Skin integrity is a crucial element shaping both an individual’s physical health and social interactions. Acne vulgaris, a problem encountered throughout a wide period from adolescence to adulthood, can leave permanent marks on the skin surface even after the active inflammation process has ended. These tissue irregularities, defined as “acne scars” in medical literature, are the result of damage occurring in the lower layers of the skin and the body’s attempt to repair this damage.
Biological Foundations of Acne Scars: Why Do Scars Remain?
To understand acne scars, it is first necessary to examine the skin’s wound healing mechanism. Not every pimple leaves a scar; scar formation is related to how deeply the inflammation penetrates the dermis layer and how the healing process is managed.
1.1. Damage to the Pilosebaceous Unit
Acne begins with the blockage of the “pilosebaceous unit,” which consists of the hair follicle and sebaceous gland, and the proliferation of Cutibacterium acnes bacteria. Increased pressure in this area can cause the follicle wall to rupture.
- Superficial Tears: Usually heal without leaving a scar.
- Deep Tears: Infected material spreads to the dermis layer (the middle layer of the skin) and destroys healthy tissue.
1.2. Wound Healing Process and Collagen Imbalance
The body initiates a series of biochemical processes to repair the damage in the dermis. However, the collagen fibers produced in this process may have a different arrangement than the original skin tissue.
- Tissue Loss (Atrophic): If sufficient tissue cannot be produced during the healing process, depressions form on the skin surface. This is the most common type of acne scar.
- Tissue Excess (Hypertrophic): If the body produces more collagen than necessary, raised structures form on the skin surface.
Types of Acne Scars and Clinical Classification
The success of the treatment protocol depends on the correct identification of the scar. In skin analyses performed at Demiderm Polyclinic, scars are categorized according to their morphological characteristics. Because each scar type responds to a different energy or application.
Acne Scar Types and Characteristics
| Scar Category | Subtype | Appearance Characteristics | Depth Level |
|---|---|---|---|
| Atrophic (Pitted) | Icepick | Very narrow (<2mm), deep, “V” shaped, holes that appear as pore dilation. | Deep Dermis / Subcutaneous |
| Atrophic (Pitted) | Boxcar | Wide, “U” shaped, with sharp edges and steep walls, flat base Depressions. | Superficial or Middle Dermis |
| Atrophic (Pitted) | Rolling (Wavy) | Large depressions with indistinct edges, giving the skin a wavy/undulating appearance. | Dermis (Contains fibrous bands) |
| Hypertrophic | Keloid | Hard, pink/red colored, raised tissue growths that extend beyond the boundaries of acne. | Extending beyond the Epidermis and Dermis |
| Color Change | Post-Inflammatory Hyperpigmentation (PIH) | Brown spots. Caused by increased melanin. | Epidermal / Dermal |
| Color Change | Post-Inflammatory Erythema (PIE) | Red spots. Caused by capillary dilation. | Vascular |
The Importance of Skin Type (Fitzpatrick Scale)
In acne scar treatments, a “single type of treatment” approach is not valid. The biggest reason for this is that each individual has a different melanin density that determines their skin color. In medicine, this is evaluated with the Fitzpatrick Skin Type Scale. This classification becomes even more critical for individuals living in a sunny region like Izmir.
Type I – II (Fair Skin): Skin that burns easily in the sun and is difficult to tan. They are generally more tolerant to laser treatments, but have a high risk of redness (erythema).
Type III – IV (Wheat and Dark Skin): These are the most common skin types in Türkiye, especially in the Aegean region. They carry a risk of “spotting” (hyperpigmentation) with incorrect energy applications. For these skin types, more controlled, non-ablative methods or radiofrequency technologies can be preferred.
Type V – VI (Dark Skin): Melanin activity is very high. Aggressive heat-based treatments should be avoided; microneedling or special chemical agents should be preferred.
The Influence of Alsancak Location and Environmental Factors
Sun and UV Index
Izmir has a high UV index for most of the year. Skin that has undergone acne scar treatment becomes hypersensitive to the sun because its defense barrier is temporarily weakened. If sun protection is not provided, the scars that need treatment can turn into permanent brown spots. Therefore, in our clinic, we offer seasonal sun protection to our clients.Treatment plans are presented; peeling procedures are generally shifted to the Autumn-Winter period, while protective and restorative protocols are applied during the summer months.
City Life and Pollution
In bustling city centers like Alsancak, air pollution and oxidative stress can affect the skin’s healing capacity. This is where the importance of antioxidant-supported treatments in treatment processes becomes apparent.
Medical Treatment Options and Application Methods
5.1. Fractional Radiofrequency (Gold Needle)
This technology is designed to deliver energy directly to the dermis layer without damaging the skin surface.
