Treatment for Depressed Acne Scars

1. Box Type

Round or oval depressions with flat bottoms and nearly perpendicular edges. They account for about 20-30% of atrophic scars, and chickenpox scars often take this form as well.

2. Ice Pick Type

Narrow, deep depressions less than 2mm in diameter, accounting for about 60-70% of atrophic scars. They extend deep into the dermis, and histologically, the dermal layer is almost completely absent.

3. Rolling Type

Gently undulating depressions over 5mm in diameter, accounting for about 15-25%. Fibrotic tissue causes the epidermis to adhere to the fascia, and muscle movement can accentuate the depression. This type is also called “anchored acne scars” or “tethered acne scars.”

4. Fat Atrophy Type

Depressions caused by reduction of subcutaneous fat, occurring when fat tissue becomes scarred due to inflammation. Age-related fat reduction may also contribute, with scars that were not noticeable in youth becoming more prominent with age.

1. Box Type Treatment

Treatment Methods

Box type depressions are relatively responsive to treatment. The main treatment methods are as follows:

• CO2 Fractional Laser (eCO2)
• Dermapen

These treatments destroy scar tissue and promote wound healing, making depressions less noticeable. After treatment, exosomes or placenta are used in combination to promote collagen and elastin production and enhance healing. Additionally, hydrocolloid patch moist therapy is applied to tissue damaged by treatment to promote wound healing and replace depressed scar tissue with flat scar tissue, making it less noticeable.

Treatment Duration and Intervals for eCO2 and Dermapen

Treatment Progress for eCO2 and Dermapen

eCO2 (CO2 Fractional Laser) Immediately After Treatment
Immediately after treatment, fine dot-like marks appear on the skin as shown in the photo. Subsequently, redness and swelling occur, sometimes accompanied by bleeding or exudate.

Dermapen (Microneedle) Immediately After Treatment
After Dermapen treatment, the skin becomes red and numerous fine wounds are visible as shown in the photo.

Our eCO2 and Dermapen treatments use high intensity and high energy while stretching the skin to thoroughly destroy acne scar tissue and promote skin regeneration. Therefore, post-treatment downtime is approximately 1-2 weeks.

After eCO2 and Dermapen treatments, hydrocolloid tape is applied to promote wound healing. Allowing wounds to dry delays healing. To regenerate the destroyed scar tissue as cleanly as possible, it’s important to maintain a moist environment (keeping wounds from drying out).

About one day after treatment, the tape absorbs exudate from the wound and becomes white and swollen throughout. Usually, the tape swells completely in 1-3 days, and when it can no longer absorb more, it needs to be changed. When changing, gently remove it while moistening with water and apply a new tape.

Applying tape for at least 3 days post-treatment promotes wound healing and leads to a smoother finish.

Case Study: Box Type Acne Scars on Temples

Treatment Details

Before treatment, deep, widespread box-type acne scars were prominent, and age-related temple hollowing emphasized the overall sunken appearance. After treatment, the depressions were significantly reduced, the skin became smoother, and plump temples were achieved, restoring a natural and youthful appearance.

• Treatment Period: 2.5 years
• Treatment Details: eCO2 5 sessions, Dermapen 3 sessions, Exosome/Placenta option 3 sessions, Subcision 2 sessions, Hyaluronic acid injection 1 session, Juvelook 3 sessions, Lenisna 1 session
• Cost (both temples): eCO2 (5×5cm) ¥16,280×5 sessions, Dermapen (5×5cm) ¥10,780×3 sessions, Exosome/Placenta ¥25,190×3 sessions, Subcision ¥19,800×2×2 sessions, Hyaluronic acid ¥79,200, Juvelook ¥44,000×3 sessions, Lenisna ¥44,000 = Total ¥484,110

Main Treatment Approach

CO2 fractional laser (eCO2) and Dermapen were used to destroy scar tissue and promote wound healing. Additionally, exosomes and placenta were used after treatment to promote collagen and elastin production and enhance treatment effects.

