Acne is a common skin condition that most often affects people between adolescence and their early 30s. Severe acne can cause permanent skin damage that lasts long after breakouts have cleared. As we age, our skin loses its elasticity, and old scar tissue may become more prominent. Preventative actions reduce the chances of scarring, while specially formulated skincare products and dermatological treatments can significantly reduce the appearance of acne scars.

Causes of Acne Scars

When acne penetrates deeply into our pores, it causes damage to the affected skin and underlying tissue. The body produces collagen to support the healing process, but too much or too little can create raised scars or depression. Inflamed blemishes like cysts are more likely to develop scar tissue. Genetics is also an underlying factor. People of African American, Hispanic, and Asian heritage are more prone to raised acne scars.

Types of Acne Scars

Most acne scars are atrophic, meaning they leave a dent or deep hole in the skin. Boxcar scars are broad depressions with sharply defined borders, while rolling scars have smoother, sloping edges. Ice pick scars are narrow, pitted cavities that resemble pinholes. Atrophic scarring gives the skin a contoured appearance, sometimes referred to as rolling scars. Raised, or hypertrophic, acne scars are more common on the back and chest.

Control Existing Acne

Before beginning treatment for scarring, it is essential to get existing acne under control. A flare-up means the skin is inflamed and irritated, and treating damage under these circumstances can cause further issues. Inflammation can also limit the effectiveness of expensive and time-consuming remedies. Additional breakouts also bring the probability of new acne scars developing after treatment.

Topical Treatments

Mild acne scarring is treatable at home with topical solutions containing salicylic acid and retinol. Available without a prescription, these over-the-counter medications help treat acne scars by increasing skin cell turnover and resurfacing the epidermis. Administered by a dermatologist, chemical peels remove one or more layers of skin to promote cell regeneration and skin remodeling. Some treatments require several sessions and often leave the skin reddened and dry.

Laser Resurfacing

Useful in the treatment of rolling and raised scars, laser resurfacing removes the damaged top layers of skin. The process generates collagen production and tightens the tissues underneath, revealing a smoother complexion after multiple sessions. Laser therapy is more expensive and requires local anesthesia, but the results are more precise than chemical peels.

Microneedling and Dermabrasion

Micro-needling uses a needle-studded roller or pen device to make tiny holes in the surface layers of skin. Usually performed by a dermatologist, micro-needling increases collagen production and encourages skin resurfacing. Rolling and boxcar scars respond well to micro-needling therapy, but it’s not a safe treatment for everyone. For example, people on anticoagulant medication should avoid it. Dermabrasion is more appropriate for severe scarring. A rotating wire brush removes damaged surface layers and reveals a smoother complexion in weeks.

Fractional Laser Therapy

Fractional laser therapy works at a deeper level than regular micro-needling and dermabrasion. The procedure focuses light energy beneath the skin to stimulate deep tissue. Similar treatments apply radiofrequency waves or carbon dioxide lasers, also without wounding the outer layer of skin. The less invasive treatment requires a shorter recovery time but is much more expensive than microdermabrasion or chemical peels. Fractional laser therapy also helps prevent future breakouts by decreasing oil production.

Injectable Acne Scar Treatments

Some dermatologists will recommend inserting fillers to improve the appearance of rolling scar tissue. Collagen and fat injections can fill out or stretch depressions on the skin, making them less noticeable. Botox shots can also play a role in post-acne skin rejuvenation. By relaxing the muscles surrounding pockmarks, the skin is less likely to pucker and exaggerate the appearance of scar tissue. Corticosteroids can also treat hypertrophic scars, though they are usually combined with other treatments.

Surgical Procedures and Punch Incisions

Acne scar surgery can remove hypertrophic scars that do not respond to other treatments. A dermatologist will perform the surgery to reduce raised scars, then follow up with additional measures to prevent regrowth. Cryosurgery is another alternative that involves freezing acne scars, causing them to die and fall off. Punch excisions work well for atrophic scars. A dermatologist will remove the indented skin and repair the wound with stitches or a skin graft.

Preventing Acne Scarring

The best approach to preventing acne scar tissue is to seek treatment as soon as flare-ups begin. Acne cysts, firm nodules, and other inflammatory blemishes are more likely to cause scarring the longer they are allowed to penetrate deep tissue. Waiting for breakouts to become more severe can lead to extensive damage and aggravate existing acne. Popping pimples and overusing skincare products can also promote scar tissue by increasing inflammation.