Skin health is one of the important parameters affecting an individual’s quality of life. Acne vulgaris (pimples), which appears during the transition from adolescence to adulthood or with hormonal fluctuations, can create long-term aesthetic concerns with the marks it leaves on the skin surface, even after the active phase ends. As Demiderm Polyclinic, serving in Alsancak, the heart of Izmir, we emphasize that acne scars are not uniform and that each type of scar is formed as a result of a different biological mechanism.
Why Do Acne Scars Form? Biological Background
The main factor determining whether a pimple will leave a scar is the depth and severity of the inflammation. The skin consists of layers: the epidermis (upper layer) and the dermis (middle layer). Pimples begin in the hair follicle and sebaceous gland. If the follicle wall ruptures and infected material spreads to the dermis layer, healthy tissue is damaged.
The body initiates a “wound healing process” to repair this damage. During this process, fibroblast cells produce collagen. However, this repair is not always exactly the same as the original tissue:
- Tissue Loss (Atrophic): If the body cannot produce enough collagen, pitting occurs.
- Tissue Excess (Hypertrophic): If the body produces more collagen than necessary, raised scars form.
Acne Scar Types and Classification
The key to creating a successful protocol is correctly diagnosing the type of scar. In most people, these scar types are found in combination.
1. Icepick Scars
Named after the mark left by an ice pick, this type appears as narrow (usually less than 2mm) but deep holes on the skin’s surface. It is often confused with “enlarged pores” but can extend deep into the dermis or subcutaneous tissue.
- Appearance: Deep, sharply edged, “V”-shaped pits.
- Difficulty Level: Due to its depth, it is the least responsive type of scar to superficial lasers.
2. Boxcar Scars
These are wide depressions with steep, sharp edges and a flat base. They resemble chickenpox scars. They can be round or oval.
- Appearance: “U” shaped, wide and well-defined depressions.
- Depth: They can be superficial (0.1-0.5 mm) or deep (>0.5 mm).
3. Rolling Scars
These are scars that give the skin a wavy, bumpy appearance. The most important feature of these scars is the presence of “fibrotic bands” under the skin. These bands pull the epidermis layer downwards and cause the skin to appear sunken.
- Appearance: Wide (4-5 mm) ripples without sharp boundaries.
- Mechanism: Subcutaneous adhesions.
4. Hypertrophic and Keloid Scars
These scars, which are raised above the skin’s surface, are usually seen on the jawline, chest, and back. They involve excessive tissue production, not tissue loss.
Customized Treatment Protocols According to Scar Type
The approach applied at Demiderm Polyclinic’s center in Alsancak is based on the principle of “speaking to each scar in its own language.” The table below summarizes which scar responds better to which method.
| Scar Type | Primary Treatment Approach | Adjunctive Methods | Mechanism |
|---|---|---|---|
| Icepick | TCA Cross (Chemical Reconstruction) | Gold Needle, Punch Excision | Acid application to the scar base to ensure closure. |
| Rolling | Subcision (Subcutaneous Release) | Filler Applications, Radiofrequency | Tivae that pull the skin down removal. |
| Boxcar | Fractional Lasers (CO2 / Erbium) | Microneedling, Peeling | Restructuring the skin by peeling and heating. |
| Hypertrophic | Intralesional Steroid Injection | Pulsed Dye Laser (PDL) | Suppression of excessive collagen production and smoothing of tissue. |
| Red Marks (PIE) | Vascular Lasers | Medical Skin Treatments | Targeting dilated blood vessels. |
Technical Details of Application Methods
A. Fractional Laser Technologies (CO2 and Erbium Yag)
These systems work on the principle of “Fractional Photothermolysis”. Instead of peeling the entire skin, damage is inflicted in microscopic columns. The healthy tissues remain, while the damaged areas…It accelerates the healing process. It is used especially in Boxcar scars to smooth the skin’s surface (resurfacing) and stimulate collagen production in the underlying layer through heat.
