Skin health is not only a matter of physical integrity but also a significant factor affecting an individual’s social life and self-confidence. Acne, a problem many people face from adolescence to adulthood, can lead to a long-term struggle with the scars it leaves on the skin’s surface, even after the active phase ends. These tissue losses or excesses, referred to as “acne scars” in medical literature, result from irregularities in the repair process of damage occurring in the lower layers of the skin.
Why and How Do Acne Scars Form? Biological Background
Understanding the basis of acne scars is critical to grasping the logic of the procedure to be applied. Acne forms as a result of the clogging of hair follicles and sebaceous glands (pilosebaceous unit) and inflammation due to bacterial (C. acnes) interaction.
Damage in the Dermis Layer
The skin consists of layers: the epidermis (upper layer) and the dermis (middle layer). Severe acne creates inflammation that penetrates down to the dermis layer. The body begins to produce collagen to repair this damage. However, this repair process doesn’t always work perfectly:
- Insufficient Collagen Production: Causes tissue loss (atrophic scars). Pits appear on the skin.
- Excessive Collagen Production: Causes excess tissue (hypertrophic scars). Raised structures form on the skin surface.
In sunny regions like Izmir, the risk of hyperpigmentation (spots) after this inflammation also increases. Therefore, in the analyses performed at Demiderm Polyclinic, not only pits but also color irregularities are evaluated.
Acne Scar Types and Classification
The most critical step in determining the treatment protocol is correctly analyzing the type of scar. Each scar type responds to a different energy or application method.
1. Atrophic Scars (Dimpled Scars)
This is the most common type of acne scar. It is divided into three main categories:
Scar Type
Appearance Characteristics
Depth
Commonly Preferred Approaches
Icepick
Very narrow (less than 2mm) but deep, “V” shaped holes. It may appear as pore enlargement.Deep Dermis / SubcutaneousTCA Cross, Radiofrequency applicationsBoxcarLarge, “U”-shaped depressions with sharp edges and steep walls.Surface or DeepLaser resurfacing, SubcisionRollingLarge depressions with indistinct edges, giving the skin a wavy appearance. It is formed by the fibers under the skin pulling the skin down.DermisSubcision, Filler applications, Radiofrequency
2. Hypertrophic and Keloid Scars
These are excess tissue that is raised, hard, and sometimes itchy above the skin surface, usually seen on the back and jawline. The aim in these scars is not to peel the skin, but to suppress excessive collagen production and smooth the tissue.
3. Post-Inflammatory Hyperpigmentation (PIH) and Erythema (PIE)
These are not true “scars” (tissue disorders) but create a scar appearance.
PIH: Brown spots (Increased melanin).
PIE: Red spots (Capillary dilation).
Medical Procedures Used in Acne Scar Treatment
Demiderm Polyclinic, in its center in Alsancak, adopts combined approaches instead of sticking to a single method when determining protocols suitable for the skin type of its clients. This is because most skin types have more than one type of scar at the same time.
A. Fractional Laser Applications
Fractional laser technologies target specific areas of the skin in microscopic columns, not the entire skin. The tissues that remain intact accelerate the healing of the damaged areas.
CO2 Fractional Laser: Especially in deep boxcar and some rolling scars, it works by peeling the upper layer of the skin in a controlled manner and triggering collagen synthesis in the lower layer with heat damage.
Erbium Yag Laser: Can be preferred in more superficial scars and in cases where a shorter healing time is desired.
B. Gold Needle Radiofrequency (Fractional Radiofrequency)
In this technology, radiofrequency energy is delivered directly to the dermis layer via micro-needles without damaging the skin’s surface.
Mechanism: While the needles provide a mechanical stimulus, the heat delivered from their tips shortens collagen fibers and stimulates the production of new ones.
Advantage: Because it does not peel the skin surface, it can be planned with a lower risk of discoloration, even in summer months or for people with dark skin. It is a frequently preferred procedure in sunny regions like Izmir. C. Subcision (Subcutaneous Release)
This is particularly critical in the treatment of “Rolling” type, wavy scars. These scars contain fibrotic bands that pull the skin down.
Procedure: These adhesions (bands) are broken by entering under the skin with a special cannula or needle.
Effect: The skin surface is freed andThe scar lifts upwards. Controlled bleeding during the procedure draws healing factors to the area.
