Q: I have some acne scarring on my face that I`d really like to get rid of. I have a rolling icepick scar and I want to know if a deep chemical peel would help. It isn`t very deep. One maybe two layers deep. Help! What should I do?

A: To understand whether any form of skin treatment or resurfacing will reduce a specific scar, it is important to appreciate the depth of the scar compared to the thickness of skin. Then one can look at the treatment method and see if it can go to the level of the depth of the scar.

Let us, for the sake of this discussion, assume that facial skin thickness is 1mm or 1000 microns. (some areas of the face are thicker and some areas are thinner, but let’s use this simplistic number as it is easier to understand) The top epithelium usually occupies about 5% or so, around 50 to 75 microns. This is the part of the skin that peels and sloughs off and is easily regenerated. The rest of the skin, 95%, is a thicker collagen called dermis. It is into the dermis that all visible scars really go. Most visible scars are at least several 100 microns (100 to 500 microns) Pitted or icepick acne scars will usually go much deeper than even that level.

Microdermabrasion, for example, removes only 2 to 4 microns of skin. This is why it is not an effective scar treatment, it simple can’t go deep enough. Microlaser peels, or superficial laser peels, remove skin from 10 to 50 microns. They have a minor effect but it will take a lot of treatments to have any visible scar reduction. Deeper CO2 laser peels do go down 200 to 400 microns which is why they can be more effective for scar reduction. But a laser peel can not go too deep (greater than 400 microns or so) or it will be a source of its own scarring.

Chemical peels, even deep ones, do not reach these laser depths. This is why a chemical peel, of any sort, is not an effective scar treatment.

 Dr. Barry Eppley