Filling agents work by elevating broad and shallow scars to approximate the surrounding normal skin; thus, decreasing shadowing which makes the scars less evident. Most filling agents are temporary, even your own collagen and fat when injected in this area may or may not survive permanently. Scars can be cut into and collagen grafts can be taken from other parts of the skin and inserted like a sandwich for sometimes permanent correction of large crateriform scars. Small icepick scars are best treated by cutting them out and resewing them or, even better, cutting them out and replacing them with small skin grafts from behind the ear – called “punch grafting.”.
A more definitive procedure for acne scarring would be dermabrasion or resurfacing with the ultrapulsed carbon dioxide laser as described above. This procedure works by filing down or burning down the surrounding normal skin to the level of the scar to give one a smoother, more even appearance. The scars are still there, they are just less deep, thus there is less shadowing. The complications from resurfacing procedures include scarring which can be thick, red and cordlike, particularly along the jawline, or more subtle whitish scars, particularly along the lips and lids. These procedures should be done by experienced physicians and every patient’s result is somewhat different; thus, while one can give a patient who has suffered the ravages of acne some significant hope for improvement, none of the surgical procedures are perfect and the patient certainly will not end up with “normal” skin or perfectly smooth skin. The goal of acne scar surgery or revision is improvement in appearance and many patients, particularly women, are more than satisfied just to be able to put on makeup smoothly without it catching in the pits. Other patients, however, enter into these kinds of procedures with the misunderstanding or false impression that they will end up with smooth or normal-appearing skin. There will always be some element of scarring.