutes to read the whole guide. If you don't have time to finish the guide right now click here and we'll email you a PDF copy.
What are acne scars?
Acne scars are typically the result of either severe breakouts or from picking at acne. Acne scarring is normal and is the result of the body's natural healing process.
How do acne scars form?
Acne lesions (pimples) occur when the pores on your skin become plugged up with dead skin cells or oil. When a breakout of acne penetrates the skin too deeply it can damage the tissues beneath the surface, which leads to an initial injury.
When that injury occurs the body releases collagen to the wound site as part of its normal healing process. The amount of collagen released typically determines the type of scar that is formed.
Too much collagen forms a hypertrophic (raised) acne scar, and too little forms an atrophic (sunken) acne scar. If the perfect amount of collagen is released you wouldn't typically experience any noticeable scaring unless the skin's tissue is damaged.
What type of acne leads to scarring?
Typically the more severe your acne, the more likely you are to be left with acne scars. Picking at your acne can also increase the likelihood that scarring will occur.
Can acne scars be removed?
Yes! And you should ignore the rumors that you have to wait until your acne clears up to begin treating your scars. If you're worried about causing more acne there are options such as silicone scar gel that are specifically designed to treat acne scars without the risk of clogging pores and causing more acne.
The best way to remove acne scars is to start as soon as they appear on your skin. This prevents further scarring. Do not wait for your acne to clear up, because while you are waiting your scars may be getting worse.
What can I do right away to get rid of acne scars?
As soon as the original wound closes you should begin using SPF 30+ sunscreen and silicone scar gel to jump-start the treatment process.
The sun is the main cause of scar hyperpigmentation (dark spots). That's the discoloration you'll notice in acne scars. Using SPF 30+ sunscreen from day 1 is the best way to protect against hyperpigmentation. Even if your acne scars are 1+ years old you should start using sunscreen right away.
The end-goal for removing any type of acne scar is to smooth out the skin's surface. This is called resurfacing, and it is the first step in the acne scar removal process. Even if you plan to use an expensive, invasive procedure like laser surgery you should still start off using a medical-grade silicone scar gel to kickstart the resurfacing process.
Medical-grade silicone scar gel will hydrate the scar tissue and help restore normal collagen levels to the scarring (abnormal collagen levels is what causes scarring). When applied to your skin the bio-adhesive gel creates an invisible, protective outer shell while working beneath the surface to diminish your scar's appearance and restore skin to a more natural texture and color.
Using both of these methods immediately will significantly reduce the severity and noticeability of the scar, and may even remove it entirely. The sooner you do this the better the results will be.
The 5 Types of Acne Scars
Knowing your acne scar type is critical to creating an effective treatment plan. Why? Because not knowing your type (or getting it wrong) can point you in the direction of products & clinical treatments that do more harm than good. Don't worry though - this guide will walk you through identifying your acne scar type.
So what are the different types of acne scars? Every article I've read on the web seems confused about this. Let's clear it up - and then clear up those scars. There are only five types of acne scars. When I say "types" I actually mean sub-types. The 5 types are split into three categories, shown here:
ACNE SCAR TYPES
- Atrophic (Depressed Scars): This category is split into three different sub-types: Boxcar, Ice Pick, & Rolling.
- Hypertrophic Scars (Raised Scars): There are two sub-types of hypertrophic acne scars: normal hypertrophic scars and keloids.
- Dark Spots (Hyperpigmentation): Despite common misconceptions, these are not technically scars - but I include an overview and treatment options in this section to be thorough.
So the 5 Types of Acne Scars are:
- Atrophic Boxcar Acne Scars
- Atrophic Ice Pick Acne Scars
- Atrophic Rolling Acne Scars
- Hypertrophic Acne Scars
- Keloid Acne Scars
- Dark Spots / Hyperpigmentation
A dark spot (hyperpigmentation) is not a type of scar, which is why I don't mark it as the 6th type. However, we still regularly treat dark spots at our clinic, so we'll cover the topic thoroughly at the end of this guide.
That’s it! We're going to go into more detail about each acne scar type and the best treatment method for that type below.
Identifying Your Acne Scar Type
So how do you know which scar type you have?
Let's start off with an easy question: Is the scar raised above your skin, or sunken below your skin? In other words, is it more of a bump - or a pit?
