People with acne scars often feel distressed because of how the scars look. A proper cosmetic evaluation and treatment plan can help improve the appearance of the scars and the skin.
Treatment for acne scars depends on the specific type you have and can include chemical peels, laser procedures, and minor surgical procedures. Learn more about acne scars and what treatments are available.
What Are Acne Scars?
Acne scars can appear as raised areas, indentations, or discolorations that develop after acne lesions heal. They are more common with severe acne, like inflammatory or cystic acne.
“These are not your run-of-the-mill whiteheads and blackheads,” says Suzan Obagi, MD, director, UPMC Cosmetic Surgery and Skin Health Center and UPMC Cosmetic Surgery and Skin Health Center MediSpa. “This is truly inflammatory or cystic acne where the lesions are very deep in the skin. And when they heal, they tend to heal with scarring.
“The type of scarring can vary from patient to patient. Even within the same patient, they might have two or three different types of scars.”
Acne scars are most common on the face but can also appear on other areas like the chest and back.
Types of acne scars
The two classes of acne scars are atrophic and hypertrophic. Atrophic acne scars are indentations in the skin, while hypertrophic are raised bumps.
There are three major types of atrophic acne scars:
- Boxcar scars — Boxcar scars are round or oval indentations in the skin. They look similar to scars from chickenpox. “You can see the edges around them very well, and they have a very well-defined base,” Dr. Obagi says. “They look almost like you can draw them out perfectly on the skin.”
- Icepick scars — Icepick scars are narrow-looking indentations. They look like tiny pinpricks on the skin’s surface but extend deep within the skin. “They look like someone took an icepick or a tiny needle and poked the skin,” Dr. Obagi says.
- Rolling scars — Also known as valley scars, rolling scars are deep indentations that make the skin look uneven. “You really don’t see a scar on the skin, but when you look at the patient under shadows or in direct light, you see this kind of unevenness to the skin,” Dr. Obagi says. “That unevenness is because they’ve lost deep tissue in the dermis. They’ve lost some fat, they’ve lost some collagen and some elastin.”
When to Seek Treatment for Acne Scars
There’s no wrong time to seek care for acne scars, as they can cause self-esteem issues or other emotional burdens. If you have acne scars and are unhappy about their appearance, see a cosmetic dermatologist.
Dr. Obagi says she treats people of all ages, from teenagers to older adults.
“Acne scars are one of those conditions that have such an emotional toll on patients, whether it’s a teenager that comes in with acne scars or even a 70-year-old patient who’s had acne scars since they were a teenager,” she says. “It’s in a very visible area, especially on the face.”
Acne Scar Treatment
Treatment for acne scars depends on the type of acne scar you have. Many people have more than one type of acne scar, so they might undergo multiple types of treatment.
Dr. Obagi recommends visiting a cosmetic dermatologist, who can develop an individualized treatment plan for you.
Retinoids
Retinoids are compounds that come from vitamin A. They can help stimulate the production of collagen and elastin, two key proteins that keep your skin healthy, elastic, and flexible. There are different levels of retinoids, ranging from over-the-counter products to stronger ones that require a prescription.
Dr. Obagi says retinoids can help prepare your skin for cosmetic procedures and help it recover.
“Anything we can do when it comes to acne scars to build collagen is going to have a benefit for them when they are going to have a treatment done,” she says.
Subcision
Subcision is a cosmetic procedure for rolling scars. Using a tiny blade, the doctor goes underneath the scar to break up the scar tissue that is holding the scar down.
Over time, the body produces collagen that will raise the skin back up and make it look smoother.
Punch graft
A punch graft is a cosmetic procedure primarily for icepick scars. The doctor uses a tiny, specialized punch instrument to cut out the scar. Then, they replace it with a skin graft from behind the ear. The graft fills the hole left behind by the scar and smooths out the skin.
CROSS technique
The chemical restructuring of skin scars (CROSS) technique is a procedure for icepick scars. It involves putting a chemical peel solution into the tract of the scar. The solution helps destroy the scar and stimulates collagen production so the skin closes during the healing process.
