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How to Find the Right Acne Scar Treatment Procedure for You—With or Without Lasers

Sara Coughlin

There’s something inherently a little daunting about the idea of getting laser treatments for a skin concern. But, as the landscape of acne scar treatments continues to evolve and expand, lasers remain at the forefront for good reason—even if the idea of them makes you think of something from Dexter’s Lab.

Still, lasers are far from the only option for treating acne scars. So, here’s what you need to know about laser and non-laser treatments for acne scars—and how to pick the best treatment option for your skin.

First off, what kind of scars do you have?

Acne scars come in all kinds of shapes and sizes and some people are more likely to develop some types rather than others, as SELF explained previously.

Your scars may be raised or depressed, widespread or minimal, deep or shallow. Raised scars, which includes keloids, are more likely to appear on the back or chest, the American Academy of Dermatology (AAD) explains. But people of color are more likely to develop raised scars in general, including on the face. Depressed scars, such as the more shallow boxcar and rolling scars as well as the deeper and narrower icepick scars, generally appear only on the face.

The type and severity of the scars you have generally determines which kind of treatment will be most effective for you. For instance, treatments that are designed to stimulate collagen, like microneedling, won’t do much good for those with raised scars that form as a result of an excess of collagen. And treatments that are meant to fill in the area left by depressed scarring won’t really help with raised scars. So, when talking to a dermatologist about your treatment options, the type of scarring you have is one of the first things they’ll want to examine.

Before you totally discount laser acne-scar treatments, here's how they work.

Like basically all other treatment options, lasers cannot completely remove your acne scars. They can only help reduce the appearance of scars and improve your skin’s texture. But still, lasers offer a straightforward, effective way to make a variety of different types of acne scars less noticeable—including raised and depressed scars. And there are actually several different types of laser treatments, with some working more gently than others.

For starters, lasers can be ablative or nonablative. Ablative ones create wounds that actually melt or otherwise destroy scar tissue and tighten up the collagen in the skin, while nonablative alternatives promote new collagen production by heating up the skin rather than causing an actual wound. Current thinking holds that ablative lasers are generally more effective for treating all kinds of scars because they’re such an aggressive form of treatment. But they are also undoubtedly harsher and riskier to use in patients of color because the wounds they create also create a greater likelihood of hyperpigmentation during the healing process. In turn, nonablative methods—which can still be incredibly effective—have become more popular.

Lasers can also differ in how they actually treat acne scars. For instance, they either work fractionally or nonfractionally. Nonfractionated lasers take a sort of “scorched earth” approach and affect the entire surface of the skin. Because of that more aggressive approach, they are generally considered to be more effective than fractional lasers. But they’re falling out of favor as gentler, safer and still effective treatments are developed, including different types of fractional treatments. Those fractional procedures treat the skin in a targeted grid, creating smaller “microcolumns of injury” while leaving some areas of the skin untouched, Neelam Vashi, M.D., associate professor of dermatology at Boston University School of Medicine and director of the Boston University Cosmetic and Laser Center, tells SELF. That triggers a healing response in the skin that generates new collagen and rebuilds the skin.

Fractional treatments (commonly known by the brand name Fraxel) can be ablative or nonablative, and even though nonablative options will be less invasive and allow for a quicker recovery time, neither are without their risks.

Laser treatments do usually come with some after-effects, including feelings of sensitivity, swelling, redness, oozing, and crusting, especially in the days immediately following the treatment, Hillary D. Johnson, M.D., Ph.D., FAAD, clinical associate professor of dermatology at the University of Iowa, tells SELF. These side effects are pretty standard across the board for all types of lasers, but may be more severe as your skin heals after more aggressive types of treatments.

After seven-to-10 days, the swelling should go down and you’ll be left looking and feeling like you have a bad sunburn, she says. So you’ll need to be extra careful about sun safety and cut back your skin-care routine to the bare minimum (definitely no exfoliating treatments) while your skin heals, which could take up to two months after treatment.

In addition to the down time, laser treatments are notoriously expensive. They can cost anywhere from $900 to $1600 per treatment, depending on the type of laser, and are generally not covered by insurance. Also, treating acne scars with lasers can require several appointments, and the amount of time it takes to complete treatment will vary from patient to patient, Dr. Vashi says. Luckily, she adds that “each laser treatment will make [the scars] somewhat better.”

So you could start to notice positive changes in your skin after a month, Dr. Johnson says, but you may also need to wait up to six months to see the final results.

