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Postacne scarring remains a challenge of therapy, no matter what the ethnicity of the subject. The skin behaves as if it had a tremendous memory of the depth and severity of the existing scarring and the skin requires an inordinate amount of therapy to alter and improve its appearance.

Methods of Assisting Postacne Scars

There are only a limited number of ways that the scarred skin may be helped. Broadly and simplistically, one can act on the scar by following methods:

Cutting it out

This includes all methods of excising scars. This is necessary in a number of instances either when the scar is dystrophic, has a white base, or is in the middle of a bearded area (Figure 18.1A, B, C, and D). This category also includes a variety of “punch” techniques such as punch elevation, punch excision, and punch grafting. These techniques at utility in treating punched out and ice pick scars (Figures 18.2A and B).

Figure 18.1

W-shaped scar. (A) Pretreatment. (B) Outlined. (C) Immediately. (D) Three weeks postexcision

Figure 18.2

Patient with type 4 skin immediately before (A) and immediately after (B) punch float technique

Filling it up

This includes autologous (autologous collagen, dermal, and fat grafting) and nonautologous temporary, semipermanent, and permanent augmentation techniques, and agents (Figure 18.3).

Figure 18.3

Patient (A) before and (B) after subcision, fat transfer, and combined CO2 and erbium laser resurfacing

Altering its color

Sometimes a scar is purely visible because of its color and sometimes the color makes an atrophic or hypertrophic scar more visible. It depends on the color as to the technique utilized. For brown or hyperpigmented scars often this represents postinflammatory hyperpigmentation and is responsive to medical therapy with bleaching preparations and light chemical skin peeling (Figure 18.4). For erythematous scarring or marking home care, vascular laser and time may be all that is required (Figure 18.5). Hypopigmented marking is more difficult and may require pigment transfer techniques (Figures 18.6 and 18.7).

Figure 18.4

Postinflammatory hyperpigmentation following acne misdiagnosed as postacne scarring

Figure 18.5

Erythematous marking in a patient recovering from active acne

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