B. Gold Needle Radiofrequency (Fractional RF)
This is a technology that delivers energy directly to the dermis layer without damaging the skin’s surface. Micro-needles penetrate the skin and emit radiofrequency energy from their tips.
Advantage: It is frequently preferred in İzmir conditions because the risk of discoloration is lower in people with darker skin and during the summer months (with sun protection).
C. Subcision
It is indispensable in the treatment of rolling scars. A special cannula or needle (Nokor needle) is inserted under the skin. Fibrotic bands that pull the skin down are mechanically cut. The skin is freed and lifted. The controlled bleeding in the area allows healing factors to accumulate there.
D. TCA Cross
High concentration of Trichloroacetic Acid (TCA) is applied to the base of the Icepick scar using a toothpick or a fine-tipped tool. This process creates whitening (frosting) at the base of the scar. During the healing process, the scar base lifts and narrows.
E. Microneedling
It triggers the skin’s self-repair mechanism by creating thousands of micro-channels on the skin. Mesotherapy products, vitamins, or growth factors such as PRP can be delivered through these channels.
Things to Consider in Treatment Planning
Skin Type (Fitzpatrick Scale)
In the analyses performed at Demiderm Polyclinic, the person’s skin color is one of the main factors determining the protocol. In individuals with dark skin (Fitzpatrick Type 4-5), methods with a lower risk of pigmentation loss (PIH), such as radiofrequency or microneedling, are prioritized instead of aggressive peeling lasers.
The Power of Combination
A single method may not be sufficient to remove all types of scars. For example, if a patient has both deep pits (Icepick) and ripples (Rolling), the protocol may be planned as follows:
Session 1: Subcision + TCA Cross
Session 2: Gold Needle
Session 3: Fractional Laser
This aims for holistic healing by approaching the skin layers from different angles.
Izmir Climate and Post-Treatment Process
At our polyclinic located in Alsancak, seasonal conditions are taken into account when creating the treatment schedule. Izmir’s high UV index makes post-treatment protection vital.
Golden Rules After Treatment
- Sun Protection: Treated skin is vulnerable to the sun. SPF 50+ sunscreens should be used even at home and reapplied every 3-4 hours.
- Moisture Support: The skin’s moisture barrier may be disrupted during the repair process. Water-based reparative creams should be used as recommended by a physician.
- Avoiding Mechanical Trauma: Any scabs that may form should never be removed by hand. This can lead to new scars or blemishes.
- Heat Insulation: In the first few days, avoid environments that dilate blood vessels, such as hot water, Turkish baths, and saunas.
Frequently Asked Questions and Medical Facts
1. Do acne scars disappear completely?
It should be known, as a matter of medical ethics, that it is biologically very difficult to completely erase the damage in the dermis layer as if it “never happened.” However, with combined treatments, the depth of the scars can be reduced, their edges softened, and they can be made more flush with the skin. The goal is significant cosmetic improvement.
2. How long does the treatment last?
Collagen synthesis (neocollagenesis) is not an immediate event. The conversion of a stimulus into collagen begins on the 21st day and continues for 3-6 months. Therefore, session intervals are usually 3-4 weeks, and the total process may take 4-6 sessions depending on the situation.
3. Can scar treatment be done while there is active acne?
As a general rule, it is necessary to stop the active inflammation (acne) first. Aggressive treatments performed while there is active acne can spread the bacteria. However, some lasers and medical treatments can be used to both dry out the acne and prevent scar formation.
Acne scars don’t have to be your destiny; however, their treatment is a process that requires patience, discipline, and proper planning. Market products or superficial treatments may be insufficient to repair this damage in the dermis layer.
Located in Alsancak, Izmir, Demiderm Polyclinic offers the scientific approach your skin needs within the framework of ethical values. You can apply to our polyclinic for your skin analysis, mapping of your scars, and the determination of a personalized roadmap. Healthy skin begins with the right information and competent application.