D. TCA Cross (Chemical Reconstruction)
This comes into play for very deep and narrow “Icepick” scars, even in areas inaccessible to lasers. High concentrations of Trichloroacetic Acid (TCA) are applied only to the base of the scar using a toothpick-like tool. This causes the base of the scar to lift and close.
E. Dermapen and Microneedling
It initiates the skin’s self-repair mechanism (wound healing process) by creating hundreds of micro-channels on the skin. Sterile solutions (mesotherapy products) containing vitamins, minerals, and building blocks that the skin needs can be delivered through these channels.
F. Enzymatic Peeling and Chemical Peels
This is a procedure to peel off the top layer of skin with a controlled acid mixture for more superficial scars, discoloration, and blemishes remaining after active acne.
How Does the Treatment Process Work? Step-by-Step Roadmap
For a client applying to Demiderm Polyclinic, the process is shaped according to individual data rather than a standard pattern.
1. Consultation and Skin Analysis
The first stage is always a detailed assessment.
- The depth, type, and extent of scars are mapped.
- The person’s skin type (Fitzpatrick scale), allergy history, and medications used (especially isotretinoin history) are inquired about.
- It is checked whether there is active acne. It is not recommended to start scar treatment while active acne is present; the active inflammation must be stopped first.
2. Protocol Planning
Based on the analysis results, it is determined which of the methods mentioned above will be applied, in what order, and how many sessions. For example, subcision can be done first, and laser treatment can be started a month later.
3. Application Phase
Procedures are performed in a clinical environment that complies with hygiene standards. Local anesthetic creams may be applied before the procedure to increase comfort. The application time may vary between 30 and 60 minutes depending on the chosen method and the size of the area.
4. Recovery Process (Downtime)
The recovery time varies for each procedure:
- Lasers: Crusting and redness may occur for 5-7 days.
- Gold Needle: There may be pinkness and slight swelling lasting 1-2 days.
- Subcision: Localized bruising may occur, which subsides within 1 week.
Izmir Climate and Things to Consider After Treatment
Izmir is a sunny city for most of the year. Sun protection is vital in acne scar treatments because the skin’s defense barrier is temporarily weakened or peeling.
Post-Treatment Golden Rules:
- Sun Protection: Broad-spectrum sunscreens with SPF 50+ should be used even if you don’t leave the house, and should be reapplied every 4 hours.
- Moisturizing: To support the skin’s repair process, water-based repair creams recommended by the physician should be used.
- Hygiene: It is recommended to avoid contact with water for the first 24 hours (this may vary depending on the procedure), not to apply makeup, and to change pillowcases frequently.
- Avoiding Heat: For the first few days after the procedure, avoid environments that dilate blood vessels such as hot showers, Turkish baths, and saunas.
Frequently Asked Questions
1. 1. Will acne scars disappear completely?
The medical reality is that it is biologically very difficult to transform tissue with deep dermis damage into a state where “no acne ever appeared.” However, with medical procedures, the depth of scars can be reduced, their visibility softened, and they can be made more flush with the skin. Success is defined not as 100% erasure, but as a noticeable cosmetic improvement.
2. How long does scar treatment take?
The collagen production process is a cumulative effect. The effect is not immediately visible after one session. Collagen synthesis begins on the 21st day and continues for 3-6 months. Average protocols can range from 3 to 6 sessions, and session intervals are usually 3-4 weeks.
3. How can I reach Demiderm Polyclinic?
Located in Alsancak, the heart of Izmir, our polyclinic offers easy access due to its central location. You can use our communication channels for detailed information and to schedule an analysis appointment.
4. Which season is best for treatment?
For exfoliating procedures like fractional laser, autumn and winter months are more suitable in Izmir. However, methods like gold needle treatment can be planned in any season with good sun protection.
Invest in Your Skin
Acne scar treatment is a process that requires patience and discipline. It is not possible to improve deep scar tissue with market products or homemade masks; because these tissues are in the dermis layer and topical products cannot reach this depth.
Demiderm Polyclinic, located in Alsancak, Izmir, offers the scientific approach your skin needs within the framework of ethical values. With skin analysis, accurate diagnosis, and combined treatment plans, you can achieve a smoother appearance.We are here to support you.
Remember, every skin is unique, and every scar tells a different story. Our job is to help you continue that story with healthier skin.