Approach to Large Depressions

For deep depressions, subcision was used to release adhesions, and Lenisna was injected to achieve a smooth finish. Juvelook was injected into the dermal layer to improve skin firmness and enhance the overall appearance.

Correction of Age-Related Volume Loss

For depressions caused by fat and bone atrophy, hyaluronic acid was injected above the periosteum to restore volume. This plumped up the entire temple area and restored youthfulness.

Treatment Points

Even seemingly single acne scars are actually caused by multiple interrelated factors. In this case, these factors were comprehensively analyzed, and multiple treatment methods were combined to achieve effective improvement. Since acne scar treatment requires long-term perseverance, early “acne treatment” is most important to prevent acne scars from forming in the first place.

1. Pain

Cream anesthesia is applied, but pain accompanies the procedure. Severe pain subsides within one day.

2. Redness

Usually improves in 3 days to 2 weeks, but rarely may continue for several months. Please schedule your next treatment after the post-treatment redness disappears.

3. Acne

Acne may temporarily increase.

4. Melasma

If hidden melasma exists, it may appear due to eCO2 or Dermapen stimulation. In such cases, separate melasma treatment such as tranexamic acid oral medication is required.

5. Pigmentation

Depending on constitution and skin type, scars after laser or Dermapen may become pigmented. Also, failure to follow tape treatment or UV protection makes pigmentation and darkening more likely. Usually improves naturally within six months, but rarely may remain long-term.

6. Burns and Scar Formation

Very rarely, there is a risk of burns after eCO2 or scar formation after Dermapen wounds due to skin type and constitution.

7. Allergies and Anaphylactic Shock

Very rarely, severe allergic reactions (anaphylaxis: systemic rash, swelling of skin/lips/tongue, difficulty breathing, palpitations, blood pressure drop, consciousness disorders, convulsions, etc.) may occur due to constitution from cream anesthesia (containing lidocaine, trace amounts of propylene glycol, ethanol, methylparaben, etc.), tape anesthesia, or local anesthesia. Theoretically, this can occur with any ingredient, so it may also occur with growth factors or placenta products. If symptoms occur after returning home, call an ambulance immediately.

Common Side Effects

1. Needle Marks, Redness, and Bruising

Needle marks improve in 1-3 days, redness in 1 day to 2 weeks, and bruising in 2-3 weeks.

2. Pain and Itching

Pain and itching may be felt at injection sites for several days after treatment.

3. Numbness and Discomfort

Numbness and discomfort may be felt due to contained anesthesia, but improve quickly.

4. Tyndall Effect

When hyaluronic acid is injected into shallow layers such as under the eyes, it may appear blue and look like dark circles. This does not occur with polylactic acid.

5. Swelling and Irregularities

Swelling and irregularities occur after injection. Also, hyaluronic acid may be palpable subcutaneously, but leave it as it is lifting depressions and wrinkles. Usually blends in gradually over about 2 weeks, but if still bothersome after 3 weeks, consult with the doctor.

Very Rare but Serious Side Effects

1. Allergies and Anaphylactic Shock

Some people may have allergies to contained anesthetic components, pre-treatment cream anesthesia or tape anesthesia components, hyaluronic acid, polylactic acid, etc. If severe allergic symptoms (systemic rash, swelling of skin/lips/tongue, difficulty breathing, palpitations, blood pressure drop, consciousness disorders, convulsions) occur after returning home, call an ambulance immediately.

2. Foreign Body Granuloma, Induration, and Nodules

Induration and nodules may occur at injection sites due to excessive fibroblast reaction, immune reaction, or allergies. Very rarely, “foreign body granuloma” lumps may appear and remain as scars.

3. Infection

People with weak immunity or immunodeficiency may develop infection from insertion sites.

4. Vascular Occlusion

Serious complications such as arterial embolism, skin necrosis, skin discoloration, blindness, visual impairment, and stroke have been reported due to accidental intravascular injection.

5. Nerve Damage

Sensory and motor nerve damage may occur. Usually improves in about 3 months, but very rarely may persist.