For sunken/pitted scars (below your normal skin level) start in the atrophic scar section.
For raised scars (above your normal skin level) start at the Hypertrophic & Keloid Scar Section.
Do neither of those fit the description? If not, try heading down to the chapter on dark spots & hyperpigmentation.
At the beginning of each chapter I include detailed descriptions and images of that specific scar type, along with some common FAQs. Use this information and the images to confirm whether or not that's your scar type and continue on from there!
If you don't have time to finish the guide right now click here and we'll email you a PDF copy.
If you are having trouble identifying your scar type just send us an email about your situation to info@tryvanish.com. We'll do our best to point you in the right direction.
What is the best acne scar treatment?
There are many different options for acne scar treatment. These treatments aim at reducing the appearance of the scars, making them less noticeable.
The important thing to remember is that the treatment that is right for you depends on your scar type, skin type, and budget. Make sure you know your acne scar type before creating your own treatment plan.
Below you'll see a detailed description and images for every type of acne scar, as well as the most frequently recommended treatment options for that acne scar type. I try to include price ranges for the treatments whenever possible.
If you don't have time to finish the guide right now click here and we'll email you a PDF copy.
If you have any questions about acne scars post them in the comment section below. We'll do our best to provide helpful information in a timely manner.
Let's get started with our first type!
ATROPHIC ACNE SCARS
Atrophic (depressed) acne scars are most frequently found on the face. The scar sits below the surrounding skin, which is why it is commonly referred to as a depressed scar. The word "depressed" here means "below the surface", and is not referring to the common psychological term "depression".
Atrophic acne scars are formed when the body produces too little collagen during the original wound’s natural healing process. There are three types of atrophic acne scars - each is shown below, along with the commonly recommended phase 1 & 2 treatment options.
1. Boxcar Scars
Boxcar atrophic scars are broad, u-shaped, sharp-edged scars. Their depth can vary from shallow to deep. The shallower a boxcar acne scar is, the easier it is to treat. Like all other atrophic scars, boxcar acne scars follow a two-step treatment process discussed below.
2. Ice Pick Scars
The Ice Pick type of acne scar takes on a narrow, V-shaped appearance and is typically the deepest below the surface. Their appearance is similar to small round/oval holes, much like the scars you would get from chickenpox. Because ice pick scars extend deep into the skin they are normally the most difficult type of acne scar to treat.
3. Rolling Scars
Rolling acne scars are typically the most common. They are depressions in the skin that typically measure a few millimeters across. They're referred to as "rolling" because of the sloping edges, which gives the skin a wavy, uneven appearance. Rolling acne scars are not always the same size as the original acne that caused them.
Still not sure what your atrophic acne scar type is?
Take a look at the image below, it should help you identify which of the three atrophic acne scar types you have:
- On the far left you can see rolling acne scars that have broad depressions and sloping edges that give a rolling or undulating appearance to the skin.
- The middle image below shows ice pick acne scars. These are deeper than they are wide, and are narrow & deeply pitted.
- On the right are boxcar acne scars. They are wider than they are deep with sharply defined edges.
If you still can't figure it out don't worry - the treatment options and treatment plans for all atrophic acne scar types are generally the same. We'll go through the best treatment options below.
Best Atrophic Acne Scar Treatments
The treatment for atrophic acne scars - including boxcar, ice pick, and rolling scars - is the same regardless of the scar's sub-type. During treatment keep in mind that the deeper your scar is the longer it will take for any treatment to show results.
The most commonly recommended atrophic acne scar treatment plan is split into two phases.
"Phase 1" is the resurfacing phase. The primary objective of phase 1 is to reduce the depth of the scar and even out the skin's surface. The length of time this phase takes varies by the depth of the atrophic scar. The deeper the scar, the longer it will take to even out the skin's surface. Clinical studies show that starting early with medical-grade silicone can help reduce the length of phase 1.
"Phase 2" in the treatment of atrophic acne scars is to reduce any discoloration. The length of this phase varies based on each individual's skin type, ethnicity, age, and other common differentiating factors. In other words - it's different for everyone.
You can click on some of the treatment options shown below to see our recommended providers.
