Acne is frustrating enough while it’s happening. What bothers many people more is what it leaves behind.
Scars that sit in the skin for years, resisting every serum and treatment that promises otherwise, are often a structural issue rather than a surface one. That's why the approach has to go deeper than skin care.
At his office in San Mateo, California, R. James Koch, MD, treats acne scarring using a combination of nonsurgical technologies determined by each patient’s type and depth of scarring.
A deep or inflamed breakout can injure the dermis, the layer of skin beneath the surface. When your body heals that injury, it lays down collagen quickly, but not always evenly.
Depending on how your skin responds, that healing process produces various types of scars, each with its own appearance and texture. Understanding which type you have matters because different scars respond to different treatments. The most common types include:
Most acne scars fall into this category. Atrophic scars sit below the surface of the surrounding skin because the healing process didn’t produce enough collagen to fill the wound. There are three main subtypes:
Ice pick scars are narrow, deep, and sharply defined, extending into the dermis and sometimes reaching the deeper subcutaneous layer. They resemble small punctures in the skin and are among the most difficult acne scars to treat because of how far down they go.
Boxcar scars have wider, flat bases with defined vertical edges, similar to chickenpox scars. They tend to show up on the cheeks and temples.
Rolling scars create an undulating, wavy texture across the skin. Fibrous bands of tissue tether the skin downward, producing depressions with sloping edges rather than the sharply defined walls you see with boxcar or ice pick scars.
These scars form when the body overproduces collagen during healing. Hypertrophic scars stay within the boundary of the original wound and can flatten over time. Keloids extend beyond it and keep growing. Both are raised and can feel firm or tender.
Flat dark spots left after a breakout aren’t technically scars but often get lumped in with them.
Post-inflammatory hyperpigmentation (PIH) is a pigment response to inflammation rather than a change in skin texture. It tends to fade on its own over time, faster with the right topical treatment, and responds well to laser resurfacing.
Atrophic scars respond well to treatments that rebuild collagen from beneath the skin. Dr. Koch uses radiofrequency (RF) microneedling with VoluDerm technology to deliver radiofrequency energy into the dermis, stimulating new collagen growth and gradually remodeling scar tissue.
For deeper or more extensive scarring, the AcuPulse™ Fractional CO2 Laser resurfaces the skin while driving collagen production in the layers below.
Rolling scars and isolated depressed scars often benefit from filler placed beneath the scar base to lift the depression to the level of the surrounding skin.
Most patients need a combination of approaches rather than a single treatment, and the right plan depends entirely on how your skin presents.
To schedule a consultation with Dr. Koch, call 669-279-3663, text the office, or book online at drkochfacialplasticsurgery.com.
