Hypertrophic Scar

An acne scar can be deep or shallow, small or large, and dark or light in appearance. Even the best acne treatment in town cannot stop an acne scar from its development because the original structure has been compromised by the skin infection. The good news is that there are many effective ways to significantly lessen the appearance of an acne scar such that it becomes invisible to the naked eye.

But not all acne scars are carved equal on the skin, pun not intended. Don't expect an atrophic scar to heal in the same manner and be treated with similar approaches as a hypertrophic scar simply because these are two different types. While an atrophic scar is caused by the loss of tissue, a hypertrophic scar is caused by excess tissue.

Within these two general types of acne scarring are four sub-types. Keep in
mind that each type of scar has specific causes, treatments and appearance just as there are many treatment options. It is best to work with a qualified dermatologist in the treatment of whatever acne scarring you may have to avoid worsening the skin's present condition.

Ice-Pick Scars
An ice-pick scar looks like it was gauged on the skin using an ice pick or other pointy instrument.
The result is a deep, narrow hole in the skin that may also look like a large and open pore. This type of acne scarring develops after a cyst infection works its way toward the skin's surface. When the skin heals, a column-like scar remains.

Effective treatment for an ice-pick scar can be either punch excision or punch grafting. Both involve excising the scar with a punch tool and then either suturing shut the skin edges (punch excision) or filling in the skin defect with a graft (punch grafting). Resurfacing techniques will then make the scar less noticeable.

Boxcar Scars
A boxcar acne scar results from the destruction of collagen due to an inflammatory breakout. It appears like a round or oval depression coupled with steep vertical sides. Think of skin with the pitted appearance of an orange, albeit with wider diameters on the holes. Similar to the ice-pick type, a boxcar scar responds well to punch excision. Other options include laser resurfacing and dermal fillers, although results will vary depending on the severity of the scarring
itself.

Rolling Scars
A rolling scar looks like a wave undulating across normal skin. It is the result of fibrous bands of skin tissue pulling on the epidermis, which leads to the rolling appearance at the skin's surface. Dermatologists often employ the procedure known as subcision wherein the skin tissue of the affected area is separated from the deeper scar tissue. Resurfacing treatments can then be administered after the incision has healed to even out the skin's appearance.

Hypertrophic Scars
A hypertrophic scar appears as a raised, firm and cyst-like tissue that often grow larger than the original pimple itself. Most of these scars happen on the torso instead of the face. The most common treatments for hypertrophic acne scarring are steroid creams and injections. The obvious goal is to shrink and then flatten the acne scar to make it less noticeable to the naked eye.