Surgery for Acne Scars At A Glance
- Best Results1-4 sessions
- Treatment Recovery5 days
- Procedure Time5 to 30 mins10-60 min
- Skin SpecialistDavin Lim, Dermatologist
- Duration of ResultsLife (if acne controlled)
- AnaestheticBlocks
- Back to Work2-5 days
- Cost$$ Partial Medicare rebate in most cases
Surgery for acne scars
Subcision & surgery is important to master & apply if & when required. Simple excision can improve & remove certain types of acne scars. Surgical procedures include punch excision, punch elevation, surgical excision, surgical scar elevation, complex surgery & subcision methods.
FactsFacts on Surgery for Acne Scars
- Deep scars are best treated with surgery
- Scar patterns include ice picks, linear, broad atrophic scars
- Punch excision is the most common surgical procedure
- Punch & surgical elevation are required for depressed scars
- Simple excision for linear scars in suitable locations
- Surgical subcision is covered on this website
- Surgical skill sets are a must when treating acne scars
Why is surgical expertise required in the management of acne scars?
Deep scars are out of reach with lasers, microneedling, RFM & even deep chemical peels. These scars require surgical procedures to remove them entirely. Surgery is called on for specific scar types.
When is surgery required to treat scars?
This method is employed when scars lend themselves to surgical intervention. As a guide the following acne scar patterns are best treated with surgical techniques-
- Deep ice pick & pick scars: Excision, punch excision
- Linear scars: Simple closure
- Geographical scars: Surgical design & complex closure
- Bridging scars: Excision
- Depressed demarcated scars, broad base: Surgical elevation
- Smaller depressed scars (2-7 mm): Punch excision
- Attached & fibrotic scars: Surgical subcision
What types of acne scars are treated with surgery?
Classic scars include ice pick & linear scars orientated in RST (relaxed skin tension lines).
Other variants include broad based scars, & bridging acne scars.
What is punch & surgical excision?
Punches are employed for deep & narrow ice picks. This special tool is like a cookie cutter. Punches come in 1,2,3,4,5,6,7 mm sizes. I pick a size depending on the width & angle of the ice pick. This technique is a surgical method to remove the scar in total. It requires a suture that remains for 5-6 days.
View our Treatment Gallery
When do I use surgical elevation techniques?
This special technique is employed to treat broad based acne scars, or sharply demarcated depressed scars. This scar pattern is very rare, however I do employ elevation procedures when called for.
Can other procedures be performed at the same time?
I often combine many techniques to treat acne scars on the same day of surgery. Combinations include lasers, peels, microneedling, RFM, & surgical methods as described. Scars are treated according to their morphology. Remember it is the method or revision that gives the biggest improvement, & not the piece of equipment.
Basic acne scar revision concepts
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👉Real life: Is not that simple. Scar signatures vary considerably even within patients.
Scar morphology changes with procedures. Classification however is a great starting point
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🛬Many doors to the same destination: In most cases the rules are not set in stone, & there are various methods to treat each scar type. Add to this the differences in devices & skill sets of operators. If all things are equal, there is a marked variation between each patient’s regenerative & remodeling potential. Furthermore age related atrophy plays an important role in acne scar revision
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👍🏻It’s much more complex than matching scars to procedures, but it is a step in the right direction💯
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😎Dr Davin Lim
Dermatologist
Brisbane 🇦🇺
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#acnescar #scarrevision #acnescartreatment #acnescarcure #icepickscars #drdavinlim #brisbanedermatologist
Some gnarly scars here
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🔍Types: Ice pick, linear, rolling, tethered, polymorphic scars with background genetic low facial volume (some element of lipoatrophy secondary to scars), compounded with a negative vector (reduced maxillary projection). The later two factors compounds the problem
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👍🏻Today: tumessent hydrodissection, punch excision, sharp two level subcision- dissection, super deep CO2 fractional (given dermal thickness measure with dissection instrument), higher density superficial CO2 given pits/pores & superficial scars
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👉Next appt: probable fat transfer given the high volume loss (will probably need 2 sessions), option to augment with dilute Ca Oh next few months. Fat-filler will support the scars, & overlying skin, address volumetric loss (genetic), improve aesthetics & negative vector👍🏻
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#laserdermatology #acnescar #scars #subcision #scarrevision #acnescarrevision #acnescartreatment #icepickscars #drdavinlim #dermatoloigstbrisbane #skinscience
Ever wondered how ice pick scars form?
