What are Acne Scars?
Skin, besides being the largest organ of the human body, is a dynamic structure at the center of our first contact with the outside world and our aesthetic perception. The problem of “Acne Vulgaris” (Pimples), which can extend from adolescence to adulthood, is not just a skin infection experienced during that period; it can turn into a lifelong aesthetic and psychological struggle with the permanent damage it leaves behind during the healing process, namely “Acne Scars”. An acne scar, medically known as a “Scar”, is a permanent tissue change that occurs as a result of severe inflammation in the lower layers of the skin, and the body’s inability to fully maintain tissue integrity or its overproduction of tissue while trying to repair this damage.
Especially in a region like Izmir, where the number of sunny days is high and humidity and air temperatures are decisive factors in the skin flora, the formation and management of acne scars are of extra importance. While sunlight (UV) increases the risk of scarring from healing acne, high humidity can disrupt the skin’s oil balance, triggering new acne breakouts. Although many patients describe redness or blemishes on their face as “marks,” true acne scarring is a condition of depression (atrophy) or swelling (hypertrophy) in the skin’s tissue. These deep-seated damages, which cannot be treated with creams alone, constitute one of the most challenging areas of medical aesthetics and dermatology.
How Do Acne Scars Form? Biological Mechanism
To understand the formation of acne scars, it’s necessary to understand the skin’s wound healing process. Acne is a bacterial (C. acnes) infection and inflammation process that begins in the hair follicle and sebaceous gland.
When pores on the skin’s surface become clogged, the sebum and bacteria accumulating inside begin to strain the follicle wall. If this pressure increases too much, the follicle wall ruptures, and infected material spreads into the dermis, the middle layer of the skin. The body sends white blood cells to the area to clear this “foreign and harmful” material, and a battle (inflammation) begins. During this battle, healthy tissues in the dermis are also damaged. When the battle is over, the body begins to produce “collagen” to repair the damage.
- Insufficient Repair (Atrophic Scar): If the body cannot produce enough collagen to fill the lost tissue, pits and depressions form on the skin surface. This is the most common type of scar.
- Excessive Repair (Hypertrophic Scar): If the body cannot stop the repair signal and produces more collagen than necessary, raised, hard tissues form on the skin surface.
Types and Classification of Acne Scars
Acne scars are not all the same. The shape, depth, and texture of the scar are the most important factors determining the treatment method to be applied (Laser, Gold Needle, Subcision, etc.).
1. Ice Pick Scars
As the name suggests, these are scars that look as if a thin ice pick or needle has been inserted into the skin. They are narrow in diameter (less than 2 mm) but deep. They extend deep into the dermis in a “V” shape. Although they appear small from the surface, their bases are deep, making them one of the most difficult types of scars to treat.
2. Boxcar Scars
These are box-shaped depressions with edges perpendicular to the skin’s surface and a flat base. They can be round or oval. They are usually seen on the cheeks and temples. Their diameter is wider than Ice Pick scars (1.5 – 4 mm). They can be superficial or deep.
3. Rolling Scars
These are scars that appear as waves on the skin’s surface, with softer transitions at the edges. The reason these scars form is that fibrotic bands (connective tissue) under the skin pull the skin downwards. The appearance of these scars lightens when the skin is stretched. They are usually 4-5 mm wide and give the skin a “bumpy” appearance.
The Difference Between Acne Scars and Acne Marks
The most common confusion among patients is the discoloration left after acne.
Red (Post-Inflammatory Erythema – PIE) or brown (Post-Inflammatory Hyperpigmentation – PIH) spots that remain after acne heals are not “scars.” These are superficial discolorations of the skin and there is no tissue loss. They may disappear over time or with blemish treatments. However, what we call “acne scars” is a permanent deterioration in the skin’s texture (architecture). The sun in Izmir plays a major role in making spots permanent, but scar formation is more related to genetics and the severity of acne.
Acne Scar Types Comparison Table
Understanding which scar type has which characteristics is important for managing treatment expectations:
| Scar Type | Appearance Characteristic | Depth | Treatment Difficulty |
|---|---|---|---|
| Ice Pick | Narrow, deep, hole-shaped. | Very Deep (Dermis/Subcutaneous). | High (Requires combination treatment). |
| Boxcar | Wide, sharp-edged, box-like. | Medium / Deep. | Medium. |
| Rolling | Wavy, soft-edged, sunken. | Variable (Has fibrous bands). | Medium (Subsidence effect). |
| Hypertrophic | Raised, hard, pink bump. | Raised from the surface. | Variable (Cortisone/Laser). |
Risk Factors: Why Do Scars Remain?
Not every pimple leaves a scar. So why do some people get severe scars while others don’t?
- Genetic Predisposition: The risk is higher in those with a family history of acne scarring.
- Severity of Acne: Cystic and nodular (deep and painful) acne has a much higher risk of scarring.
- Intervention (Squeezing/Poking): Squeezing pimples bursts the follicle wall, deepening the infection and increasing tissue damage.
- Delay in Treatment: Failure to treat active acne in a timely manner prolongs the inflammation period, increasing the risk of scarring.
Acne Scar Management and Environmental Effects in Izmir
When planning acne scar treatment in Izmir, the “Sun Factor” can never be ignored.
Treatment methods used for acne scars (Fractional Lasers, Chemical Peels, Gold Needle, etc.) work by peeling or micro-damaging the upper layer of the skin. After this process, the skin becomes vulnerable to UV rays. In Izmir, these types of treatments are generally preferred during the winter months (October-March) when the sun’s effect is reduced. In the summer months, it is necessary to opt for treatments that do not peel the skin, are more protective, and strengthen the barrier. Furthermore, for patients in Izmir, the use of high-factor sunscreen is an integral part of the treatment.
Modern Treatment Approaches
There is no single “miracle” method for treating acne scars. Generally, combined treatments (Multimodal Approach) yield the best results.
The methods applied in clinics in Izmir are chosen according to the type of scar. For example, for Rolling scars, a “Subcision” procedure that breaks the bonds under the skin is performed, while for Boxcar scars, “Fractional Laser” or “Gold Needle” may be preferred. For Ice Pick scars, “TCA Cross” (high-intensity acid) application can be effective. For large depressions with volume loss, skin level can be raised with “Dermal Fillers” or “Stem Cell” treatments.
Conclusion: A Process Requiring Patience and Expertise
In short; the answer to the question “What are acne scars?” is not a simple cosmetic defect, but a deep and permanent damage to the anatomical structure of the skin. Repairing this damage is a process that requires time and patience, triggering the skin to produce collagen again.
If you want to get rid of these scars on your skin and achieve smoother skin in Izmir, it is necessary to first correctly analyze the type of scar. Choosing the wrong treatment (for example, laser treatment while there is active acne) can worsen the situation. Therefore, starting with expert physicians who evaluate your skin as a whole and offer a treatment plan suitable for your lifestyle and the climate conditions of Izmir is the key to success.