Sometimes dermatologists will suggest a laser in addition to other acne scar treatments.

When you’re considering a treatment plan, it’s always important to ask your derm about all of your options to make sure you know what else is out there. And even if you decide on a laser treatment, it’s likely that your doctor will bolster their laser treatments with other, non-laser procedures. It’s actually pretty rare that a treatment plan for acne scars will consist of just one method—it’s more likely to feature some combination of treatments that each address a different type of acne scar, Dr. Johnson says. And Dr. Vashi echoes the importance of a multimodal approach: “There are very few patients I do one thing for.”

Even if that sounds complicated (or, for the laser-shy among us, just plain bad), Dr. Johnson says this tends to yield the best, most visible results, which is your dermatologist’s number-one goal. So don’t be surprised if your derm does, ultimately, recommend including some laser treatments as part of a larger plan.

Still not down for lasers? Here are some other acne scar treatments.

Chemical treatments

All chemical peels work via the same basic process: Apply a concentrated chemical substance to the skin, which essentially destroys the outer later of skin to remove damage and kickstart the body’s repair process.

Chemical peels can be an effective way to manage acne itself and, when done safely, they can also make subtle changes to very shallow scars, Dr. Vashi says. Light- to medium-depth peels containing an alpha- or beta-hydroxy-acid (such as glycolic acid or salicylic acid) will exfoliate the skin and reduce hyperpigmentation, she says. That can make the skin’s overall pigment and texture look more even.

But Dr. Johnson notes that these kinds of peels really can’t get deep enough to have an impact on deeper acne scars. There are so-called “deep” chemical peels that might be used for more intense wrinkles, scars, or precancerous growths, the Mayo Clinic says, but neither Dr. Vashi nor Dr. Johnson offer them in their own practices due to their potential risks, such as infections and scarring.

One type of chemical procedure—which involves the use of trichloroacetic acid (TCA)—has been found to be particularly effective in treating deeper, narrower scars known as “icepick scars.” These tend to be so deep that lasers and needles can’t penetrate far enough to reach their base, so, a tiny dose of TCA is dabbed into the scar to help close it up. But this type of treatment usually takes multiple sessions, lasting up to six months, to see improvements, Dr. Johnson says.

It should be noted that, although most chemical peel options are superficial enough that they won’t increase the risk of hyperpigmentation for people with darker skin, procedures involving TCA might be an exception.

Best for: Treating acne itself and the shallowest scars. To get deeper into the skin, look into TCA treatments, which are especially useful for deep icepick scars.

Cost: $150-200 per treatment

Dermabrasion and microdermabrasion

Along the same lines as traditional ablative laser treatments, dermabrasion works by removing layers of the skin in order to reduce the depth and appearance of any scars. And, like nonfractionated lasers, it does not take a targeted approach.

Although dermabrasion used to be a popular treatment for scarring, its risks and long-term side effects (such as prolonged redness and swelling) have started to eclipse the appeal it once had. “Only pursue [dermabrasion] if it’s in the hands of an expert,” Dr. Johnson says. “It can go very badly—it’s easily overdone.”

Microdermabrasion, on the other hand, is more similar to a mild chemical peel in that it’ll help exfoliate the skin and unclog pores, but probably won’t offer much in the way of significant scar reduction. Simply put, as laser and needling techniques become more sophisticated and precise, both dermabrasion and microdermabrasion have continued to fall out of favor.

Best for: Shallow, widespread depressed scars. For deeper scars, surgery may also be required.

Cost: $150-200 per treatment

Microneedling

They may seem different at first, but microneedling actually follows the same concept as laser treatments: Using needles instead of heat or pulsated light, it creates microscopic wounds in the skin that ultimately spur new collagen growth. A study published in 2016 in Dermatologic Surgery found that, in 46 patients with depressed acne scars, three monthly treatments of microneedling may be as effective as nonablative fractional laser treatments—with shorter downtime and fewer side effects.

In fact, Dr. Vashi co-published a review earlier this year in Dermatologic Surgery noting the treatment’s effectiveness at managing acne scars with less redness and swelling than laser treatments.

That said, results from microneedling treatments can be somewhat user-dependent since the devices are applied manually, Dr. Johnson says, so it’s important to see someone who’s very familiar with this somewhat newer procedure.

Best for: Widespread scars, but only useful for depressed scars—not raised ones.

