Box car scars can be characterized by presence of clearly defined and steep edges. They are smaller and deeper than other types of rolling scars. Nevertheless, these scars are much larger than ice pick scars. Due to its complex nature, boxcar acne scars are more difficult to smooth out, blend to match it with the surrounding skin. Laser resurfacing, particularly ablative resurfacing with an Er:YAG or CO2 laser cannot achieve desired results, as these scars are simply too deep.
Boxcar scars often affects smaller areas than rolling scars and hence these scars are better candidates for excision.
Boxcar scars often cast deep shadows and are more visible in low light. Having cosmetic facial makeup can do little help as the holes are too deep to camouflage. The scar we strive for is flat and narrow. It does not cast shadow, and it can be easily covered with facial makeup. Simply, you are trading a bad scar for a better one.
To treat Boxcar scar acne scars, injections are not recommended. Typically, injections may offer little to no improvement due to the tightness of the underlying scar. Similarly, peeling and laser therapy can provide little benefit for deep boxcar acne scars, as these scars are simply too deep.
The proper treatment of boxcar acne scar is excision
Ellipse wedge excision is the best treatment of Box acne scars. The skin has a great deal of elasticity, and the hole created as a result of excision procedure can be easily closed without any tension on the skin closure. Fine sutures are used and removed after 5 days.
During the procedure, careful detailed photographs are taken and reviewed on a large monitor together with the patient. Based on your choice and Dr. Sadove’s advice, the patient decides which scars they would like to be removed. These are then marked with a marking pen. Dr. Sadove will ask you to smile and make various facial animations in order to determine the best orientation for the scar. These are called Langer’s lines. Before undergoing the procedure, make sure to inform Dr. Sadove if you are allergic to lidocaine.
The marked areas are later injected with local anesthesia via a tiny needle, which is something like the needle used by the dentist. To curb the very low risk for infection, antibiotic prep solution is applied onto the target skin area. Then the scar is cut out in a “football” shaped ellipse oriented in the proper direction. A fine suture is used to close the hole carefully by employing plastic surgery technique. After the surgery, a dot band aid is to be applied for one day. This may be removed after a day and routine face washing can be done. A small amount of antibiotic ointment may be applied two or three times every day. The fine suture can be removed after five days.
The final result often takes several months to see until redness and wound healing are completed.
These deep tight scars are best not treated with lasers or peels.