What You Can Do About Acne Scars

Acne is one thing, scars are another. Acne will eventually go away (really, it will). Scars, on the other hand, are a bit tougher to deal with. But scar treatment has come a long way, and there are many things you can do about acne scars.

What to Do First

Acne scars are created when skin tissue is damaged. Doing things like picking at and popping pimples can definitely damage your skin and cause scarring. But even if you're really careful with your skin, scars can still develop.

Severe blemishes, those that are very inflamed, are more likely to scar. Some people are just very prone to scarring with even minor blemishes leaving scars.

If you have noticed some scarring, there are a few things you can do. First things first: acne needs to be brought under control. If you haven't seen a dermatologist yet, do it. If you're already being treated by a dermatologist, follow their directions exactly and let them know if you have any concerns. Once your skin is fairly clear, then you can decide on what steps need to be taken next.

Don't waste time using over-the-counter products. If acne is scarring your skin, getting on a prescription acne treatment ASAP will help minimize scarring.

Topical Retinoids

Topical retinoids are used to clear acne, but they're also prescribed to fade dark marks that acne blemishes leave behind. These dark spots on the skin (usually brown, red, or purple) are super common, and nearly everyone with acne gets them to some extent. It's called post-inflammatory hyperpigmentation.

Post-inflammatory hyperpigmentation isn't a true acne scar. In some cases, it even fades away all by itself without treatment. Topical retinoids help speed the process up and work to fade away even stubborn marks.

Topical retinoids only work on dark marks. Pitted or depressed scars need more than just topical creams.

Laser Treatments

Laser treatments come in two forms: ablative and non-ablative. Ablative lasers resurface the skin by removing outer layers. Non-ablative lasers create changes in the dermis without causing damage to the skin's surface. They are often called lunchtime lasers because they can be done quickly, such as over a lunch hour. Unlike ablative lasers, there is minimal to no downtime.

The most common ablative lasers used to treat acne scars are the carbon dioxide and erbium-YAG lasers. These lasers burn skin tissue in a controlled manner to a specific depth. The usual result is that "new" skin is smoother, atrophic scars are reduced in-depth, and the overall look of scarring is softened. Skin generally heals within two weeks but can remain red for a period of time after healing. The redness fades over the course of several weeks to several months.

Non-ablative lasers tighten the skin and stimulate new collagen formation. These lasers are most beneficial for mild acne scarring and pigmentation problems, rather than deep, pitted scars. However, pulsed dye lasers are a form of non-ablative laser that are used to improve raised scars and keloids.

Hypopigmentation, or the loss of skin color, is a possible side effect of laser treatment, especially in darker skin tones. Your dermatologist can tell you if you're a good candidate for laser treatment.

Punch Excision, Punch Elevation and Punch Grafting

The punch techniques are used to treat ice pick and other depressed scars. A small punch tool, which is often described as a tiny, circular cookie cutter, is used to cut the scar from the skin. After the scar is excised, the skin is sutured closed. A small scar resulting from the treatment may be left, but it is generally less obvious than the original one. The new scar can grow fainter with time, or be more speedily faded using resurfacing techniques such as microdermabrasion or laser treatment.

After a scar is excised, a skin graft can be used to fill the void. The graft is usually taken from the skin behind the ear. Again, punch grafts leave their own scars. But they are less noticeable than pitted scars and can be resurfaced more easily.

For deep boxcar scars whose bases are comprised of normal-looking skin, the punch elevation technique may be used. During punch elevation, only the base of the scar is excised. The dermatologist then elevates the base to the skin's surface, where it is attached with sutures, steri-strips, or skin glue such as Dermabond. Unlike with skin grafting, the skin after punch elevation has the same tone and texture as the surrounding tissue.

Subcutaneous Incision

Subcutaneous incision, also known as subcision, is used to treat rolling acne scars, as well as some depressed acne scars. Subcision is a simple surgical procedure performed under local anesthesia.

A needle or small scalpel is inserted to run parallel to the skin's surface. The instrument cuts the bands of tissue that tether the skin to deeper structures. The skin visibly lifts once these bands have been released, smoothing the skin surface's appearance.

Dermabrasion

Dermabrasion is performed under local anesthesia at your dermatologist's office. A rapidly rotating wire brush abrades the top layers of the skin. After healing, the look of scars has softened and pitted scars are reduced in depth. Dermabrasion is used to treat depressed boxcar scarring. This procedure may make ice pick scars look more prominent because while narrow at the skin's surface, they often widen near the base.

Once considered the gold standard in acne scar treatment, dermabrasion is used less often in favor of laser resurfacing techniques. It may cause pigmentation changes in darker skin tones.

Microdermabrasion

Not to be confused with dermabrasion, microdermabrasion is a cosmetic procedure that is performed at day spas as well as dermatologists' offices. During a microdermabrasion treatment, a machine is used to discharge ultra-fine aluminum oxide crystals through a tube and onto the skin. The crystals are simultaneously vacuumed away. A series of treatments is needed.

As only the surface skin cells are removed, microdermabrasion works best on hyperpigmentation. This treatment won't do anything for pitted or depressed scarring.

Dermal Fillers

Another treatment option for depressed acne scars is the use of dermal fillers. A filler substance is injected into the acne scar, elevating the base of the scar so it is more even with the skin's surface. Results are not permanent, so treatment will need to be repeated after several months.

Substances used as dermal fillers include human and bovine collagen, hyaluronic acid, and fat transferred from the patient's own body. Your dermatologist will help you decide which filler will be most appropriate for you.

Steroid Treatments

Steroid treatments are often used for raised hypertrophic and keloid scars. Steroids may be injected directly into the scar tissue, causing the tissue to shrink or flatten, softening the scar tissue and improving the overall appearance. Corticosteroid creams and impregnated tapes (which are infused with a corticosteroid, applied over the scar and left on for several hours at a time) may also be used to treat hypertrophic scars.

A Word from Verywell

It's important to be realistic, and understand that most scars can't be completely erased. But much improvement can be achieved with the right treatment or combination of treatments. Your dermatologist can recommend the most appropriate scar treatments for you.

Many people choose to not treat their scars, and that's OK too. Remember, the scars are much more obvious to you than they are to anyone else.