Phase 1 Treatment Options
1. Medical-Grade Silicone Scar Gel
Hydrates the scar tissue and helps restore normal collagen levels to raise the atrophic scar back to the surface. When applied to your skin the bio-adhesive gel creates an invisible, protective outer shell while working beneath the surface to restore natural collagen levels. Silicone Scar Gel is effective for both shallow and deep acne scars, and is the most cost-effective phase 1 treatment method.
2. Chemical Peels
Chemical peels are a common treatment method for atrophic acne scars. The chemical solution used during a the treatment destroys the top layer of damaged skin, causing that layer to peel off. This brings a fresh, new layer of skin to the surface. This method is typically only effective for shallow atrophic acne scars, and isn't normally safe for sensitive skin. Talk to your dermatologist before trying a chemical peel.
3. Dermabrasion
The tools used during a dermabrasion or micro-dermabrasion session will sand down the top layers of your skin. This can help make boxcar scars more shallow, but the treatment usually requires multiple visits to a dermatologist, is ineffective against deeper scarring, and is not safe for sensitive skin types.
4. Dermal Fillers
Dermal fillers are a common treatment for deeper atrophic acne scars such as ice picks. A dermal filler is the injection of a substance that improves the appearance of the skin and evens out the skin's surface. Dermal fillers are a temporary solution because they do not help with the collagen deficiency that caused the atrophic scarring. It's important to talk with a dermatologist before deciding if dermal fillers are the right option for you.
5. Laser Scar Surgery
There are two types of laser therapy for scars. The first is known as Ablative Laser Therapy. This process uses high-energy light to remove outer skin layers and stimulate collagen growth. The second is Nonablative laser therapy, which uses heat to encourage collagen production in the inner layers of skin. Both methods are effective for the resurfacing of both shallow and deep atrophic acne scars, but the high cost of laser therapy removes it as an option for most patients. Silicone Scar Gel is a great supplicant to laser surgery and will improve your results over the long-term.
6. Microneedling
This process uses needles to create tiny injuries across the surface area of the scar. This forms small, pocket-like wounds where the body naturally produces more collagen. Atrophic scars are formed due to a lack of collagen, so naturally producing more may effectively heal the scar over time. This process is effective for both deep and shallow acne scars, but generally takes a longer period of time to show results than the other methods on this list.
7. Punch Excision
This is a more invasive procedure which involves cutting the scar tissue out of your skin and then pulling & stitching together the skin. It is only recommended for severe cases with exceptionally deep scarring and must be done by a licensed and experienced professional. It is commonly recommended to start with an over-the-counter option like silicone scar gel before considering an invasive surgery such as punch excision.
8. Punch Grafting
Similar to punch excision, but goes one step further. Instead of just stitching the area back together your doctor will remove healthy skin from another part of your body and place it where the scar tissue used to be. They'll then sew the area back up. Again, this is an invasive surgery and is only recommended for severe cases.
9. Subcision
During this process the scar tissue is broken up, which will cause it to be raised up to the skin's normal level (or near it) instead of continuing to be pulled down. This is an invasive operation. You should talk with your dermatologist about whether subcision is the right option for you.
10. Chemical Reconstruction
Also known as TCA Cross, the application of trichloroacetic acid (TCA) onto the scar will help form extra collagen and may help raise the scar up to surface level. This is a somewhat dangerous process that could result in skin damage - especially for those with sensitive skin. The image on the left shows facial skin during an in-process chemical reconstruction. It's commonly recommended to start with a medical-grade silicone gel before attempting something as aggressive as chemical reconstruction.
Phase 2: Reducing Atrophic Scar Discoloration
After the resurfacing of the scar is completed in phase 1, it's time to move on to the second phase of atrophic acne scar treatment.
The goal of phase 2 is to reduce discoloration. We hate to sound like a broken record, but clinical studies show that using SPF 30+ sunscreen and silicone scar gel before and during phase 1 can drastically shorten phase 2 - so make sure that's a part of your treatment plan.
You'll notice that there is overlap in the phase 1 & 2 treatment options for atrophic acne scars. This is not a mistake.
Phase 2 Treatment Options
1. Chemical Peels
As we mentioned above, chemical peels are a common treatment method for atrophic acne scars. The chemical solution used during a the treatment destroys the top layer of damaged skin, causing that layer to peel off. This brings a fresh, new layer of skin to the surface. This method is typically only effective for shallow atrophic acne scars, and isn't normally safe for sensitive skin. Talk to your dermatologist before trying a chemical peel.
