Written By: Erin Storm, PA-C
The Skinny
For those that deal with regular breakouts, the frustrations associated with acneic skin do not always clear up when the pimples do. Depending on the severity of the acne lesions, patients can be left with visible marks and scars that may or may not fade over time (check out our complete guide to Acne Scar Concerns). Happily, however, there are a host of professional and at-home treatment options to minimize the appearance of acne scarring.
The Specifics
Who needs acne scar treatment?
Acne is the most common skin condition in the United States, impacting people from their teenage years through adulthood. While some breakouts clear up without a trace, acne lesions have the ability to damage the skin in the same way a traditional wound does, leaving behind permanent marks and scars.There are two main classifications of scars-atrophic and hypertrophic-which develop as a result of how much collagen the body produces during the healing process.
- Atrophic (a.k.a. depressed) Acne Scars: Occur when the body produces an insufficient amount of collagen during the healing process, resulting in cave-like depressions on the surface of the skin.
- Hypertrophic (a.k.a. raised) Acne Scars: Occur when the body produces too much collagen during the healing process, resulting in protruding bumps.
Within those two classifications, there are more specific scar types (atrophic boxcar scars, ice pick scars, rolling scars, and hypertrophic keloid scars), and, just as there is an array of ways to treat active breakouts, there are many options for improving the appearance of acne scars as well.
The best way to determine what course of treatment is most appropriate for you and your scar type is to consult with an experienced board-certified dermatologist who can recommend both professional and over-the-counter remedies.
What can you expect from acne scar treatments?
Depending on a patient’s preference and scar type, there are both temporary and permanent procedures and treatments to correct acne scarring. A dermatologist can provide realistic expectations regarding what to expect from a particular approach, but remedies may range from skin-care products to laser resurfacing.Certain procedures may come with a longer recovery time while others may just require you to apply a cream or gel once a day. Most treatments aim to exfoliate the skin and encourage the production of new collagen during the body’s healing process to replace scar tissue with new skin.
When should you seek treatment for acne scars?
While the answer is quite personal, many people choose to treat acne scars for physical, emotional, and social reasons. Individuals who previously suffered from severe acne may have had scarring during or after they received proper acne treatment. Although the acne may be gone, several dark marks and areas of scar tissue may remain. In addition to improving skin health, minimizing the appearance of acne scars can also improve confidence and self-esteem.With that said, patients are often advised to clear up any active acne lesions or formations of new acne before working to correct scarring. The inflammation from current breakouts can interfere with the effectiveness of certain scar treatments.
Why should you seek treatment for acne scars?
Each individual’s skin type is as different as the severity of scarring that has occurred. Those with darker skin complexions may not have such noticeable scars compared to those with lighter skin. Some may have smaller scars that are barely visible while others have more noticeable scars.The goal of acne scar treatments is to diminish the appearance of acne scars and dark spots, and to improve skin tone and texture. In-office procedures like dermabrasion and laser skin resurfacing can effectively reduce the visibility of acne scarring, while other treatments can help prevent future scarring.
Once you’ve decided to pursue acne scar treatment, there are a host of different procedures available depending on the type and severity of the scarring. Deep scars often require professional treatments to see results, while more superficial marks can be corrected with less aggressive, and even at-home approaches.
Cosmetic Procedures for Acne Scars
Dermatologists and plastic surgeons offer both invasive and noninvasive in-office procedures to treat acne scars. Many of these treatments can be combined, modified, and customized depending on the needs of the patient.- Dermabrasion for Acne Scars
- Overview: Not to be confused with the less-invasive Microdermabrasion, dermabrasion involves the surgical removal of the skin's outer layer using instruments that ablade (scrape away) the epidermis to bring the acne scar closer to the surface.
- Cost: $1,100 - $4,000
- Recovery & Results: Some patients achieve their desired results after one procedure, but others may require more than one round to eliminate or lessen the appearance of particularly severe scars. Regardless, recovery can take up to six weeks depending on the size and scope of the treated area.
- Microneedling for Acne Scars
- Overview: To stimulate collagen production in the treatment of atrophic scars, physicians roll a handheld, needle-studded device across the depressed areas of skin. The micro-wounds caused by the needling triggers the body’s natural healing process.
- Cost: $100 - $1,000
- Recovery & Results: Many patients require multiple treatments and a period of months to see a noticeable change. Some swelling and bruising is usually seen with this method.
