/ 101.skin  
For the science of dermatology & procedures with out the BS
.
.
Acne scar revision at a medical level has a complex algorithm based upon physician approaches & patient factors. Patient’s understanding of the BIOLOGY of scar revision in the context of the level at which scars lie is important.
.
.
Scar Types: Understanding the different scar types is the very first step. Scars can be broadly classified as ATROPHIC (hole) or Hypertrophic- Keloid - raised. They can be divided as to the colour- hypo, hyper, PIE (red) etc...
Atrophic scars include boxcar acne scars, icepick acne scars, rolling acne scars, & 'divots'. This broad classification can be further divided into others including narrow boxcar acne scars, broad, linear, deep, undifferentiated, mixed etc... same goes for icepick acne scars- pick, pits, deep pits, icepicks, deep icepicks. The algorithm of how to manage is then based upon one's skin type (1-6), as well as patient downtime.
.
.
Skill sets: Revision specialists should be able to surgically operate as well as fill, laser, peel, & operate suitable devices. The order is flexible as there are many ways to the same destination. For example the use of RF #microneedling can be a substitute for lasers.
.
.
Bell curve & biology. Patients sit on a bell curve. This applies to immune response, mental understanding, & other important factors. Some are fast responders, some are slow responders based upon physiology.
.
.
Scar types : Deep vs superficial #acnescars. Rolling, tethered & atrophic scars are much harder to treat cf superficial scars. This video illustrates the concept of volumes, atrophy & thought processes for #dermalfillers
.
.
Age related issues: Loss of volume both dermal, fat, bone CONTRIBUTES to the APPEARANCE of acne scars. Scars do not worsen (if inflammation is absent), you lose the SUPPORT for atrophic scars. No two ways around this- treat age related changes & scars will improve.See previous posts that emphasise this point
.
.
In the majority of cases results are largely predictable. If skill sets & correct application of techniques are met, & if patients understand the concept of support, the vast majority of acne scars / traumatic scars can be improved
.
.
Davin Lim @drdavinlim. Brisbane Dermatologist
Australia.