2. Laser Therapy
As I mentioned above, there are two types of laser therapy for scars. The first is known as Ablative Laser Therapy. This process uses high-energy light to remove outer skin layers and stimulate collagen growth. The second is Nonablative laser therapy, which uses heat to encourage collagen production in the inner layers of skin. Both methods are effective for the resurfacing of both shallow and deep atrophic acne scars, but the high cost of laser therapy removes it as an option for most patients. Silicone Scar Gel is a great supplicant to laser surgery and will improve your results over the long-term.
3. Sunscreen
The best way to reduce atrophic acne scar discoloration is to prevent it from happening. Using SPF 30+ sunscreen daily is the best way to protect against hyperpigmentation (discoloration). You should be using sunscreen during phase 1 of your atrophic acne scar treatment plan as well.
What's the best atrophic acne scar treatment plan?
If possible, you should always involve your doctor or dermatologist in any conversation about scar treatment plans. That being said, the best way to remove your atrophic acne scar depends on your skin type (sensitivity) and budget.
But regardless of your budget you should begin using medical-grade silicone scar gel and SPF 30+ sunscreen right away. They are the first step in the recovery process for atrophic acne scars. The longer you wait to start using these products the more difficult treatment will become, and the longer it will take.
Thinking of jumping right to a more invasive option? Laser Surgery and Scar Revision surgery are very effective, but can also be very painful and expensive.
In severe cases I sometimes recommends that patients skip using topical scar creams in phase 1 and go directly to surgery, but these surgeries can be costly and painful. How much more more does it really cost?
It is typically 1,800% (18x) more expensive to complete phase 1 of atrophic scar removal using laser surgery or scar revision surgery than it is using a silicone scar gel.
Here's how the average prices compare
- Laser Surgery: ~$2,700
- Scar Revision Surgery: ~$4,000
- 6 months of silicone scar gel: <$180
Because of the massive price difference and the fact that the results are most often the same we normally recommend that patients begin phase 1 of their atrophic acne scar treatment plan using silicone scar gel. If after 3-6 months the results aren't satisfactory, it's then time to explore the possibility of surgery.
For us it's a no-brainer... don't waste money jumping to surgery when you can finish all of phase 1 with a significantly cheaper, less invasive solution.
If you're sure that you have an atrophic scar don't just keep reading - you should skip the next two chapters. Click here to jump to the end of this guide.
If you have any questions about atrophic acne scars comment below and we’ll get back to you with some helpful tips!
HYPERTROPHIC & KELOID ACNE SCARS
Hypertrophic acne scars are generally wide, thick, elevated scars that form on the skin region that has suffered from acne. While atrophic acne scars sit below the surface of the skin, hypertrophic acne scars are raised above the skin's normal surface level.
There are two main types of hypertrophic acne scars: Normal Hypertrophic Scars & Keloid Scars. The treatment methods are typically the same, but it's important to understand which type you have because keloids are significantly more destructive.
How are hypertrophic scars different from keloid scars?
Hypertrophic scars have similarities to keloid scars but are much milder and are different than keloid scars because, unlike keloids, hypetrophic acne scars do not continue to grow and expand beyond the scar’s original boundaries. That's right - keloid acne scars actually grow. They're the only scar type that does this. Keloid acne scars are typically more painful than hypertrophic acne scars as well.
Below is a comparison image of a keloid scar (left) next to a hypertrophic scar (right). You can see that the keloid scar is bulging out and growing, while the hypertrophic scar is simply raised above the skin's surface level. Keloid scars are also typically darker than hypertrophic scars.
What is the best treatment option for hypertrophic acne scars?
Unlike atrophic acne scars, there is only one phase for hypertrophic acne scar treatment. The goal of this single phase is to flatten the scar back to your skin's normal level while simultaneously removing any discoloration.
There are many options for hypertrophic acne scar treatment, ranging from professional to at-home remedies.
A full treatment plan should include the use of multiple different treatment methods. One of our most commonly recommended hypertrophic acne scar treatment plans is listed below as an "example plan".