Dermal fillers
Dermal fillers are injectable treatments that add fullness to the skin. Doctors can inject fillers into scars to add volume and help elevate the scar. Fillers are typically used for boxcar scars and rolling scars.
Laser resurfacing
Laser resurfacing can help smooth out the skin. Different lasers are available, which may use nonablative (superficial) laser energy or ablative (deep) laser energy to stimulate collagen production. Nonablative lasers have no downtime compared to ablative laser resurfacing, which may require five to seven days of recovery.
Laser resurfacing can treat boxcar scars and rolling scars after they’ve been elevated using fillers or subcision.
UPMC offers several different laser treatments, including the Clear + Brilliant®️ laser, the CO2RE® Fractional system, and the CoolBreeze®️ laser.
Microneedling
Microneedling is a procedure for shallow atrophic scars, a type of boxcar scar that doesn’t go as deep into the skin. During microneedling, an anesthetic is applied to the skin. Then, a device stamps tiny holes into the skin. These tiny punctures help to stimulate collagen production, which can reduce the appearance of the scars over time.
Downtime with this treatment is minimal compared to ablative laser resurfacing.
Are There Home Remedies for Acne Scars?
While some have touted using products like aloe vera or honey for acne scars, there is no scientific evidence of their benefits.
Dr. Obagi urges people to seek professional treatment instead of trying home remedies. Devices sold online for microneedling or peeling the skin at home are not monitored by physicians. Patients may cause infections and further scarring.
“When you have acne scars, you have such a deficit of collagen in those scars that you really need a more aggressive treatment to improve those scars,” Dr. Obagi says.
Preventing Acne Scars
While treatment can be effective for acne scars, some simple steps can help prevent them from developing in the first place. Dr. Obagi urges people with inflammatory or cystic acne to seek treatment from a dermatologist as soon as possible.
“If you’re just talking about the run-of-the-mill small acne lesions, pimples, and things like that, you can use over-the-counter products first, and if they don’t respond, come and see a dermatologist,” she says. “But if you’re getting the red, angry, painful types of lesions, those are going to scar. So we’d want to get those treated quickly.”
Dermatologists can develop an individualized treatment plan, including medications, for inflammatory and cystic acne. Dr. Obagi says it’s important to follow the treatment plan consistently. If you notice the treatments aren’t effective against your acne, tell your dermatologist so they can adjust your treatment.
“Don’t accept just a mediocre response to treatment,” she says. “If your skin is still breaking out and you’re still getting inflammatory acne or cystic acne, we need to move up to a different regimen. Don’t just coast at that level and say that that’s as good as it gets. We can achieve much better improvement.”
Other ways to prevent acne scars include:
- Avoid picking your acne — Picking or squeezing your acne can cause scars to develop.
- Learn and avoid dietary triggers — Dr. Obagi says certain triggers, such as greasy food, sugar, or dairy products, can worsen acne breakouts. While there is no test to diagnose your dietary triggers, pay attention to whether your acne worsens after eating certain foods. Then, try to avoid those foods.
- Wear sunscreen — Wearing sunscreen daily can prevent acne scars from worsening. It can also help prevent post-inflammatory hyperpigmentation — dark skin patches that can develop after skin injuries like acne. Dr. Obagi recommends a mineral sunscreen with zinc oxide or titanium oxide as the main active ingredient. The sun protection factor (SPF) should be at least 30.
Can Acne Scars Get Better?
Acne scars can improve with time and the right treatment plan. Depending on the treatment, results can take weeks to months.
Dr. Obagi says that while she can’t promise to remove all of a person’s scars, most patients improve with treatment.
“It’s going to be a process, and we just have to find the right treatment that’s going to work for them,” she says. “It’s going to be maybe starting with a certain procedure, then moving on to something different, and then something after that.
“So, it’s a process that we’re going to work with for the long haul. But I think over time, we get a lot of our patients much better.”
The UPMC Cosmetic Surgery and Skin Health Center provides expert care for acne scars and many other skin conditions. To learn more about the services we offer, visit our website.