- Best Results1-4 sessions
- Treatment Recovery1-3 days
- Procedure Time5-20 minutes
- Skin SpecialistDavin Lim, nurses
- Duration of ResultsVariable
- Back to Work1 days
Chicken Pox Scars
Though much rarer than two decades ago, chickenpox is still a relatively common viral infection. It is more severe in adults compared to children in both systemic symptoms & skin scarring. Early & timely management of scars can, in most cases, lead to an excellent outcome without the need for surgical intervention. Old chicken pox scars can respond to limited subcision & dermal fillers.
FactsFacts On Treating Chicken Pox Scars
- Chickenpox scars can be pigmented & or depressed
- Pigmented scars can be treated with pigment correctors & pico lasers
- Depressed scars can be improved with microneedling & fractional lasers
- Home microneedling using 0.2 to 0.25 stamps can help mild scarring
- Resistant atrophic scars can be treated with subcision & clinical microneedling
- Fractional lasers can give good results for mild to moderate atrophic scars
- Subcision can be combined with saline, PRP or dermal fillers
- Dermal fillers provide predictable correction of chickenpox scars
How do I approach chickenpox scars?
A scar is not a scar. The optimal treatment will depend on many factors. Here are my thought processes for every scar patient-
- What is the level of scarring? Is it pigmented or atrophic or a combination of colour & depression. Is depression due to collagen loss, fibrosis or both?
- Where is the scar located? Chickenpox scars on the apex of the cheek, forehead, and bony nose areas are notoriously difficult to treat.
- What is the skin quality of the patient? What is the dermal thickness, what is the background skin like? How good is the patient with sun protection?
- What skin type is the patient? Darker skin patients are more prone to pigment changes.
- Has the patient got insight – realistic expectations? What other factors contribute to scarring? Background acne etc. I also profile the ability of a patient to generate collagen, smoking vs non-smokers, ethnicity, age & others. Body dysmorphic patients see scars that others do not.
How do I treat pigmentation changes from chickenpox?
Ideally simple home treatments (see below) can reduce skin PIH or postinflammatory hyperpigmentation. These include sunscreen & pigment correctors such as ascorbic acid & retinol.
If your pigment is stubborn, I use both nano & pico lasers to improve pigmentation. Pico lasers can markedly improve PIH within 2-5 months Treatments are painless & take 5-10 minutes to perform. I generally do space treatments 4- 6 weeks apart.
Book an appointment with my laser nurses for pico lasers. This will save you a consultation fee with myself. Believe it or not, post-inflammatory skin colour changes from acne & chickenpox are really basic treatments at Cutis.
What simple skin care ingredients can help fade chickenpox scars?
A good proportion of post-inflammatory hyperpigmentation can be faded with DIY topical skin care, so the chance of this working is about 60 to 70%. You are more likely to gain better results if you treat & prevent pigmentation early.
Start off with sunscreen. Apply 2 ml twice a day. If you are not good with sun protection, all else will fail.
Add a good formulation of L-ascorbic acid (10-20%) in the morning, before sunscreen. In the evening use retinol serum 0.1%. From there slowly add pigment correctors that contain the following ingredients: azelaic acid, vitamin C, kojic acid, liquorice root, arbutin, glycolic, lactic, citric acids, botanicals including bearberry. For more on pigmentation inhibitors go to The Formulated.
If you have long standing pigment, pico lasers give the best results. 2-4 sessions are usually recommended over 2-4 months.
What simple DIY steps can you take to treat chickenpox scars?
Early treatment is the key. Treat scarring with two goals in mind, firstly to decrease pigment (Post inflammatory hyperpigmentation) & secondly to reduce contour changes.
Ways to reduce pigment include-
- Sunscreen twice a day, regardless of sun exposure.
- Retinol & vitamin C can reduce pigmentation production.
- Hydroquinone, arbutin, liquorice extract are potent pigment inhibitors.
- Vitamin E can be useful.
Ways to reduce atrophy (depressed scars)
- Retinol increase collagen production
- Microneedling DIY at home with a roller or derma stamping tool. Use a 0.2 to 0.25 mm roller or stamper. Do not use longer needles. Perform this weekly. See the section on DIY acne scar treatments as it is similar to the chickenpox protocol
See the section on injectables for a more detailed explanation.
View our Treatment Gallery
Can lasers help reduce chickenpox scars?
Yes. I use various types of lasers based upon the clinical features of your scar type & your ethnic skin colour. To understand what lasers are best, I will break it down into pigment lasers & resurfacing lasers. The former treats PIH while the latter improves contour changes from atrophy (divots, depressed scars).