Example Treatment Plan: Use SPF 30+ sunscreen and silicone scar gel for 3-6 months. If results aren't satisfactory after 6 months of treatment proceed to laser scar therapy .
When it comes to professional treatments such as laser therapy and surgical removal, it's important to know that most doctors won’t use clinical treatments on early stage hypertrophic scars. You will have to wait until the scar matures for any clinical treatment to commence, which can take up to a year.
However, as soon as the original wound closes you can begin using SPF 30+ sunscreen and silicone scar gel to jump-start the removal process.
Using both of these methods immediately will significantly reduce the severity and noticeability of the scar, and can even remove it entirely.
Below are the top recommended at-home treatment options for hypertrophic acne scars, followed by the top recommended clinical treatment options.
At-Home Hypertrophic Acne Scar Treatments
We define a “home treatment” for hypertrophic scarring as anything you are able to do without a professional consultation with a doctor or dermatologist. These treatment methods are often less invasive, less expensive, and equally as effective as clinical scar treatments. It is commonly recommended that you start with 3-6 months of one or more of the options below (along with SPF 30+ sunscreen) when attempting to remove or improve the appearance of a hypertrophic acne scar.
1. Silicone Scar Gel
Medical grade silicone scar gel has been the #1 doctor & dermatologist recommended scar treatment for over 16 years. It is highly recommended to begin using a medical-grade silicone scar gel as soon as your scar has healed.
In other words, it’s commonly recommended to switch directly from Neosporin to using silicone gel once the wound has closed. This helps prevent scarring and discoloration, and can decrease the total scar removal time by more than half if used immediately. For the best possible results the gel should be applied 2-3 times daily and rubbed into your skin using the pressure & massage technique discussed below.
Silicone gel therapy is the only over-the-counter scar treatment that has undergone extensive clinical testing and been shown to vastly improve the appearance of both old & new hypertrophic scars. It’s the first line of defense against scars, and normally the most effective & affordable treatment option for hypertrophic scars.
2. Silicone Scar Sheets
Silicone elastomer sheets are often regarded as an alternative first response treatment to medical-grade silicone scar gel. These sheets can be applied right after an injury. They are available over the counter (OTC) and are effective alternative to silicone scar gel.
Wait... before we continue with the list, what's the difference between silicone gel and sheets? What should you choose?
Both scar sheets and scar gel are applied directly over an injury and must remain there continuously for 12-24 hours per day for a duration of 3-9 months.
There is no clinical data showing any difference in scar treatment times when comparing the effectiveness of scar sheets and medical-grade silicone scar gel. They both work in the exact same way.
But while scar sheets must be removed & then re-applied while showering or in the water, scar gels can be used multiple times per day and are easy to re-apply after water contact.
The main problem reported with silicone scar sheets is that the bandage-like adhesive used to attach them is often ineffective, so the sheets have to be constantly replaced.
Since a pack of 4 costs an average of $30 and each sheet only has enough adhesive for 2-3 days (less if you are removing the sheets to shower) the total treatment cost is over $120/month. That’s over 4x the average cost of silicone scar gel therapy.
Let's get back to the list of at-home scar treatment options.
3. Onion Extract Creams
Another over the counter approach to hypertrophic acne scar treatment is using a topical gel made of onion extract. However, keep in mind that onion extract scar creams (such as Mederma and Mederma PM) can irritate sensitive skin and have been clinically shown to be less effective than silicone scar gel. While onion extract based scar creams may not be as effective as clinical or other OTC treatments, they are still an option. Just keep in mind that there is still limited clinical data about the efficacy of these creams in enhancing the appearance of hypertrophic scars.
4. Scar Massage Therapy
Perhaps the most inexpensive hypertrophic acne scar treatment (absolutely free) is massaging the scar area. Applying pressure to a hypertrophic scar over time can flatten out the scar, making it less noticeable. Massage should be done for 3-5 minutes using a circular motion. It is often recommended to make a habit of massaging the scar area when applying your scar gel. Multiple clinical studies have shown that massage is an effective scar treatment method when combined with medical-grade silicone scar gel.
