An atrophic scar is one that is generally sunken, pitted, or indented. These scars are the polar opposite of the other major scar category, hypertrophic scars, which are raised above skin level. The most common cause for atrophic scars is acne. Other causes include chickenpox, surgery (especially shave excisions), and injury.
Three Types Of Atrophic Scar:
There are three main types of atrophic scars: ice pick, rolling, and boxcar.
Ice Pick Atrophic Scar
Ice pick atrophic scars resemble very dilated pores. They have an “upsidedown-V” shape in the skin.
Rolling Atrophic Scars
This type of scar is shallower and wider than the ice pick scar. One scar seems to roll into the next without discernible borders separating the two.
Boxcar Atrophic Scars
Boxcar scars are somewhere in between ice pick and rolling scars. They have discernible edges but are wider than ice pick scars. They often have a rectangular or square shape.
How To Get Rid Of An Atrophic Scar:
There are a number of modalities for the treatment of an atrophic scar. Which one is most suitable for you depends mostly on the type(s) of atrophic scars you have.
Atrophic Scar Skin Resurfacing
These treatments cause controlled damage to the skin’s upper surfaces. Regeneration of these layers creates an evened-out, smoother appearance. The overall result is decreased visibility of atrophic scars, especially boxcar and rolling types. There are several ways to perform skin resurfacing:
This technique uses a chemical agent such as glycolic acid to cause a controlled burn to the skin surface.
Dermabrasion And Microdermabrasion
Dermabrasion uses a mechanical roller resembling sandpaper to denude the upper skin layers. Microdermabrasion makes use of a sandblasting-type approach. Both techniques are designed to carefully remove the upper skin layers.
Lasers such as Carbon Dioxide, use light energy to remove the top skin layer. Healing is generally with a smoother appearance that obscures an atrophic scar’s appearance.
These approaches to scar treatment cause the production of collagen deep in the skin. Build up of collagen lends support from below to indented and pitted atrophic scars. This “plumps up” the skin and decreases the visibility of the atrophic scar. Collagen regeneration can be accomplished by a variety of techniques:
Rollers or cartridges that bear multiple tiny needles are used to create numerous small puncture wounds in the skin’s surface. The healing of these wounds stimulates collagen production.
Unlike ablative lasers, these systems bypass the skin’s uppermost layers. Light energy is transmitted to deeper skin tissues to stimulate collagen production. Collagen production helps to smooth and diminish the visibility of atrophic scars.
Atrophic Scar Surgery
Multiple surgical procedures have been developed to deal with atrophic scars. These techniques surgically remove the atrophic scar and either stitch the wound closed or use grafts from healthier areas of skin to replace the atrophic scar. Punch excision and punch grafting are amongst the surgical methods used to treat atrophic scars in this way. Subcision is a surgical technique that takes a different approach. With subcision, a needle is inserted into the skin and underneath the scar. The sharp needle tip is then used to release fibrous bands that are holding the scar down. The release of fibrous bands with subcision can be effective to improve the appearance of atrophic scars.
Fillers use either natural (fat) or synthetic substances to minimize the appearance of atrophic scars. The material is injected below the atrophic scar. This provides structural support from underneath the scar, lifting the scar up and reducing the visibility of the scar. The most common synthetic filler used is hyaluronic acid.
An atrophic scar is a sunken, pitted, or indented scar. Inadequate volumes of collagen and other supportive skin structures are the underlying problem that gives these scars their characteristic appearance. Several treatment modalities exist to treat these scars. Some methods resurface the upper layers of skin, and others promote collagen regeneration deeper in the skin. Surgical techniques and filler substances are also mainstays of management. The approaches that will best suit you depend mostly on the type of scar being treated as well as budget considerations.