What You Can Do About Acne Scars

Acne will eventually go away on its own. Acne scars, on the other hand, can be harder to deal with. The good news is that scar treatment has come a long way. Today, there are many things you can do to reduce the appearance of acne scars.

This article looks at some of the types of acne scars, and what you can do about them.

Types of Acne Scarring

Acne scars form when skin tissue is damaged. Picking at and popping pimples can damage your skin and cause scars. Even if you're really careful with your skin, scars can still form. 

Severe blemishes and those that are very red and inflamed are more likely to scar. If you're very prone to scarring, even minor blemishes can leave scars.

Different treatments are effective for different types of acne scars. Some common types of acne scars include:

• Ice pick scars are deep pits in the skin. They are also sometimes called pockmarks.
• Boxcar scars are round or oval-shaped depressions.
• Rolling scars happen when bands of scar tissue form under the skin. They give the skin an uneven appearance.
• Atrophic scars are indented but tend to be thinner and flatter than boxcar and rolling scars.
• Hypertrophic scars have a raised appearance.
• Keloid scars are thick and irregular with a lumpy appearance.

What to Do First

There are a few things you can do about your acne scars. First, your acne needs to be controlled. See a dermatologist if you haven't already. Don't waste time on over-the-counter products. If you have acne scars, get a prescription acne treatment right away. This will help minimize scarring overall.

If you're already seeing a dermatologist, follow their directions exactly. Let them know if you have any concerns. Once your skin is fairly clear, you can decide how to treat your scars.

Topical Retinoids

Topical retinoids can help clear acne. They're also prescribed to treat the dark marks that blemishes leave behind. These spots are called post-inflammatory hyperpigmentation and are usually brown, red, or purple. They're common, and nearly everyone with acne gets them to some extent.

These dark spots aren't true acne scars. In some cases, they even fade away without treatment. Topical retinoids help speed the process and can help fade away even stubborn marks.

Microneedling

During this procedure, a device is used to create small pricks on the skin. This process stimulates healing, which can reduce some acne scars for some people. Microneedling is usually done in a dermatologist's office. It can be done with or without radiofrequency, which is sometimes used to enhance the effects of the treatment.

You can also buy at-home devices for self-administered microneedling. Keep in mind that it can be risky to do this at home. You can cause serious skin damage that doesn't fix your scars. It may even produce more scarring. The risk will be higher if the device is used incorrectly.

Chemical Peels

During this procedure, a doctor applies a chemical to exfoliate the top layer of skin. Different chemical peels can be used for different reasons. For example, trichloroacetic acid (TCA) cross-hatching is good for ice pick scars. Other chemical peels may be more helpful for hyperpigmentation. Light chemical peels are also sometimes used to treat severe acne.

Laser Treatments

Laser treatments come in two forms:

• Ablative
• Non-ablative

Ablative lasers resurface the skin by removing outer layers. Non-ablative lasers create changes in the dermis, the second layer of skin. They do this without damaging the skin's surface.

Ablative Lasers

The most common ablative lasers used to treat acne scars are:

• Carbon dioxide lasers
• Erbium-YAG lasers

These lasers burn skin tissue in a controlled manner to a specific depth. This can help:

• Encourage smoother new skin cells to grow
• Reduce the depth of atrophic scars
• Soften the overall look of scarring

It usually takes two weeks for your skin to heal after this procedure. Your skin may remain red for a while afterward. The redness fades over the course of several weeks to several months.

Non-Ablative Lasers

Non-ablative lasers tighten the skin and stimulate new collagen formation. They are often called lunchtime lasers because they can be done quickly. Unlike ablative lasers, there is little to no downtime.

These lasers are most beneficial for mild acne scarring and pigmentation problems. They don't tend to work as well for deep, pitted scars. Raised scars and keloids are sometimes treated with a form of non-ablative laser called pulsed dye lasers.

Side Effects

Hypopigmentation is the loss of skin color. This 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 Techniques

Punch techniques include:

• Punch excision
• Punch elevation
• Punch grafting
  

These treatments can be used for ice pick scars and other depressed scars. The scar is cut from the skin with a small punch tool resembling a tiny, circular cookie cutter. After the scar is cut out, the skin is sewed closed.

A small scar may remain after this treatment. It is usually less obvious than the original one. The new scar may grow fainter with time, and it can be more easily resurfaced with techniques like microdermabrasion or laser treatment. After a scar is removed, a skin graft can be used to fill the void. The graft is usually taken from the skin behind the ear.

Punch elevation may be used for deep boxcar scars with normal-looking skin at the base. During punch elevation, only the base of the scar is cut away. The dermatologist then elevates the base to the skin's surface and attaches it with sutures, steri-strips, or skin glue. After this procedure, the skin will have the same tone and texture as the surrounding tissue.

Subcutaneous Incision

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

A needle or small scalpel is inserted 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. This creates a smoother 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 scars look softer, and pitted scars aren't as deep.

Dermabrasion is used to treat depressed boxcar scarring. This procedure may make ice-pick scars look more prominent. This is because ice pick scars are narrow at the skin's surface but often widen near the base. Dermabrasion was once considered the gold standard in acne scar treatment, but today it's used less often in favor of laser resurfacing.

Microdermabrasion

Microdermabrasion is a cosmetic procedure performed at day spas as well as by dermatologists. It should not be confused with dermabrasion.

During this treatment, a machine sprays ultra-fine aluminum oxide crystals onto the skin. The crystals are then vacuumed away. These treatments usually need to be done more than once.

Microdermabrasion only removes the surface skin cells. This is why it works best on hyperpigmentation. It won't do anything for pitted or depressed scarring.

Dermal Fillers

Dermal fillers are another treatment for depressed acne scars. A filler substance is injected into the scar. This elevates the base of the scar so it is more even with the skin's surface. The results are not permanent, so it needs to be repeated after several months.

Different fillers can be used, including:

• Human and bovine collagen
• Hyaluronic acid
• Fat transferred from the patient's body

Your dermatologist will help you decide which filler will be best for you.

Steroid Treatments

Steroid treatments are often used for raised hypertrophic and keloid scars. Steroids may be injected directly into the scar tissue. This causes the tissue to shrink or flatten, softening the scar and improving the overall appearance.

Corticosteroid creams and impregnated tapes may also be used to treat these types of scars. Impregnated tapes are infused with a corticosteroid, applied over the scar, and left on for several hours at a time.

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Summary

Acne scars can form when you pick at your skin or pop pimples. Severe blemishes are also more likely to scar.

Before seeking treatment for acne scars, see a dermatologist for help getting your acne under control. Once your acne has improved, there are a few different treatments available to help reduce the appearance of scars. These include microneedling and laser treatments, chemical peels, and treatments that cut out the scar. The method used often depends on the type of scarring you have. Your dermatologist can help you choose the right one.

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 best 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.