ACNE SCARRING
As if acne itself wasn’t bad enough! Some people get stuck with acne scars – an eternal reminder of those bad skin days. So what’s a girl (or guy) to do about acne scarring?
HOW DO ACNE SCARS FORM?
The inflammation caused by acne leaves wounds in the skin. As the wounds heal, collagen is left behind that forms acne scars and makes skin uneven. Acne scarring can also cause skin discoloration when an inflamed pimple causes over-production of pigment in the skin. This discoloration, called post-inflammatory hyperpigmentation (PIH), usually fades with time.
Acne scarring treatment improves scars, but rarely removes them entirely. Most scar treatments reduce the size and visibility of acne scarring. With time, many scars become hardly noticeable.
The first step in acne scar treatment is stopping the formation of new acne.
Many acne scars come from picking pimples. Instead of picking, apply a spot treatment that contains salicylic acid, charcoal, benzoil peroxide or sulfur. These ingredients clear acne more quickly.
Breakouts cause redness and swelling. Calming the redness will make a pimple heal faster. Look for ingredients that decrease inflammation like licorice, yeast, horse chestnut, green tea or oats. A cortisone cream will also reduce swelling and is available in drug stores without a prescription. To learn more about adult acne and how to treat it, read our blog post, 17 of the Best Ways to Treat Adult Acne.
Acne scars need time to fade. After a break out, new blood vessels form in the injured area and bring nourishment to the skin. This added circulation is the reason new scars look pink. Months later, collagen forms, filling in the injured area. Because cystic acne destroys both skin and underlying fat, it can take up to a year for these scars to become less noticeable.
Hyperpigmentation is a word that refers to the dark marks left behind after a pimple heals. These marks are not scars. They get confused with scars because they can last years before fading.
There are skincare products available without a prescription that lighten the hyperpigmentation left by acne scarring.
- Hydroquinone works like a bleach to lighten skin, but is losing popularity because it causes skin irritation and has possible links to cancer.
- Kojic Acid (a natural skin lightener from mushroom extract)
- Arbutin (also known as bearberry extract)
- Vitamin C (ascorbic acid) is another effective ingredient available in lightening creams.
HALCYON SKINCARE makes a great Melasma and Sun Damage cream for lightening spots!
If you develop an acne scar, you can help raise depressions and even out skin texture.
Try exfoliating and using Vitamins A & C.
Using a mild exfoliant regularly will remove scarred skin cells. Look for these exfoliating ingredients:
- rice extract,
- salicylic acid
- lactic acid.
They help skin cells turnover more quickly, bringing new skin to the surface.
Exfoliating and brightening skin care products fade old red or brown spots. Vitamin C (ascorbic acid) and Vitamin A (retinol) increase cell turnover and will lessen acne scarring. Use these products once daily for several weeks.
The topical combination of vitamin C (15%), vitamin E (1%) and ferulic acid (0.5%) in CBE Ferulic by Halcyon Skincare will help. Once absorbed, this serum can’t be washed or rubbed off. It remains effective for a minimum of 72 hours, making it an excellent step in your skincare routine.
Medical offices have many effective treatments for depressed acne scarring.
We have the most effective ways to treat acne scars, (especially deep ones). Treatment options like laser resurfacing, dermabrasion, chemical peels, fillers, microneedling and surgery. Additionally, Dr. Trussler our Medical Director or our NP may order a retinoid to build skin collagen and improve a scar’s appearance.
There are several ways to treat acne scars. Surgical techniques (punch graft, punch excision, subcision), resurfacing techniques (dermabrasion, ablative laser treatment, chemical peels), non-ablative treatment (lasers, micro-needling), and filler injections are the most common. Each technique has a variable outcome and complications sometimes occur. Acne scar treatment should be based upon the type and and severity of the scar being treated.
*To date, no treatment has been found effective on all types of acne scars. To get the BEST results, different types of acne scar treatments may need to be used in combination, e.g., micro-needling with chemical peels or micro-needling with surgery.
