Contouring the defects: Fill ’er up!

Another option for improving the appearance of certain acne scars
is known as soft tissue augmentation. These procedures have a very
limited use, and at most, they can help with some of the shallow
“hill and valley” soft scars with gentle sloping edges. They don’t
work well for ice-pick, deep boxcar, or depressed fibrotic scars.
Materials, including your own fat, can be injected into the depressed
area of the scar to elevate it to the level of the normal surrounding
skin. The material is injected under the skin to stretch and fill out
superficial and deep “soft” scars. Many substances are available and
many new ones continue to be introduced. Most doctors have a vari-
ety of fillers to choose from, including the following:
 Collagen: Collagen injections are intended to replenish your
natural collagen and minimize surface unevenness by lifting
and filling depressed lines and scars. The original bovine col-
lagens Zyplast and Zyderm can’t be used in people with
autoimmune diseases. Skin testing to look for possible allergic
reactions is necessary before they’re injected.
The newer human-derived collagen products such as
Cosmoderm and Cosmoplast offer alternatives to those who
are allergic to the bovine derived collagen. No skin testing is
required with these agents.
Collagen injections are temporary, and last about six months
(give or take a few months), so ongoing touch-ups are
necessary.
 Fat: To correct deeper defects caused by scarring from nodu-
lar acne, fat transplantation utilizes your own fat. The fat is
taken from another site on your own body and injectedbeneath the surface of the skin to elevate depressed scars.
Because the fat is reabsorbed into the skin over a period of 6
to 18 months, the procedure usually must be repeated.
 Newer fillers: There has been an increase in the number and
quality of filler substances used to help plump up acne scars.
Restylane and Hylaform are now available and there are many
more to come. Longer-lasting results are expected from these
materials.
Unless the borders of atrophic scars are soft, there is little place
for fillers in the treatment of acne scars. They’re probably best
used as a complementary procedure with other surgical treat-
ments described in this chapter. Depending on the type and
amount of filler used, treatment can cost between $400 and $750
and $1,000 and $1,200.