But we get it, knowing you’re in good company offers cold comfort when you’re feeling low about your acne scars.
If you feel like your skin is letting you down, we’re here to reassure you that science is on your side, with ever-increasing options for the treatment of acne scars. And injectables, including dermal fillers, botulinum toxin and platelet-rich plasma therapy, are leading the way.
Can all types of acne scars be treated with injectables?Yes, potentially. There are, however, a lot of factors at play, including the time elapsed between the onset of acne and the start of effective treatment, the severity of the scarring, and the types of scar.
Balsam Alabassi, Founder of DermRefine Skin Clinic stresses: “Detailed assessments are paramount for effective and safe treatment. The knowledge, skill and experience of the practitioner will play a vital role in identifying the type of scarring and the most suitable treatment option.”
Managing expectationsThere is no doubt that injectables can produce incredible results when used to treat acne scarring but, equally, it is important to be realistic with your expectations.
Dr Ioannis Liakas, Medical Director at Vie Aesthetics, says: “Patients should be aware that the objective is always an improvement, rather than a complete resolution of the issue, and that it will be an ongoing endeavour.”
Alabassi echoes this sentiment, saying: “It’s not only about the treatment protocol but rather the journey to scar reduction; the patient and treatment must be continuously reviewed.”
Injectable acne scar treatments aren’t for everyone“If you have taken Roaccutane within the last six months, or if you have active acne, then, unfortunately, it isn’t the right time for your acne scars to be treated with any injectables”, says Sean White, Medical Aesthetician at Sean White Aesthetics.
In the case of active acne, White recommends that you seek guidance from an expert professional and begin a prescribed treatment protocol to treat the acne.
He says: “For a lot of patients, a combined treatment approach, using ZO Skin Health Acne products alongside Dermalux led phototherapy, gets the best results in the fastest time. Once the active acne has been tackled, then the scars can be treated.”
Are you sure you have acne scars?This question isn’t as daft as it sounds. Julie Scott, Clinical Director at Facial Aesthetics, says: “I get an awful lot of people coming to me for treatment of what they think is acne scarring, but is actually post-inflammatory hyperpigmentation.”
Post-inflammatory hyperpigmentation (PIH) are the dark patches that are left on the skin following an acne breakout. PIH will fade naturally, although you can use products to speed up the process.
The easiest way to tell the difference between PIH and genuine acne scars is by touch. PIH patches are flat, whereas acne scars cause textual changes to the skin.
The majority of acne scars (75 per cent) are caused by insufficient collagen production during the wound healing process, which causes a depression in the skin, known as atrophic scarring.
You may also have raised scarring, known as hypertrophic scars or keloids, which occur when too much collagen is produced during the wound healing process.
Scott says: “Most patients present with more than one type of acne scar, and require more than one type of treatment. It’s usual for a treatment plan to consist of more than one thing, so starting with an accurate assessment of the types of acne scars is essential.”
What type of acne scarring do you have?
Hypertrophic scars: Raised, keloid scars are the least common type of acne scar, and also the most difficult to treat. White says: “The excess collagen that creates these scars is produced as the result of the trauma caused by acne. So we absolutely need to avoid any procedure that causes more trauma as it may make the scar worse.”
This doesn’t, however, mean that injectables are totally out of bounds when treating hypertrophic scars. On the contrary, one of the most effective ways of flattening keloid scars is with the use of steroid injections.
Atrophic scars: “There are three types of atrophic acne scar: rolling scars, boxcar scars, and ice-pick scars,” says Scott. “I most commonly see patients with rolling and ice-pick scars, but all three types are treatable.”
- Ice-pick scars, which account for up to 70 per cent of atrophic scars, are little holes that go deep into the skin.
- Boxcar scars form a round or oval indent on the skin and have a flat bottom, a lot like chicken pox scars.
- Rolling scars create soft indents on the skin, creating a wave-like effect. Whilst they are the least common type of atrophic acne scarring, they are the most likely to respond well to injectables.
There can be a minor hurdle to overcome before treating atrophic scars with injectables; the scar damage can make the skin quite tough and difficult to inject. Fortunately, this obstacle is an easy one to overcome.
Scott says: “There’s no point even trying to inject into hard scar tissue. You need to separate the tethered tissue first and you do this with a technique called subcision.”
What is subcision?“For a lot of patients, subcision will be the first line treatment, to release and separate the scar tissue,” says Alabassi.
This is done using a needle to gently move and break down the hard skin tissue. No downtime is required, so injectable treatments can be given during the same appointment.
Which injectable treatment is best for acne scarring?This is a question that can only be answered by a professional, and only once they have examined the area in question.
“There is no such thing as one type of treatment, not even for a single face,” says Scott. “There are different scar types, different combinations of scars, different severities of scars, individual health concerns or contraindications. Every case and every face is unique.”
