Acne Scars

Why acne scars form

Inflamed acne spots (papules, pustules, nodules and cysts) damage the deeper skin layer, the dermis. As the skin heals, it makes new collagen. If too little collagen is made, the skin heals with a depression: an atrophic scar. If too much is made, it forms a raised scar. The deeper and longer-lasting the inflammation, the higher the risk. Picking and squeezing push inflammation deeper and increase scarring.

Types of acne scars

Most people have a mixture. A dermatologist will assess which types you have, because treatment is matched to the scar type.

Marks that are not scars

• Post-inflammatory hyperpigmentation: flat brown or dark marks, more common in medium to dark skin. See post-inflammatory hyperpigmentation.
• Post-inflammatory erythema: flat red or pink marks, more common in lighter skin.

These are changes in color, not texture. They fade over 3 to 12 months, faster with sun protection and treatments like retinoids, azelaic acid or vitamin C.

Who is most at risk

• people with severe nodular or cystic acne
• delayed or inadequate acne treatment
• picking, squeezing or popping spots
• a family history of acne scarring
• darker skin types for keloids and pigment changes

Prevention: treat acne early

Scarring is much easier to prevent than to fix. See a doctor or dermatologist if acne is moderate or severe, causing cysts, or not responding to over-the-counter treatment after 2 to 3 months. Effective options include topical retinoids, benzoyl peroxide, oral antibiotics, hormonal treatments for women and isotretinoin for severe acne. Avoid picking spots.

Treatment of acne scars

Treatment usually begins once active acne is controlled. Most people need several sessions and a combination of methods. Expect improvement, not perfect skin.

Topical treatments

Retinoids (adapalene, tretinoin) promote collagen remodeling and fade marks. They give mild improvement in shallow scars over months.

Chemical peels

Acids such as glycolic, salicylic or trichloroacetic acid (TCA) remove outer layers and stimulate collagen. Superficial peels help marks; deeper peels help shallow scars. TCA CROSS applies high-strength acid into individual ice pick scars.

Microneedling

Fine needles create tiny injuries that trigger collagen production. Several sessions 4 to 6 weeks apart improve rolling and boxcar scars, with little downtime. It is relatively safe for darker skin. Radiofrequency microneedling adds heat.

Laser treatments

• Ablative fractional lasers (CO2, erbium) give the most improvement for atrophic scars but need more recovery time.
• Non-ablative fractional lasers have less downtime and need more sessions.
• Vascular lasers treat red marks and help raised scars.

Lasers carry a risk of pigment change in darker skin, so experience matters.

Subcision

A needle is passed under a rolling scar to cut the fibrous bands tethering it down, letting the skin lift.

Fillers

Hyaluronic acid or collagen-stimulating fillers lift depressed rolling scars. Results last months to years depending on the product.

Punch techniques

Deep ice pick and boxcar scars can be cut out (punch excision) and closed, replaced with a skin graft, or lifted (punch elevation).

Raised scars

Steroid injections every 4 to 6 weeks, silicone gels or sheets, cryotherapy and lasers flatten hypertrophic and keloid scars. Keloids often recur and may need combined treatment.

Isotretinoin and procedures

Older advice was to wait 6 to 12 months after isotretinoin before procedures. Current evidence suggests some gentle procedures may be safe sooner, but discuss timing with your dermatologist.

Living with acne scars

Acne and its scars are linked to anxiety, depression and social withdrawal. If scars affect your mood, tell your doctor; psychological support can help alongside treatment. Makeup designed for texture and color correction can also help in the meantime.

Frequently asked questions

Can acne scars go away on their own?

True textural scars, such as ice pick, boxcar and rolling scars, are permanent and do not go away on their own, though they can soften slightly over time. Red and brown marks after acne are not scars and usually fade within 3 to 12 months.

What is the best treatment for acne scars?

There is no single best treatment. It depends on the scar type: subcision and fillers for rolling scars, punch techniques or TCA CROSS for ice pick scars, and lasers or microneedling for boxcar and mixed scars. Most people do best with a combination.

Do over-the-counter creams work on acne scars?

Over-the-counter retinoids such as adapalene, and products with azelaic acid or vitamin C, help fade marks and slightly improve shallow scars over months. They do not significantly change deep pitted scars, which need in-office procedures.

How many treatments will I need?

Most procedures need 3 to 6 sessions spaced 4 to 6 weeks apart, and collagen keeps remodeling for months after. Deeper treatments like ablative lasers may need fewer sessions. Your dermatologist will give a plan based on your scar types and skin.