Cost: $400-600 per treatment, an average of four-to-six treatments usually needed.

Fillers

Fillers containing hyaluronic acid or collagen can certainly work in tandem with other treatments to minimize the appearance of acne scars. But they only offer a temporary “mask” for a scar’s depression, Dr. Johnson says. Even if this method appeals to you and works for your skin, repeat appointments can add up, making it a potentially pricey solution.

That said, some types of fillers are longer lasting than others, and there are ones that even claim to be permanent. These usually contain some kind of plastic or silicone, which Dr. Johnson describes as much higher-risk than their temporary counterparts.

Best for: Fillers are best at temporarily disguising a few depressed but shallow scars, like boxcar and rolling scars.

Cost: $650-900 per syringe. Between one and two treatments is usually enough to see results, but know that fillers aren’t permanent and you’ll need to repeat the process after anywhere between six months and two years after your last procedure.

Injections

Dr. Vashi says she’ll usually treat raised scars (which, depending on their age, can be very difficult to address) with several rounds of steroids that are injected directly into the scar or lesion in order to reduce its height.

Although some studies have found this treatment to be effective the scar could still come back months or even years after undergoing the procedure. And there is a risk for atrophy in the surrounding tissues associated with steroid injections. So—we can’t say this enough—be sure you’re seeking treatment in a medical setting with a doctor you trust.

In some cases, your dermatologist may instead use injections of 5-fluorouracil (5-FU), a chemotherapy drug, Mary L. Stevenson, assistant professor in the Ronald O. Perelman Department of Dermatology at NYU Langone Health, tells SELF. Steroid injections can also be used in combination with 5-FU injections if needed, she says.

Best for: Raised acne scars.

Cost: The cost and amount of treatments needed varies widely depending on the scar.

Surgery

Surgical options for acne scars may seem a little counterintuitive, since surgeries in and of themselves leave scars behind. According to the AAD, these post-operation scars will gradually fade. The AAD also notes that acne scar surgery may involve lifting the scar so that it leaves less of a depression in the skin, or a procedure called subcision, in which the scar tissue that’s pulling the skin down is broken up.

Subcision works particularly well as a precursor to laser treatments as it frees up the skin, so to speak, and allows the laser to work more efficiently over the area, Dr. Vashi says. As with any surgery, there’s always a risk of bleeding or infection, Dr. Johnson says, so, again, be sure that your provider is an experienced, board-certified dermatologist.

Best for: Those who have just a few depressed scars. Some types of surgery can also address raised scars that haven’t responded to other treatments, like injections.

Cost: $200-400 per scar/lesion

Topical silicone treatments

With new or only slightly raised scars, Dr. Vashi says silicone gel sheets, which work to reduce the scar’s size and stiffness have been found, anecdotally, to be effective treatment options. Silicone gels and sheets are also an attractive option because they can be purchased over-the-counter at drugstores or online.

But they take a fair amount of dedication to get results: You’ll need to wear the sheet (basically all day) in the same spot every single day for a while, possibly months, the AAD says. That can cause side effects, including rashes. And, if you’re treating acne scars on your face, you may not want to put up with that. Even if you do, know that silicone treatments aren’t likely to completely treat the scar.

Also, know that topical silicone treatments are most effective if used “while the scar is healing and before it thickens,” Dr. Stevenson says. So if you’ve had a raised scar for a few years and are just now thinking about trying to minimize it, you may not see great results with topical silicone.

Best for: New or only slightly-raised scars.

Cost: $20-40 for a package of eight sheets.

There is no one “right” way to address acne scars.

Just as a reminder, scars are not inherently dangerous or bad for you. They’re usually a normal part of the healing process. And the treatments out there to make them less noticeable are costly and definitely not perfect. So, if they don’t bother you, it’s perfectly fine to keep them around!

But if you do want to try to get rid of them, there are plenty of options out there. And your best course of action will be to talk to your dermatologist about which procedures are best for you.

And, instead of viewing lasers as something to avoid when planning your scar regimen, think of them as the Tony Stark of the Avengers-esque assembly of treatments your dermatologist will prescribe—undoubtedly intense, but they’re going to anchor the rest of the team. (We know you didn’t ask, but dermabrasion is obviously the Hulk.)

When carried out by an experienced derm and taken as just one part of your overall treatment plan, laser treatments don’t have to be scary. But the most important thing is to work with a dermatologist you trust to find a plan that works for you—with or without lasers.

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Originally Appeared on Self