Grade 1 Acne Scarring

This involves mainly surface and colour issues, with areas of scarring showing up as flat, pink areas, and in some cases brown (especially in darker skin types) or too white. Treatment options in this case include: skin products to use at home (e.g. containing vitamin C, retinol, tretinoin, hydroquinone, azelaic acid, glycolic acid), medical-grade chemical peels, microdermabrasion, laser (e.g. Genesis) and broad band (BBL) or intense pulse light (IPL). Microneedling (medical-grade) +/- PRP (platelet-rich plasma) or RF (radio frequency; e.g. Forma®) is also particularly helpful for mild/Grade 1 acne scarring.

Grade 2 Acne Scarring

Again mainly surface marks, but also mild depressed or slightly thickened skin that can be covered with makeup and may not be that obvious from a distance. This form of scarring is a result of altered collagen reflectance, loss of skin glow, and shadows cast by scars. These scars require skin surface improvement and mild volume changes. Treatment options include skin products at home as mentioned in Grade 1 scarring, & also chemical reconstruction of skin scars (TCA CROSS) and subcision. As well, chemical peels (medical-grade, not “spa” peels), microdermabrasion, and resurfacing lasers (e.g. ProFractional laser) can gradually improve the quality of the underlying collagen. Microneedling (medical-grade) +/- PRP (platelet-rich plasma) or RF (radio frequency; e.g. Forma® or Morpheus8®) is also particularly helpful for all severities of acne scarring.

Grade 3 Acne Scarring: “Moderate Scarring”

With this type of acne scarring, there is moderate atrophic (depressed scars), or hypertrophic (thickened) scars. This type of scarring is visible at conversational distance, & can be flattened through stretching out of the skin, but not easily covered with makeup. This form of scarring often benefits from “multi-modality” treatment, meaning improving volume with fillers, using laser resurfacing techniques (e.g. ProFractional laser), sometimes use of neurotoxins (e.g. Botox® or Dysport®) to reduce movement in the area, and surgical options such as subcision or punch excisions. Microneedling (medical-grade) +/- PRP (platelet-rich plasma) or RF (radio frequency; e.g. Morpheus8®) is also particularly helpful for all severities of acne scarring.

Subcision is particularly useful for freeing up scars that are dish-like in quality and tend to be tethered down to underlying structures. The freeing up of the scar is performed with a hypodermic or other needle, often with concurrent saline injection (“chemical subcision”) or with fillers depending on age and depth of scarring. Our Toronto dermatologists have extensive experience treating acne scars with subcision.

Grade 4 Acne Scarring: “Severe Scarring”

This type of acne scarring is non-distensable and represents severe atrophic (depressed) or hypertrophic (thick) scarring that is obvious at a conversational distance and unable to be flattened by stretching of the skin. The type of scarring observed here includes: deep box-car scarring, ice-pick scarring, deep divots, and hypertrophic (thick) scarring. When treating severe acne scarring, we again want to improve the skin surface with the TCA CROSS technique (for ice-pick scars) or laser resurfacing (e.g. ProFractional laser), improve volume (e.g. use fillers in depressed areas such as Restylane® or Juvederm®), use neurotoxins like BOTOX®or Dysport® to reduce movement in some areas, and surgical options such as punch excisions or ellipse excisions of severely scarred areas. Microneedling (medical-grade) +/- PRP (platelet-rich plasma) or RF (radio frequency; e.g. Morpheus8®) is also particularly helpful for all severities of acne scarring.