5. Scar Pressure Therapy
Pressure (different than massage) can be applied using bandages or tape; how long the pressure should be exerted is at the discretion of the individual. This often isn't the best option for facial hypertrophic acne scars because the bandages are visible. Theoretically the scar tissue would be weakened and become less noticeable over time, but there is currently no clinical data showing that pressure is an effective scar treatment. While this is definitely the cheapest way to "treat" hypertrophic scars, it is also the least effective if not used in combination with another treatment method such as silicone gel.
6. Bio-Oil for Scar Treatment
Bio-Oil is a widely-available product you could grab at almost any beauty supply store. While many people use Bio-Oil on their scars clinical trials have not been able to prove any efficacy in the treatment. It is possible that bio oil is a scar treatment myth. Our team at Vanish is currently conducting a full clinical study to determine the efficacy of Bio-Oil as a scar treatment method.
WARNING: Our patients have reported increases in breakouts when using bio-oil for acne scars.
What is the best at-home hypertrophic acne scar treatment?
In almost every case we recommend starting with 3-6 months of SPF 30+ sunscreen and a medical-grade silicone scar gel as soon as possible. If your scars persist after that point it's then time to explore clinical treatment options.
Our team here at Vanish is also available to answer your scar related questions. Either post your question in the comment section below or email us at info@tryvanish.com and we'll do our best to help.
Now let's move on to the clinical treatments that are only available through doctors & dermatologists.
Clinical Hypertrophic Acne Scar Treatments
We define clinical treatments as those that only available through a doctor or dermatologist. Our research has found that clinical treatments are often unnecessarily invasive in the treatment and removal of hypertrophic acne scars. In other words, most patients would have typically seen the same results (and spent less) by using an at-home treatment method.
That being said, in certain cases clinical treatments have proven to be very effective in the removal of hypertrophic scars. Here are the most common:
1. Surgical Scar Removal
This is a highly invasive procedure compared to other treatment options, and is commonly viewed as the last resort in any treatment plan. This surgery method is still a relatively new addition to the list of hypertrophic scar treatments. It involves the old school approach of cutting out the hypertrophic scar and closing it with stitches. The working principle of surgery is to re-heal the injury while simultaneously removing the tissue that originally caused the scar. It is normally recommended to try over-the-counter remedies such as silicone scar gel before attempting to remove a scar using revision surgery.
2. Laser Scar Resurfacing
Laser scar treatment is a therapy that focuses light beams on damaged areas of the body in an attempt to remove the scar tissue. Laser treatment works better for newly formed scars than it does for older ones. In this treatment, lasers flatten out elevated scars on the skin, making them less noticeable. Lasers can also lighten red and pink pigments in scars.
3. Scar Cryotherapy
Cryotherapy is a clinical procedure in which liquid nitrogen is used to flatten out a scar. In this procedure, a doctor freezes the scar and flattens it at a low temperature. It is a tried and tested approach, found to be non-toxic, safe, and successful in most applications. It is the same process commonly used for wart removal.
4. Dermabrasion Scar Treatment
Dermabrasion is a hypertrophic scar treatment technique that uses abrasive material to remove the epidermis of skin on the scar. Dermabrasion yields smoother, less pitted skin. However, its results are only temporary; thus, multiple treatments may be necessary to maintain the results.
5. Microdermabrasion Scar Treatment
Microdermabrasion, a subset of the dermabrasion technique, is also a skin resurfacing treatment technique for treating scars. Small crystals or diamond-tipped tools are used to scrub off the skin's supper scared portion to reveal the underlying smoother skin. Microdermabrasion also packs a home kit for you to execute the procedure by yourself.
6. Steroid Injections
Corticosteroid scar injections are often considered the first-line therapy in hypertrophic scar treatment. Injecting asteroid into the scar would flatten the scar, if done every six weeks.
7. Bleomycin Scar Injections
Bleomycin is a metabolite derived from a strain of soil bacteria. Bleomycin is injected directly into a hypertrophic scar to dissolve and disperse collagen concentrated at the injured area, which improves the scar's appearance. This is a relatively new approach, and there is not much data or testimonials to validate its efficacy.
Reach out to your doctor or dermatologist for more information on any clinical hypertrophic acne scar treatment.
Or ask us a question in the comments section below!
What's the best hypertrophic acne scar treatment plan?
If possible, you should always involve your doctor or dermatologist in any conversation about scar treatment plans. That being said, the best way to remove a hypertrophic acne scar depends on your skin type (sensitivity) and budget.
