Over-the-counter skin care products will do little to nothing for to help raise very depressed acne scars.There are some prescription topical that may provide some improvement, but nothing dramatic. Save some money and when you have enough, consult with a board-certified dermatologist or plastic surgeon for these options that can give you way better results than any creams can do. Trust!
TYPE OF SCARS AND POSSIBLE TREATMENTS
Ice Pick (looks like an ice-pick pierced the skin) – Laser (CO2, Er:YAG, or fractional laser), Medium chemical peels, dermabrasion, punch technique
Boxcar – Laser (CO2, Er:YAG, or fractional laser), Augmentation, dermabrasion, punch technique
Rolling – Laser (CO2, Er:YAG, or fractional laser), Skin needling/rolling, Augmentation, Subcision, peels, dermabrasion,
Hypertrophic – Steroid injection, cytotoxic injection, Cryosurgery
CO2 Laser – The CO2 laser system can be used in several ways: "focused" for cutting skin without bleeding, "defocused" for superficially removing your skin, and "ultra pulsed" for facial resurfacing.
Er: YAG laser – When the laser is pulsing, called "Q-switched," the laser blasts the damaged or unwanted tissue away. The pulsing should lessen the heat on the skin, therefore reducing potential for damage. Some Yag lasers use a cooling spray simultaneously when the laser is heating the skin. One of these lasers is the CoolTouch 1320; it works by spraying the outer skin and sensitive nerve endings with a cooling liquid keeping the skin to 111ºF-118ºF. Er: YAG is less ablative than CO2.
Fractional laser – This is a non-ablative laser that does not burn off layers of skin. Rather, it uses high energy beans to create microscopic columns deep into the dermis, which trigger our natural wound healing reponse. The areas of skin that are not affect by the laser speeds up the healing process, thus, less downtime.
Dermabrasion - Superficial dermabrasion removes portions of the epidermis and deep dermabrasion removes all of the epidermis and portions of the dermis. Deep methods are the preferred method for treatment of scarring. Deep methods are effective but generally require weeks of healing time and carry a higher risk of complications
Skin needling/rolling – similar method to laser as it uses sharp needles to prick the skin, creating small injuries that can trigger wound healing process. The depth of wounds depends on the length of the needle. Usually people get 1.5-mm needle because it can reach the dermis in that length.
Chemical peels – light (superficial) peels range glycolic, lactic, or salicylic acids, for example. Medium peels usually mean the use of trichloroacetic acid because it penetrates deeper into the skin layer. Deep peels means the use of phenols, which is very strong and is rarely used anymore as it can create mark of demarcation in skin color. These acids exfoliate and stimulate collagen formation. Bottom line: the higher the concentration (or strength) of acids the higher the potential of irritation.
Steroid injection – the use of steroids (corticorsteroids) reduces inflammation and stops the growth of fibroblasts and collagen formation.
Augmentation - A needle is used to inject filler material into the atrophic scar. There is a wide range of materials used, from bovine collagen to fat to silicone; most are not permanent. Researchers are still searching for the ideal material. When fat is used, it is taken from elsewhere on the body (thighs, abs, buttocks). 50% of fat will be resorbed after 1 year. Silicone and Gore-Tex® are permanent. However, silicone has significant potential side effects, and Gore-Tex is not FDA approved.
Cytotoxic injection - Fluorouracil (a cancer drug) or bleomycin (an antibiotic) are injected into the raised or keloid scar, in the hopes of improving the scar's appearance. These medications are often injected in conjunction with low-strength steroids to improve results.
Subsicion - Local anesthesia is used and a needle is then inserted under the scar and gently moved underneath the skin to release the scar tissue. This method has been tested in recent studies and shown to be effective.
Cyrosurgery - Very cold liquid nitrogen is applied to the scar with a cotton ball or sprayer. Time of application can range from 10 seconds to 2 minutes. Sometimes this is combined with steroid injections for better results. The goal of cryosurgery is to freeze the scar, which damages the scar/skin tissue. The tissue dies and is sloughed off, flattening the formerly raised area.
Punch technique: Punch Excision: surgical removal of scar followed by suture. Punch Elevation: center of scar (usually boxcar) is cut loose from the bottom, but is not discarded. It is allowed to float up to the level of the surrounding skin. Punch Grafting: scar is removed and skin from elsewhere on the body, often from behind the ear, is attached in its place. This tends to work best for deep scars.