Use this chart and the following pictures to figure out which type of acne scars you have.
- Underneath each scar category, you will find acne scar treatments that have been proven to successfully reduce your type of scar.
Boxcar Acne Scars resemble chicken pox scars.
They are angular with sharp vertical edges. Usually they’re found on the cheeks and temples. They can be shallow or deep.
Surgery for Boxcar Acne Scar Treatment
Box-car scars, including large, linear scars, can be surgically removed. There are several techniques.
- In one, a small scar is “punched out” with a surgical instrument, then the area is closed with stitches. It leaves a flat slit-like scar.
- Another method of closing the surgical wound uses a small skin graft from another area of the body. The graft is pressed into the opened area then is sutured or glued into place.
Surgery is best for treating a few depressed scars. A large number of deep acne scars will usually require surgery combined with dermabrasion, aggressive laser peels, or micro-needling. The goal of surgery is to create a scar that is less noticeable and that will fade with time. Results are dependent upon the skill of the medical provider and the condition of the person’s skin. This procedure can be done in the doctor’s office.
Resurfacing Techniques (ablative laser treatment, chemical peels, dermabrasion) in Boxcar Acne Scar Treatment:
Resurfacing procedures minimize the appearance of widespread acne scarring by removing layers of skin and allowing the body to make new skin. Resurfacing works best for acne scars that are not very deep. It makes scar edges less noticeable. Deep scars usually require skin surgery in combination with resurfacing. Ablative lasers vaporize the top layers of skin. The damage to the skin stimulates new collagen formation to fill in scars and even out skin texture. Unfortunately, treatments with ablative lasers require 2 weeks or more of downtime. Additionally, pigment loss is high in people with dark skin, demarcation lines are noticeable, and skin is tight. (A demarcation line is a line that shows the boundary of the areas treated by the laser. It usually appears as lightened skin on the face and normal skin color below the jawline.) With this type of treatment, usually only one procedure is necessary.
During a chemical peel, a chemical solution is applied to the skin. The chemical causes the skin to blister and peel over several days. As the treated skin peels off, new skin replaces it. This chemical exfoliation reduces acne scarring, improves pigmentation and makes skin smoother.
Of the peels, AHA peels are the most gentle; TCA peels are stronger; and phenol peels are the strongest.
Chemical peels work best for people with superficial acne and acne scars.
Dermabrasion removes the upper, damaged layers of skin with a small, spinning, abrasive wheel. It injures the skin causing bleeding. As the skin heals, new skin grows to replace the skin that was removed. Downtime is about two days.
Dermabrasion is effective on nearly flat acne scars. Deep, pitted acne scars require a different treatment.
Non-Ablative Treatments (lasers, microneedling) for Boxcar Acne Scars
Non-Ablative Lasers work by causing damage to the skin and stimulating collagen formation to fill in scars and even out skin texture. Unfortunately, lasers require downtime and not all lasers are approved for dark skin. Non-ablative treatments to minimize acne scars involve several office visits in a series.
- Non-ablative lasers start collagen production by heating the dermis without damaging the skin’s surface. The results are not as good as those of ablative lasers, but non-ablative lasers are more popular because the risks are lower with good skin improvement.
- Fractional resurfacing lasers minimize risk and shorten recovery time to about one week. They use heat to destroy microscopic columns of the epidermis (top layer of skin) and dermis over a fraction of the skin’s surface. Fractional resurfacing is more effective than non-ablative laser resurfacing and has a faster recovery time than ablative lasers. The results are not as impressive as those of ablative lasers, but fractional lasers are more popular because the risks are lower with good skin improvement. In one to three sessions, fractional lasers can even out the skin surface and increase the formation of new collagen – which will fill in your acne scars.