But regardless of your budget you should begin using medical-grade silicone scar gel and SPF 30+ sunscreen right away. They are the first step in the recovery process for hypertrophic acne scars. The longer you wait to start using these products the more difficult treatment will become, and the longer it will take.
Thinking of jumping right to a more invasive option? Laser Surgery and Scar Revision surgery are very effective, but can also be very painful and expensive.
In severe cases I sometimes recommends that patients skip using topical scar creams and go directly to surgery, but these surgeries can be costly and painful.
It is typically 1,800% (18x) more expensive to remove a hypertrophic scar using laser surgery or scar revision surgery than it is using a silicone scar gel.
Here's how the average prices compare
- Laser Surgery: ~$2,700
- Scar Revision Surgery: ~$4,000
- 6 months of silicone scar gel: <$180
Because of the massive price difference and the fact that the results are most often the same we normally recommend that patients begin their hypertrophic acne scar treatment plan using silicone scar gel. If after 3-6 months the results aren't satisfactory, it's then time to explore the possibility of surgery.
For us it's a no-brainer... don't waste money jumping to surgery when you can finish all of phase 1 with a significantly cheaper, less invasive solution.
If you're sure that you have a hypertrophic acne scar don't just keep reading - you should skip the next chapter. Click here to jump to the end of this guide.
If you have any questions about hypertrophic acne scars comment below and we’ll get back to you with some helpful tips!
DARK SPOTS & HYPERPIGMENTATION
The medical term for a dark spot is "hyperpigmentation". Dark spots are not a type of acne scar. It's just skin discoloration left behind by a zit that has cleared up.
Dark spots are normally purple, red, or brown marks and in most cases will clear up on their own after a few months. However, hyperpigmentation (dark spots) can become significantly worse if you are frequently exposed to sunlight without first applying an SPF 30+ sunscreen.
Below are three example images of what dark spots normally look like.
Dark spots VS scars
Scars form due to an abnormal amount of collagen being produced during the injury recovery process. Dark spots (also known as Post-Inflammatory Hyperpigmentation, or PIH) are left behind after mild to moderate acne breakouts. Dark spots cause the production of epidermal melanin, which slowly appears as your body naturally heals your dark spots over time.
WARNING: If you don't take care of your dark spots there is a risk that they could turn into permanent scars.
Below is a quick comparison image. On the left you can see acne scars, and on the right dark spots (hyperpigmentation).
How do you prevent dark spots from becoming scars?
Sun exposure can turn temporary skin discoloration into permanent scarring. This occurs because the "new" skin of the dark spot is more susceptible to hyperpigmentation. Using a combination of SPF 30+ sunscreen and medical-grade silicone will help prevent dark spots from becoming permanent scars. Both of these can be used during the dark spot treatment process.
How do you get rid of dark spots?
Although dark spots will normally fade on their own after a few months, not everyone wants to wait that long. Below is a list of the top at-home treatment options for dark spots.
We don't recommend pursuing clinical treatment options for dark spots unless they persist for over 6 months. But to be thorough, we'll still include a list of possible clinical treatments for dark spots (below the at-home treatment section).
Here are our top recommendations.
At-Home Dark Spot (Hyperpigmentation) Treatments
1. Vitamin C Serum
Vitamin C Serum is the most common and least invasive option for fading dark spots. It acts as a chemical exfoliant, which removes discolored skin over time. The serum also includes antioxidant properties that aid in your skin's natural regeneration process, which will help your body replace the discolored skin cells with healthy, even-toned cells.
2. Hydroquinone Creams & Serums
If your dark spots are more severe you might want to opt for a hydroquinone cream or serum. This chemical compound interacts with the melanin-producing cells of the skin, causing a decrease in the production of pigment. While this cream is effective, there are multiple negative side effects that you should make sure you're fully aware of before using it. I recommend speaking with your dermatologist before using hydroquinone creams.
3. Kojic Acid
Kojic acid acts similar to hydroquinone, inhibiting the production of excess pigment. This helps to lighten existing sun spots over time, but much like hydroquinone treatments kojic acid can have some significant side effects, and shouldn't be used without the supervision of a dermatologist.