Mechanism: Gold-coated micro-needles penetrate the skin and emit radiofrequency energy from their tips. This energy heats the collagen fibers, triggering tightening and new collagen production.
Suitability: Its suitability for all skin types (Type I-VI) and its safe use even in summer months makes it a preferred choice in sunny regions like Izmir.
5.2. Fractional Laser Systems (CO2 and Erbium)
Laser beams vaporize the skin by scanning it in microscopic columns. The healthy tissues remaining in between accelerate healing.
- Ablative (Peeling) Effect: Especially in deep boxcar scars, it provides smoothing by peeling off the upper layer of the skin.
- Thermal Effect: It creates heat in the lower layer, causing the skin to tighten.
Note: Requires a healing time (downtime). Crusting is normal for 5-7 days after the procedure.
5.3. Subcision (Subcutaneous Release)
Especially in “Rolling” type wavy scars, there are fibrotic bands that pull the skin down. Lasers or creams cannot break these bands.
Procedure: A special needle (cannula) is inserted under the skin, and the ligaments pulling the skin down are mechanically cut.
Result: The skin surface is freed, and the depression lifts upwards. It is usually combined with filler applications or energy-based devices. 5.4. TCA Cross (Chemical Reconstruction)
This is a specific method for “Icepick” scars that are too narrow for lasers to reach.
Application: High concentrations of Trichloroacetic Acid (TCA) are precisely applied only to the base of the scar.
Purpose: To create controlled inflammation at the base of the scar, causing it to close or shallow. 5.5. Mesotherapy and Biorevitalization
This involves injecting hyaluronic acid, amino acids, vitamins, and DNA repair agents (salmon DNA, etc.), which are the building blocks of the skin, into the skin using micro-needles.
Function: It does not eliminate scars on its own, but it enhances the effectiveness of other treatments (laser, gold needle) and maximizes the skin’s healing capacity.
Treatment Planning and Process Management
Consultation and Mapping
The physician examines the skin with a magnifying glass or special imaging systems. The depth, type, and extent of the scars are noted. The person’s social life (expected return-to-work time) and medical history (history of Roaccutane/Zoretanin use, keloid tendency, etc.) are inquired about.
Combination Strategy
Most skin does not have a single type of scar. Therefore, treatments are usually combined.
Example Protocol: First, subcision to break deep bonds, then Gold Needle for overall tissue quality, and finally Laser or Peeling for superficial correction.
Session Intervals
Collagen production (neocollagenosis) begins biologically on day 21 and continues for months. Therefore, sessions are usually scheduled 3-4 weeks apart. Rushing can strain the skin’s healing capacity.
Post-Treatment Care and Protection
The success of the treatment depends 50% on clinical application and 50% on the care the client will apply at home. A detailed post-treatment care guide is provided at our clinic in Alsancak.
Critical Care Rules:
- Zero Sun Exposure: The skin is vulnerable to UV rays after the procedure. High factor (SPF 50+) sunscreens should be used even indoors and reapplied every 3-4 hours.
- Hygiene: For the first 24 hours after the procedure (this may vary depending on the application), do not get wet or apply makeup. Pillowcases should be changed daily.
- Moisturizing: For dryness and tightness in the skin, use the reparative creams recommended by your doctor.
- Do Not Touch the Scabs: Any scabs that may form should absolutely not be removed; this can lead to new scars.
Frequently Asked Questions
Do acne scars completely disappear?
It is medically very difficult for damage to the dermis layer to return 100% to its original state, “as if it had never occurred”. However, with medical aesthetic procedures, the depth of scars can be reduced, their visibility blurred, and they can be made to blend more seamlessly with the skin. The goal is to achieve a significant cosmetic improvement.
Will there be any pain during the treatment?
To increase the comfort of the procedure, a strong local anesthetic is applied before the procedure.Creams are applied and the skin is allowed to become numb. Many clients describe the procedure as a tolerable tingling or warming sensation. How long after medication can the procedure be performed?
Individuals undergoing systemic isotretinoin (oral acne medication) treatment are advised to wait a certain period (usually 3-6 months) after stopping the medication to allow the skin’s sensitivity and healing capacity to return to normal. This period may vary depending on the physician’s assessment.
Acne scars don’t have to be your destiny. When the possibilities offered by science are combined with the right technology and competent application, it is possible to achieve significant improvements in skin quality.
Demiderm Polyclinic in Alsancak, Izmir, offers the care your skin needs with its ethical, transparent, and medically sound approach. Determining a roadmap tailored to your skin type and the structure of your scars is the most valuable investment you can make in your future skin.
Remember; every skin is unique, and every treatment process should be planned individually.