- MicroNeedling (also known as collagen-induction therapy and needling) is an acne scar treatment that works by repeatedly inserting tiny needles in the skin. These micro-injuries and the healing afterward increase circulation and build collagen and elastin. It’s best done in a medical office, where the procedure and needles are sterile. Results start to show after about a month and continue for as long as a year after treatment. It’s safe for all skin colors and works well to reduce widespread depressed acne scars.
- Fillers are best for treating a few depressed scars, even deep acne scars, but not ice pick scars.Skin Tightening/Radiofrequency in Boxcar Acne Scar TreatmentSkin tightening is a newer treatment and tends to be more affordable. This treatment is safe for all skin colors. Dermatologists often use a technology called radiofrequency to tighten the skin. As the skin tightens, depressed acne scars become less noticeable. Radiofrequency requires repeat appointments. Most patients return once a month for 4 months. After treatment, many patients feel a burning sensation for about 1 hour. Treated skin has a pinkish color for 2 to 3 days.Radiofrequency treatments are best for depressed acne scars. Sometimes skin tightening effectively treats deep icepick and boxcar scars.Electrodesiccation in Boxcar Acne Scar Treatment
Electrodesiccation uses an electric probe to heat scar tissue causing the tissue to die. Electrodesiccation by itself is not an effective treatment for acne scars.
Electrodesiccation is best for reducing the edges of boxcar scars.
Rolling Acne Scars are caused by damage under the surface of the skin.
They give the skin a wave-like appearance. Rolling scars are usually wide and shallow and are very common.
Surgical Techniques in Rolling Acne Scar Treatment
Subcision is a type of surgery that breaks up fibrous bands of tissue under the skin. A needle is inserted under the scar and moved back and forth to break up scar tissue. After the surgery and over a period of several weeks, the depressed scar moves upwards. Bruising can last 1-2 weeks, but there is very little skin damage.
Scar subcision works best for very deep rolling acne scars.
Resurfacing Techniques (ablative laser treatment, chemical peels, dermabrasion) for Rolling Acne Scar Treatment
Resurfacing procedures minimize the appearance of widespread acne scarring by removing layers of skin and allowing the body to make new skin. Resurfacing works best for acne scars that are not very deep. It makes scar edges less noticeable. Deep scars usually require skin surgery in combination with resurfacing. Ablative lasers vaporize the top layers of skin. The damage to the skin stimulates new collagen formation to fill in scars and even out skin texture. Unfortunately, treatments with ablative lasers require 2 weeks or more of downtime. Additionally, pigment loss is high in people with dark skin, demarcation lines are noticeable, and skin is tight. (A demarcation line is a line that shows the boundary of the areas treated by the laser. It usually appears as lightened skin on the face and normal skin color below the jawline.) With this type of acne scar treatment, usually only one procedure is necessary.
During a chemical peel, a chemical solution is applied to the skin. The chemical causes the skin to blister and peel over several days. As the treated skin peels off, new skin replaces it. This chemical exfoliation reduces acne scarring, improves pigmentation and makes skin smoother.
Of the peels, AHA peels are the most gentle; TCA peels are stronger; and phenol peels are the strongest.
Chemical peels work best for people with superficial acne and acne scars.
Dermabrasion removes the upper, damaged layers of skin with a small, spinning, abrasive wheel. It injures the skin causing bleeding. As the skin heals, new skin grows to replace the skin that was removed. Downtime is about two days.
Dermabrasion is effective on nearly flat acne scars. Deeper, pitted acne scars require a different treatment.
Non-Ablative Methods (lasers, micro-needling) for Rolling Acne Scar Treatment
Lasers work by causing damage to the skin and stimulating collagen formation to fill in scars and improve skin tone. Unfortunately, lasers require downtime and not all lasers are approved for dark skin. Non-ablative treatments to minimize acne scars involve several office visits in a series. - Non-ablative lasers start collagen production by heating the dermis without damaging the surface of your skin. The results are not as good as those of ablative lasers, but non-ablative lasers are more popular because the risks are lower with good skin improvement.
