Simple Ways To Treat Your Acne Scars

Coping with acne breakouts is challenging enough, but the scars left behind can be equally frustrating. These scars often linger long after the pimples have healed, seeming to be permanent despite efforts with skincare products. The permanence of acne scars not only poses physical challenges but can also have a significant negative impact on mental health, body image, and social interactions.

According to a 2023 study published in Clinical, Cosmetic and Investigational Dermatology, many patients view their acne scars as a permanent form of disfigurement, leading to feelings of depression, anxiety, and social avoidance.

Despite the prevalence of acne, outdated stigmas about breakouts persist even in 2024. Skin care technology has advanced rapidly in recent years, offering effective in-office treatments for acne scars. Here, board-certified dermatologists Y. Claire Chang, MD; Jeaneen A. Chappell, MD; and Hope Mitchell, MD, explain how acne scars develop, how to identify them, and the best ways to reduce their appearance.

Understanding Acne Scars

In simple terms, acne scars are marks that form after a deep pimple or acne breakout has healed, as explained by Dr. Chang. They are more common in individuals with cystic acne, a genetic predisposition to scarring, and those who engage in picking or squeezing their pimples. Acne scars can appear as raised lesions or indented areas, not just as patches of discoloration.

While people often refer to all acne marks as scars, including pink, red, brown, and purple marks, these are technically hyperpigmentation. Hyperpigmentation is easier to address through exfoliation, laser treatments, microneedling, and time. True acne scars, which are indented and pitted, require more specialized treatments due to their formation.

Distinguishing Acne Scars from Hyperpigmentation

Hyperpigmentation, flat brown or red marks on the skin, is not a scar, according to Dr. Chang. It can fade over time, especially with treatments. Although it may take months or years, topical and laser treatments can effectively reduce hyperpigmentation. While hyperpigmentation is commonly referred to as acne scars in casual conversation, they are not the same.

Causes of Acne Scars

Acne scars are primarily triggered by the skin’s response to inflammation during the acne healing process, explains Dr. Mitchell. Severe inflammation, often seen with cystic nodules, can damage collagen fibers in the skin’s middle layer, affecting its structure and firmness, as noted by Dr. Chappell. This collagen loss can lead to pitted scars or an overgrowth of collagen, resulting in raised bumps. Picking or squeezing pimples can also contribute to acne scar formation by worsening inflammation.

Types of Acne Scars

Acne scars come in various forms, each with unique characteristics that influence treatment options, says Dr. Mitchell. To identify the type of acne scar you have, examine your skin under good lighting for uneven textures, raised areas, or depressions.

Atrophic scars are characterized by indented, hole-like scars on the skin, indicating collagen loss during the healing process. These scars, which account for over 80% of all acne scars, can be classified as ice pick, boxcar, or rolling scars based on their shape and depth.

Hypertrophic scars, raised bumps resembling keloids, are less common but prevalent in individuals with deeper skin tones. These scars result from an overgrowth of collagen in the original acne site and differ from keloids in their growth pattern.

Can Acne Scars Disappear?

Acne scars typically do not fade on their own, but in-office treatments can significantly improve their appearance. Multiple treatment sessions tailored to your specific scars and skin type can produce noticeable improvements over time, offering relief to those struggling with mental health issues related to acne scars.

Best Treatments for Acne Scars

Consult a board-certified dermatologist to determine the most suitable in-office treatments for your acne scars and skin type. Treatment modalities vary based on the scar type present, and options like laser treatments stimulate collagen production, resurface the skin, and promote a smoother texture, explains Dr. Mitchell.

Laser Treatments for Acne Scars

The most common treatments for both atrophic and hypertrophic acne scars involve laser procedures, which fall into two main categories:

According to Dr. Chang, there is a comparison between ablative and non-ablative lasers.

Ablative lasers work by heating the skin rapidly, vaporizing some surface layers, and prompting a wound-healing response that boosts collagen production. This type of laser is considered intense as it removes the top skin layers, causing discomfort during the treatment, scabbing, inflammation, and temporary hyperpigmentation for up to two weeks afterward. The carbon dioxide (CO2) laser therapy is a common ablative laser recommended for acne scars due to its effectiveness in fading scars, even after one session. However, ablative lasers have a longer downtime, lasting about two weeks.

Non-ablative lasers, like Fraxel Dual, send light energy beams into the skin’s middle layer, creating small injuries that stimulate the growth of new collagen fibers to improve acne scars. Since this laser treatment bypasses the skin’s surface, it typically has a shorter recovery time of around three days compared to ablative lasers.

Microneedling is a technique that involves creating controlled micro-injuries to stimulate collagen production for both atrophic and hypertrophic scars. This method is generally well-tolerated with minimal side effects, such as temporary redness for a few days.

Combining microneedling with platelet-rich plasma (PRP) has shown to be effective in enhancing skin healing. The micro-injuries from microneedling allow PRP to improve collagen and elastin production, resulting in smoother and clearer skin.

Subcision is recommended by Dr. Chang for atrophic acne scars, as it involves lifting the indented skin with a needle or blunt blade to encourage connective tissue regrowth. This method is particularly effective for rolling scars.

Dermal fillers, such as those made with hyaluronic acid, can help fill in depressed scars for a more even skin tone. However, these fillers are temporary and may only last between three to 18 months. For hypertrophic acne scars, steroid injections can be used to reduce scar size in combination with laser treatments.

To naturally treat acne scars, dermatologists suggest in-office treatments as the most effective option, especially for deeper scars. However, topical retinoids and gentle exfoliating products containing alpha-hydroxy acids (AHAs) can help improve the appearance of acne scars when used at home.

Removing acne scars is a process that requires patience and dedication. While in-office treatments may be painful and time-consuming, they can produce significant results over time. It is essential to understand that the results of acne scar treatments vary based on individual factors such as skin type, scar severity, and chosen treatment methods. A combination of different treatments may be needed to see a noticeable change in scars and skin condition. Consulting a board-certified dermatologist can help determine the best course of action for addressing acne scars effectively.