Pigment lasers include pico lasers such as Picoway & Picosure. Settings matter, so not all providers will give you equal results. Laser is best combined with accurate skin care ingredients & sunscreen.
Resurfacing lasers can be useful in some cases of chickenpox scarring. My preferred laser is a small spot CO2 with a short pulse duration. These include eCO2, Mixto, CORE & Deka lasers. I do not recommend the Ultrapulse for pox scarring as the sequential delivery of beams is too close for pox scars. This will leave grids. 3-4 sessions are required over 4 to 8 months.
Non-ablative lasers in the 1927, 1440 to 1550 wavelength can be used. These are gentler compared to CO2 or erbium lasers. In most cases you will require at least double the sessions to gain the same amount of traction as ablative lasers.
Can microneedling help?
Yes. Sensible DIY microneedling with a 0.2 to 0.25 mm device can help. Do not go deeper than this as scarring is a side effect of DIY needling. Obviously clinical microneedling goes much deeper.
Microneedling works by scar remodelling through collagen stimulation. Shallow needles stimulate cytokines & growth factors to activate fibroblasts. These cells lay down new collagen & can plump up depressed scars.
Deep microneedling denatures scar tissue & fibrosis. As a guide 4-8 sessions of microneedling is the norm. Microneedling will not free up extremely fibrotic scars, nor will they give good correction in long standing atrophic scars.
Why do I use fillers to treat chickenpox scars?
Understand this concept (the same applies to acne scarring), & you will get ‘scar revision.’ Dermatologists employ methods to assist your immune system to remodel & produce collagen. These treatments include lasers, microneedling, peels & energy devices. If your immune system cannot do this, we use fillers to replace loss collagen.
Fillers are designed to replace volume loss in the dermis or hypodermis. In some cases of scarring, the volume deficit is too great.
For resistant chickenpox scars use dermal fillers & limited subcision to insert hyaluronic acid in the lower dermis to replace collagen. Correction may be partial, or scars may be fully correct with fillers. It normally takes me 1-3 sessions to get a good result.
What are other solutions to treat atrophy apart from fillers?
We all would like a long lasting & permanent solution for everything from scars, hair loss, volume loss & wrinkles. Your choices are limited. Fillers can provide correction as hyaluronic acid acts as a spacer (to replace collagen loss due to inflammation).
All other procedures rely on your own immune system to regenerate collagen. This is dependent on individual factors such as age & genetics. If you are against fillers, you have several options to choose from including-
- Saline injections: 3-6 sessions over 6 months
- Dermal grafting: 2-4 sessions over 4 months
- Nanofat injections: 2-3 injections over 6 months
- PRP: 3-4 injections over 6 months
These injections are less predictable than dermal injections of hyaluronic acid – calcium hydroxyapatite.
What to do if you have been diagnosed with chickenpox (scar prevention) ?
The level of scarring is directly proportional to the time it takes to commence treatment. The longer you leave it, the greater the chance of chickenpox scars. The number one way to reduce the severity of this viral infection is to take Valtrex or Acyclovir within 24 hours of developing the rash. Every single hour counts. See you GP.
How to treat chicken pox (acute infections)?
Scarring occurs due to 2 factors. The infection itself (hence treating early will mitigate scars), & scratching. Here are some helpful hints to reduce itching & scratching-
- Antihistamines. Get the ones that bomb you out, phenergan or polaramine is a good option.
- Trim your nails really short. If possible, wear cotton gloves.
- Pat or slap your skin if you itch, don’t scratch (easier said than done)
- Have an oatmeal bath
- Use Calamine lotion on itchy spots
- Menthol + Sulphur + Calamine is a favourite amounts dermatologists
- Ice packs can help, sedation with tablets can stop you scratching
Your GP will look after you regarding the other effects of acute chickenpox including monitoring your respiratory function, coughing, eating etc.
Why treat chickenpox scars early?
Scars, including acne & chicken pox are best treated early as collagen remodelling can be enhanced with minimally invasive treatments including lasers, microneedling & even LED phototherapy.
If we catch the scars in a timely manner, we can, in most cases, prevent atrophic changes (contour changes). Pico lasers can address pigmentation changes as well as early collagen loss. Treating pox scars early means less downtime, less costs & better results.
Who is at risk for more severe scarring following chickenpox?
Ethnic adults are most at risk for scarring. This is because chickenpox is more severe in adults.
Darker skin types including Asians, Central & South American as well as Middle Eastern & Islander patients have a much higher rate of skin colour changes following chickenpox infection. This is known as post-inflammatory hyperpigmentation or PIH.