- Fractional resurfacing lasers minimize risk and shorten recovery time to about one week. They use heat to destroy microscopic columns of the epidermis and dermis over a fraction of the skin’s surface. Fractional resurfacing is more effective than non-ablative laser resurfacing and has a faster recovery time than ablative lasers. The results are not as impressive as those of ablative lasers, but fractional lasers are more popular because the risks are lower with good skin improvement. In one to three sessions, fractional lasers can even out the skin surface and increase the formation of new collagen – which will fill in acne scars.
MicroNeedling (also known as collagen-induction therapy and needling) works by repeatedly inserting tiny needles in the skin to increase circulation and build collagen and elastin. It is best done in a medical office, where the procedure and needles are sterile. Results start to show after about a month and continue for as long as a year after treatment. It is safe for all skin colors and works well to reduce widespread depressed acne scars.
Rolling Acne Scar Treatment with Fillers
Fillers fill in the indentations of even deep acne scars. Results are immediate. There is no downtime and they can be used on any skin color. Scars may be filled with collagen, the patient’s own fat, or hyaluronic acid.
Many fillers give temporary results that last between 6 and 18 months. Some fillers are permanent. Be sure to ask your provider about the filler he/she recommends, as both temporary and permanent fillers have unique pros and cons.
Fillers are best for treating a few depressed scars, even deep acne scars, but not ice pick scars.
Ice Pick Acne are deep pits, usually less than 2 mm across.
They extend into the skin giving it the appearance of having been punctured.
Surgical Techniques for Ice Pick Acne Scar Treatment
Ice-pick scars may be removed surgically. A small scar is “punched out” with a surgical instrument, then the area is closed with stitches. It leaves a flat slit-like scar. Another method of closing the surgical wound uses a small skin graft from another area of the body. The graft is pressed into the opened area then is sutured or glued into place.
Acne Scar surgery is best for treating a few depressed scars. A large number of deep acne scars will usually require surgery combined with dermabrasion, aggressive laser peels or micro-needling.
The goal of surgery is to create a scar that is less noticeable and that will fade with time. Results are dependent upon the skill of the medical provider and the condition of the person’s skin. This procedure can be done in the doctor’s office.
Resurfacing Techniques (ablative laser treatment, chemical peels, dermabrasion) for Ice Pick Acne Scar Treatment
Resurfacing procedures minimize the appearance of widespread acne scarring by removing layers of skin and allowing the body to make new skin. Resurfacing works best for acne scars that are not very deep. It makes scar edges less noticeable. Deep scars usually require skin surgery in combination with resurfacing.
Ablative lasers vaporize the top layers of skin. The damage to the skin stimulates new collagen formation to fill in scars and even out skin texture. Unfortunately, treatments with ablative lasers require 2 weeks or more of downtime. Additionally, pigment loss is high in people with dark skin, demarcation lines are noticeable, and skin is tight. (A demarcation line is a line that shows the boundary of the areas treated by the laser. It usually appears as lightened skin on the face and normal skin color below the jawline.) With this type of acne scar treatment, usually only one procedure is necessary.
Non-Ablative Methods (lasers, micro-needling) for Ice Pick Acne Scar Treatment
Lasers work by causing damage to the skin and stimulating collagen formation to fill in scars and even out skin texture. Unfortunately, lasers require downtime and not all lasers are approved for dark skin. Non-ablative acne scar treatments usually require several office visits in a series.
- Non-ablative lasers start collagen production by heating the dermis without damaging the surface of your skin. The results are not as good as those of ablative lasers, but non-ablative lasers are more popular because the risks are lower with good skin improvement.