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🔬Skin Science: Ice picks are part of the classic description of acne scars including boxcar, rolling, (atrophic) & hypertrophic. In reality there are many more scar types including saucer, bridging, hypopigmented, & commonly, polymorphic undifferentiated scars
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👍🏻Think histology to effectively revise scars: icepicks are a paradox. They are ‘superficial but deep.’ Going under the scar itself with subcision often releases the base of ice picks, hence in some, pathology is in the subcutaneous layers
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👌🏻Solutions: Contrary to the literature, ice picks are relatively easy to treat. Accurate TCA or phenol placement will improve. It’s a matter of treatment sessions & proper selection.
Faster options include punches. 🔫Small diameter lasers can hit the side walls, causing remodeling in shallower icepicks
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🚬🔥Smoking & scars: anecdotally this scar type is more common in smokers. I suspect changes in the microcirculation may predispose genetically susceptible individuals to this scar morphology
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🎬Action: book an appointment with Alison or Katie @cliniccutis They can assess your scar types & come up with a treatment plan. Alternatively I am more than happy to be involved in more challenging cases
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#dermatology #icepickscars #acnescars #drdavinlim #davinlim #scars #acnescartreatment #nomorescars #pockscars #laserdermatology #dermatologist
#skinclinic #brisbanedermatologist
Back to basics, I found this decade old slide, using it for the upcoming lecture.
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🔬Skin science: Treat scars based upon their merits, in many cases you don’t require lasers or energy devices. If the planets line up (scars in relaxed skin tension lines), simple excision will do the trick. Ice picks can be punched or treated with high concentration focal peels. In some cases a scalpel, punch & packet of suture material will give far better results than even the most powerful lasers/energy devices💯
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👊Keeping it real…& simple
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😎Davin Lim
Dermatologist
Brisbane 🇦🇺
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#acnescars #scars #scarrevision #icepickscars #skinsurgery #skinscience #drdavinlim
#dermatologistbrisbane #dermatology
How many treatments will I require?
It depends on the extent of scarring. In isolated cases, only one session is required. Some patients have hundreds of deep ice pick scars. In these cases 3-5 sessions are required over a period of 4 to 10 months.
What are the risks of surgery?
Surgical procedures, along with lasers & peels carry risks.
These include-
- Spread scars- 4% of cases. Due to lack of collagen surrounding the scars.
- Infection – 3%.
- Skin colour changes 3%.
- Hypertrophic or keloid scars- 2%
How long is the recovery following acne scar surgery?
Sutures or surgical strips are in place for 4-7 days. During this time you must limit your activities. It often takes 3-6 months or even longer for scars to remodel after surgery.
What is the cost of surgery for acne scars?
Cost will depend on the extent & complexity of closure. All skin surgery is performed by myself.
Medicare Australia provides rebates for scar revision under the care of Specialist dermatologists or plastic surgeons, however according to the Medicare director ‘severe scars must compromise activities of daily living including eating, drinking & speech.’
Davin’s Viewpoint on Surgical Techniques for Acne Scars
Surgery is important to master in the management of acne scars. Linear, ice pick, pick, geometrical, & broad based depressed scars can be effectively treated with surgery. In some cases, surgery is not only an option, it is the treatment of choice.
Most of my revision procedures are based upon treating scar patterns with methods. Scar revision at a specialist level is never about the piece of equipment, it is about applying methods to cases. In some cases it is surgical, in others, peels, lasers & devices maybe appropriate.