4. Soy Extract
The proteins in topical soy extracts help to diminish redness and blotchy colorings. The soy delivers a soothing sensation that calms skin down. It is one of the more mild treatment options for dark spots, and is typically safe for children and those with sensitive skin. This should go without saying, but to be extremely clear you should absolutely never use soy extract on your skin if you are allergic to soy.
5. Sun Protection
As I mentioned above, sun exposure can turn temporary skin discoloration into permanent scarring. This occurs because the "new" skin of the dark spot is more susceptible to hyperpigmentation. Using a combination of SPF 30+ sunscreen and medical-grade silicone will help prevent dark spots from becoming permanent scars. Both of these can be used during the dark spot treatment process.
Clinical Dark Spot (Hyperpigmentation) Treatments
We define clinical treatments as those that are only available through a doctor or dermatologist. Our research has found that clinical treatments are often unnecessarily invasive in the treatment and removal of dark spots. In other words, most patients would have typically seen the same results (and spent less) by using an at-home treatment method.
That being said, in certain cases clinical treatments have proven to be very effective in the removal of dark spots. Here are the most common:
1. Laser Resurfacing
Laser resurfacing treatment for dark spots is very similar to laser scar therapy. This procedure focuses light beams on damaged areas of the body in an attempt to remove dark spots. Laser treatment works better for newly formed dark spots than it does for older ones. The light beam from the lasers encourage collagen growth, which speeds up the dark spot healing process.
2. Chemical Peels
Chemical peels are a common treatment method for dark spots. The chemical solution used during a the treatment destroys the top layer of damaged skin, causing that layer to peel off. This brings a fresh, new layer of skin to the surface. This is the least invasive clinical option and the one we most commonly recommend. Make sure you use sunscreen and medical-grade silicone after your chemical peel treatment to prevent further hyperpigmentation.
3. Microdermabrasion
The tools used during a dermabrasion or micro-dermabrasion session will sand down the top layers of your skin. This helps bring a new layer of fresh, healthy skin to the surface. However, the treatment usually requires multiple visits to a dermatologist and is not safe for sensitive skin types. Make sure you use sunscreen and medical-grade silicone after your chemical peel treatment to prevent further hyperpigmentation.
4. Microneedling
This process uses needles to create tiny injuries across the surface area of the skin. This forms small, pocket-like wounds where the body naturally produces more collagen. Collagen can help normalize your skins coloring, which is why encouraging more natural collagen production can effectively heal dark spots over time.
What is the best treatment plan for dark spots?
In most cases discoloration will eventually fade with proper care, treatment, and sun protection. Using a silicone scar gel can help speed up this process. However, if your scarring or discoloration lasts more than a year despite using over the counter treatments it is a good idea to go see a dermatologist.
Your dermatologist can help develop the proper treatment plan for your situation and specifically tailor it to your skin. They can also prescribe stronger treatments and perform laser therapy, which you wouldn't be able to do on your own.
It's never a bad idea to get another opinion. Want to hear ours? Leave a comment about your situation below - or email us at info@tryvanish.com and we'll send some helpful tips.
Wrapping it all up
That was a lot of information! I hope you found this detailed guide helpful.
Despite the fact that there are only 5 basic acne scar types, every situation is unique. It's always better to start with SPF 30+ sunscreen and silicone scar gel as soon as possible to prevent further damage and jump-start your treatment plan.
There are many treatment options available for every type of acne scar, with some commonly overlapping and helping multiple types. If you aren't confident in your treatment plan we recommend either emailing us at info@tryvanish.com or reaching out to your dermatologist.
If you made it this far KUDOS to you! Here's an insanely helpful reward: click here to get your first order of medical-grade silicone scar gel for only $19.99! That's over $30 off the normal price. The coupon will be applied automatically at checkout.
Congratulations on starting your journey. In conclusion I'll just say this: "The best time to plant a tree was 20 years ago. The second best time is today." - Ancient Chinese Proverb
About the Author
Dr. Aarons is the founder of Vanish and the creator of Vanish Scar Gel. According to The New England Journal of Medicine he is among the world’s leading scar therapy experts. He has over 30 years of experience treating severe scar patients and has pioneered some of the most-read medical research on scar treatment. Dr. Aarons is a scar treatment expert and the creator of the #1 doctor recommended scar treatment.
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