What is RF microneedling?
RF microneedling (RFM) incorporates heating with microneedles. Heat can be delivered through non-insulated needles (Secret RF, Scarlet, Instensif) or insulated needles (Infini, Genius RF). Heating generates more collagen remodelling as it activates proteins called HSP or heat shock protein. (This name says it all).
In the majority of cases, I do not normally use RFM for isolated chickenpox scars as the grid pattern of RFM is much larger than the scars themselves. High settings of RFM, especially on the forehead & temples can often leave grids. I do believe that RFM is useful for acne scarring (deep, rolling & atrophic scars), however in the context of chickenpox scars, I prefer small spot size lasers.
What is the difference between chicken pox and acne scarring?
The histology of a varicella lesion is akin to an explosion in the epidermis & dermis. Big bang takes out collagen up high & low, leading to atrophy. The degree of inflammation is acute & extensive. This correlates with the clinical findings of chickenpox scars as they are –
- Wider than acne scars
- More focal than acne scars
- Have more focal dermal atrophy
In general, I find chicken pox scarring harder to treat than acne scars as in most cases, your immune system cannot generate enough collagen to correct the divot. In many cases I need to use dermal fillers.
Can microdermabrasion help?
Microdermabrasion can be effective in reducing the look of chickenpox scars. It works by improving the luminosity of skin, aiding in reflecting light. This reduces the perception of scars by reducing dull skin. It does not improve collagen production.
This simple cost-effective treatment can be performed with no downtime. Another treatment we use at Cutis is Hydrafacial. It works around the same principle as microdermabrasion.
Do Medicare rebates apply to chicken pox scarring?
No. The rebate only applies to select forms of objectively severe facial scarring from acne, burns, surgery & trauma.
Lasers including fractional, nano & pico lasers are not claimable through Medicare. Medicare favours the management of lighter skin types as there are item numbers for the management of red skin conditions including visible red veins at a distance of three meters.
Who to see for scar treatment?
For early intervention of chickenpox scars, book an appointment with my laser nurses. They are versed in the use of pico & fractional lasers.
For intermediate to late/advanced scarring, you are best off booking an appointment with my nursing team. They can guide you through the process of lasers. They offer a excellent scar revision service at an affordable price (often cheaper than GP-cosmetic physicians & other ‘cosmetic clinics’)
I can intervene with dermal fillers for complex scars or severe scarring. In most cases of chickenpox scarring Medicare does not give a rebate. In some cases of severe scarring (measured objectively, not subjectively), a rebate may apply depending on the modality used.
Davin’s Viewpoint on Treating Chicken Pox Scars
In my era, the majority of people would have chickenpox at school. The upside of this infection early in life is that severity & scarring is much less compared to adult chickenpox. I do think the vaccine is a good thing, only if you can remember to get your booster shot. Even then, it is 95% effective.
If you do catch chickenpox early, you can mitigate scarring (as lesion counts are lower). Early valacyclovir, acyclovir or famciclovir is warranted. IVIG in special cases.
If you have early scars, timely intervention is highly effective. This can reduce pigmentation or PIH, as well as reduce atrophic scars. For pigment, the use of ascorbic acid, botanical pigment correctors, HQ & retinol is first line. For severe cases I use tranexamic acid orally in the absence of contraindications. Pico lasers are great because they address both pigmentation and mildly atrophic scars.
For intermediate cases of atrophic chickenpox scars a combination of intradermal saline & small spot lasers such as thulium, CO2 or even LP 1064 Nd Yag genesis mode can give an excellent outcome. Microneedling is another option, however lasers provide better remodelling.
For long standing chickenpox scars, I do prefer HA dermal fillers, sometimes with lasers or at home microneedling. Pox scars are much harder to treat compared to acne scars as there is more dense fibrosis with the former. I understand that patients want a permanent solution, rather than a temporary one (fillers). In most cases, even though the filler dissolves in 1-3 years, the presence of HA stimulates fibroblasts to produce collagen.
Other options include the use of dermal graft & stem cell nano-fat. I occasionally perform these procedures for patient’s that insist on natural products (very rarely requested). Fibroblast & adipose stem cell transfer are much less predictable than sticking in some filler. A dermal graft involves harvesting donor tissue from the back of your ear, processing the constituents (dermal harvest kits or dermal smashing), then reimplantation underneath the scar. ASC involves harvesting nanofat. The costs for grafts & stems really add up, namely ranging from $4900 to $8900 per procedure. Fillers are only a fraction of the price & offer more predictable results.
Join the conversation
Join Dr Davin Lim on Instagram to stay up to date