Acne vulgaris, or cystic acne, is a common but extremely difficult problem. For some patients, topical or even oral antibiotics are required, and in persistent cases, special medications such as Accutane (isotretinoin) may be prescribed. Though the pustules, comedones, and cysts are most prevalent in adolescence and the teen years, significant and even disfiguring scars may remain for years after routine breakouts have stopped. This can cause serious emotional distress and serves as a constant reminder of those difficult times.

Fortunately, there are treatments for acne scarring. The deepest scars, sometimes referred to as “ice pick” scarring because of the deep, pinpoint holes in the skin surface, may be treated with meticulous excision (removal). Dr. Ransom uses special instruments that are only 1 or 2 millimeters in size to remove the scarred areas and closes the defects with tiny, hair-thin sutures. Once the deepest scars have been removed and the skin is healed, he then performs laser resurfacing, or a chemical peel to even the skin surface and promote healthy skin growth. As the skin heals from the inside out, new collagen is formed and a more even color and texture become apparent.

Non-surgical options may be preferable for some patients and offer excellent results in many cases. This includes radiofrequency microneedling with the INFINI™ device. This technology combines the benefits of radiofrequency energy – which can deliver heat to the deepest layers of the skin without the risk of scarring or pigmentation change – with microneedling that is clinically proven to stimulate collagen growth. For persistent scars or skin surface irregularities, Dr. Ransom also uses Bellafill®, a two-in-one filler that promotes remodeling of the skin where it is injected. Bellafill® contains bovine collagen, which works as a temporary soft tissue filler, and polymethyl methacrylate (PMMA), which is a potent stimulator of the body’s own collagen production. Native collagen is made as the injected collagen is slowly absorbed, with significant long-term improvement in tone and texture of the treated areas – up to 5 years!

Using the latest in aesthetic medical treatments before and after your procedure, Dr. Ransom makes sure that your skin heels quickly, with an even color, improved texture, and smooth contour. By personally administering your resurfacing procedure, Dr. Ransom ensures that you achieve the best result in the most comfortable and convenient way possible – and with the quickest recovery.

Who is a candidate?

Anyone with deep scarring or skin texture irregularities from acne can undergo treatment. However, the exact method and timing of the treatment will differ between patients, based on the degree of scarring, areas involved, overall skin health, and other factors. Treatment of acne scarring is undertaken after the acne has resolved. For younger patients (teenage to early 20’s) or those with ongoing outbreaks, treatment may need to be delayed; in these cases, Dr. Ransom focuses on medical treatments and minimally invasive procedures. Finally, skin resurfacing procedures may be contraindicated in patients with certain rare skin and connective tissue disorders or those who have undergone radiation therapy to the affected areas. For patients who have used Accutane (isotretinoin), special consideration is given to the type and timing of scar treatments. Most patients are suitable for INFINI™ treatment, regardless of skin type or color. Bellafill® cannot be administered to patients with an allergy to bovine collagen; luckily, this is quite rare.

Frequently Asked Questions

Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.

During the active phase of acne, significant inflammation occurs in the skin. The body uses inflammatory cells (white blood cells) to help fight infection, but unfortunately, this process can cause collateral damage. As a side effect of inflammation, changes can occur in the pigmentation (color), texture, and surface contour of areas affected by acne. This is particularly true where the acne has been cystic (pockets of fluid or pus). In these cases, the area where the skin has been damaged is not always replaced with normal skin. It may instead be replaced with scar tissue – causing a visible and palpable difference in the skin, or not heal at all – leaving a pinpoint hole (“ice pick”) or flat area (“boxcar”).

With “ice pick” scars, the deep holes are removed completely and the skin surface is dramatically improved. With larger areas of diffuse scarring (so called “rolling” scars), a significant improvement can be achieved. Complete resolution, however, is often not possible, and patients should not expect to have no evidence of scarring. With a carefully planned and executed treatment plan, including scar revision, resurfacing, and medical management, skin color, texture, and overall appearance will be greatly improved.

Depending on the method used, recovery can be a couple days to a week or more. For excision of “ice pick” scars, sutures are left in place for about five days and recovery is very quick. Bellafill® treatment may cause slight irritation at the injection site, but otherwise does not require significant downtime. With skin resurfacing and INFINI™, there is an initial healing phase that lasts about a week. This is followed by a gradual repair of the skin from the inside out, with improvements in skin color and texture over a few weeks. Dermabrasion and laser resurfacing require an occlusive dressing or thick ointment to be worn over the treated areas. Pain is minimal, though the skin will be sensitive to ultraviolet rays (UV), so patients must avoid direct sun exposure during healing.

Double Board Certified Plastic Surgeon at

Dr. Evan Ransom is an Ivy League-educated and Ivy League trained Facial Plastic and Reconstructive Surgeon. He is a Double Board Certified Head and Neck Surgeon and Facial Plastic and Reconstructive Surgery and fellowship-trained in facial plastic, reconstructive, and laser surgery. His practice is in the San Francisco Bay Area, serving patients from San Francisco, Oakland, Marin County, Palo Alto, Silicon Valley, Walnut Creek, the East Bay, and all over Northern California.