- Fractional resurfacing lasers minimize risk and shorten recovery time to about one week. They use heat to destroy microscopic columns of the epidermis and dermis over a fraction of the skin’s surface. Fractional resurfacing is more effective than non-ablative laser resurfacing and has a faster recovery time than ablative lasers. The results are not as impressive as those of ablative lasers, but fractional lasers are more popular because the risks are lower with good skin improvement. In one to three sessions, fractional lasers can even out the skin surface and increase the formation of new collagen – which will fill in acne scars.Boxcar Acne Scar Treatment with FillersFillers fill the indentations of even deep acne scars. Results are immediate. There’s no downtime and they can be used on any skin color. Scars may be filled with collagen, the patient’s own fat, or hyaluronic acid.Many fillers give temporary results that last between 6 and 18 months. Some fillers are permanent. Be sure to ask your provider about the filler he/she recommends, as both temporary and permanent fillers have unique pros and cons.
Skin Tightening/Radiofrequency for Ice Pick Acne Scarring Treatment
Skin tightening is a newer acne scar treatment that tends to be more affordable. This treatment is safe for all skin colors. Dermatologists often use a technology called radiofrequency to tighten the skin. As the skin tightens, depressed acne scars become less noticeable. Radiofrequency requires repeat appointments. Most patients return once a month for 4 months. After treatment, many patients feel a burning sensation for about 1 hour. Treated skin has a pinkish color for 2 to 3 days.
Radiofrequency treatments are best for depressed acne scars. Sometimes skin tightening effectively treats deep ice pick and boxcar scars.
Raised Acne Scarring come in two types.
- Hypertrophic Acne Scars are raised, lumpy and stay within the boundary of the original wound. They are less common than depressed acne scars. These raised scars tend to appear on the back and chest, but can also appear on the neck and face. They may decrease in size over time and are often the result of acne cysts.
- Keloid Acne Scars are firm, raised and look shiny and dome-shaped. They range in color from pink to red or dark brown. Some keloids become large and unsightly. These scars can be itchy, tender, and painful to touch. In severe cases, keloid scars can restrict movement. They do not get smaller over time and are most often seen on the chest, back, shoulders, earlobes and along the jawline.
Raised Acne Scar Treatment Methods
Acne scar surgery: Dermatologists and plastic surgeons perform scar surgery to reduce raised acne scars. The surgery can be done in the office. Acne scar surgery is often followed by another treatment because it gives the best results.
Acne scar surgery followed by injections: After surgery, doctors often treat raised scars with corticosteroids, 5-FU, or interferon injections once a month for a several months. This is one of the most effective raised acne scar treatments.
Injections: Corticosteroids or chemotherapy medication (5-FU) is injected into thick, raised scars to soften and flatten them. Some scars respond best when injections of both the chemotherapy agents and corticosteroids are used. Interferon, which is used to treat cancer, can be effective also. If the scar does not respond after the fourth injection, acne scar surgery may be recommended. To get the best results repeat visits are required, usually once every few weeks.
Injections work best for painful, raised scars.
Acne scar surgery followed by radiation: Radiation can prevent raised scars from returning after scar surgery; however, it can cause serious problems years later.
Acne scar surgery followed by radiation is best for raised scars that do not respond well to injections.
Lasers and IPL: Lasers and other light treatments can safely treat raised scars. A pulsed dye laser (PDL) can reduce the itch and pain, normalize color, and flatten a raised scar. For light skinned people, intense pulsed light (IPL) may be an option.
Lasers and IPL are best for all types of acne scars. Treatments usually take multiple visits with significant down time and are not recommended for people with dark skin.
Cryotherapy freezes scar tissue. Freezing the tissue causes it to die and slowly fall off. Best results are achieved with a series of sessions and corticosteroid injections. Cryotherapy can cause permanent light spots on treated skin.
Cryotherapy is best for treating raised scars in people with light skin. It is not recommended for skin of color.
Silicone Dressings and Bandages are available without a prescription and can be used at home to treat raised scars. They are extremely effective at reducing the itch and discomfort of a scar. They shrink, flatten, and fade raised scars with very few side effects. To be effective, these products must be used continuously, which can be difficult on facial scars.
Silicone bandages work best for reducing scar size and discomfort. None of them will eliminate a raised scar.
You may also enjoy our articles about microneedling, Juvederm filler injections, and Scars and Stretch Marks.