“Ultimately, the combination of injectables with other treatments will have the greatest impact in reducing acne scarring,” says Dr Liakas.
Below are some of your options:
Dermal filler injectionsWhile there are several different types of filler that can be used to treat acne scars, they all have the same thing in common: the potential to instantly, and dramatically, improve the appearance of acne scars.
Dermal fillers work by filling the depression caused by the scar, creating a more even skin texture.
Hyaluronic acid is, by far, the most common type of dermal filler. A substance that naturally occurs in the human body, these injections smooth acne scars and are best suited to rolling scars and boxcar scars.
Downtime is minimal and results last for at least six months.
Scott is a fan: “I adore Belotero Soft hyaluronic acid as it sits very superficially and is very forgiving on scar tissue.” Other brands of hyaluronic acid filler that are popular with practitioners for treating acne scars include Viscoderm, Restylane, Teoxane and Juvederm. Dr Liakas says: “In terms of injectables, Juvederm Volite dermal fillers can help to enhance skin quality through hydration.”
But hyaluronic acid isn’t the only dermal filler on the block for the treatment of acne scars:
- Sculptra poly-L-lactic acid dermal filler lasts between two and five years and not only replaces the lost volume caused by acne scars, but also encourages the body to naturally replace collagen.
- Ellansé polycaprolactone dermal filler works in a similar way to Sculptra, encouraging natural collagen production and giving results that last between one and four years.
Botulinum toxin injectionsEffective at smoothing out puckered skin around acne scars, particularly rolling scars, botulinum toxin injections including Botox are usually used in combination with dermal fillers.
The toxin relaxes the muscle around the scar, putting the damaged area of skin under less stress, while the filler smooths out the depressed area.
Results from botulinum toxin aren’t as immediate as with dermal fillers and don’t last as long, but downtime is equally minimal.
Micro-infusionBest known under its brand name, Aquagold Fine Touch, White advocates micro-infusion as the go-to treatment for acne scarring. “Needles thinner than a human hair deliver a cocktail of nutrients straight into the acne scar. Dermal filler and botulinum toxin can be included in this cocktail. It really is a revolutionary treatment.”
The micro-infusion device features 20 gold-plated needles, so tiny that you will feel zero discomfort (honestly!). A blend of nutrients selected to treat acne scarring will smooth and hydrate the skin. There is no downtime with micro-infusion and results last three to four months.
Dr Liakas uses the micro-channelling device for his ‘ReTouch Gold with WOW Fusion’ treatment and says: “The benefits of this new micro-channelling method are pretty vast. The fact there are 20 needles administering the product simultaneously means it can treat large areas that would otherwise be tricky to address. The skin remodelling properties in the injected solution help regenerate the skin.”
Platelet Rich Plasma therapy (PRP)Don’t let its ‘Vampire facial’ nickname detract from the fact that PRP can be a highly effective treatment for all three types of atrophic acne scar, with growing evidence to suggest it may also be a viable treatment for hypertrophic acne scarring.
Dr Liakas says: “PRP therapy provides great results with the treatment of acne scarring as it utilises the body's own healing properties to rejuvenate, tighten and re-dermalise the skin.”
A small amount of your blood is taken at the start of the treatment, from which the plasma is isolated and injected into the acne scars.
The platelet-rich plasma immediately begins to release its proteins, which increase volume in the skin and enhance collagen production. Two or three treatments are usually needed to get the best results, which then last for up to 18 months. There is no downtime.
Steroid injectionsRaised hypertrophic or keloid acne scars can be treated with cortisone steroid injections, which work to flatten the scar by breaking down the bonds between the collagen fibres.
Downtime is minimal, and a course of around six injections is usually needed for best results. However, there are risks attached so it’s important to discuss this option with a professional before making any decisions.
Cortisone (also known as hydrocortisone) is a prescription-only medication and, consequently, these injections are only available from a doctor, dermatologist, nurse-prescriber or other practitioner who is licensed to prescribe and is fully trained in administrating cortisone shots.
Julie Scott, Owner & Clinical Director
Julie Scott has over 25 years experience in the field of plastics and skin rejuvenation and is a member of the BACN and RGN, having qualified as a Plastic...Book with Julie Scott
Ioannis Liakas, Medical Director
Dr Ioannis Liakas is a shining gem in the aesthetics world. Prior to becoming an industry leading practitioner, he worked for the NHS for more than 20...Book with Ioannis Liakas
Balsam Alabassi, Owner and Founder of Dermrefine Skin Clinic
I am an Independent Prescriber and hold level 7 in Aesthetic Medicine. I adopt a personalised approach to provide you with a complete care solution, thereby...Book with Balsam Alabassi
Sean White, Director
Sean began his journey in the field of aesthetic medicine in 2016 and has enjoyed training with a range of industry experts. He committed to a career in...Book with Sean White