For Boxcar Scars
- Dermal Fillers & Injectables for Acne Scars
- Overview: Like autologous fat transfers, hyaluronic acid-based dermal fillers (like Juvederm®, Restylane®, and Belotero®) can be injected into atrophic rolling or boxcar scars to add volume to the depressions.
- Cost: $300 - $3000
- Recovery & Results: Patients experience little to no downtime, but regular maintenance is required. Most dermal fillers need to be touched up every six to 18 months.
- Autologous Fat Transfer for Acne Scars
- Overview: Autologous fat transfer involves liposuctioning fat from one part of the body (think: butt, flanks, thighs), so it can be injected into regions with atrophic depressed scars to fill them in.
- Cost: $1,000 - $3,000
- Recovery & Results: Patients may experience soreness at the incision and injection sites in the immediate aftermath of the procedure. And, as with any fat transfer, 30 to 50 percent of the fat may eventually be reabsorbed into the body, which could cause acne scar contours to become visible again.
- Chemical Peels for Acne Scars
- Overview: Chemical peels are a method of chemically removing layers of skin that have been damaged by acne, and there are different levels of peels to address varying degrees of scarring. Superficial peels are often sufficient for minor pigmentation issues, while more potent peels can provide results for patients with severely pitted skin.
- Cost: from $100
- Recovery & Results: After the initial redness, flaking, and sensitivity that accompanies any peel, the layer of skin that has been chemically removed is replaced with a healthier layer of skin over the course of several months.
For Keloid Scars
- Laser Skin Resurfacing for Acne Scars
- Overview: Ablative, non-ablative lasers, and Hybrid Fractional Lasers like Halo™ can be used to treat both atrophic and hypertrophic scarring by stimulating collagen production and improving cell turnover.
- Cost: $750 - $3,500
- Recovery & Results: Laser treatments are frequently coupled with other resurfacing procedures like Chemical Peels and Microdermabrasion, and the number of sessions required depends on the intensity of the laser used. Irritation and inflammation can last anywhere from a few days to a few weeks post-treatment.
For Ice Pick Scars
- Punch Excision
- Overview: Deep-set scars can be treated with a punch excision and graft procedures, whereby the skin is punched in a circular fashion to remove the acne scar. The treated area is then replaced with non-scarred skin, which is often excised from the rear of the earlobe or another part of the patient's body.
- Cost: from $100
- Recovery & Results: Bandages are required for the first five to seven days post-op, but it typically takes only about that long for the new skin graft to heal.
For Rolling Scars
- Subcision
- Overview: The procedure treats depressed acne scars by inserting a needle under the affected skin and moving it back and forth to break up the fibrotic strands of the acne scars. The subcuticular tension is then released, allowing the scar to rise.
- Cost: from $100
- Recovery & Results: Often combined with laser treatments, repeated subcision sittings may be required for ideal cosmetic results.
At-Home Acne Scar Treatments
For patients with minimal acne-related scarring or for those looking to complement in-office procedures, there are several over-the-counter treatment options.Over-the-Counter Skincare for Acne Scars
Similar to fighting active breakouts with products containing anti-bacterial and anti-inflammatory ingredients, there are products that can be incorporated into skincare routines to promote the healing and fading of acne marks and scars.
Antioxidants like vitamin C and vitamin E are known to promote collagen production. Additionally, acid-based (think: salicylic, lactic, mandelic, and glycolic) cleansers, serums, and toners can be used as chemical exfoliants to increase cell turnover. As a natural alternative, tea tree oil mimics the detoxifying qualities of salicylic acid, and may help to reduce the severity of breakouts, which may lessen minimize scarring long term.
Prescription Skincare for Acne Scars
A dermatologist may prescribe topical treatments, like a hydroquinone solution, to brighten the skin of those dealing with dark spots related to acne scarring or any kind of post-inflammatory hyperpigmentation (PIH).
Scar Creams and Gels
Over-the-counter formulas containing soothing ingredients like vitamin E and silicone can help to reduce the itch and discomfort associated with the wound healing process, as well as shrink, flatten, and fade raised acne scars. While creams and gels may be good options for reducing the scar size, they are unlikely to eliminate a scar completely.
The Takeaway
There are no two ways about it: acne scars can be frustrating. Fortunately, there are an array of professional and at-home treatment options that can address the causes, side-effects, and appearance of said scars. While it is common to experience a bit of downtime (think: pain, swelling, itching, and redness) in the aftermath of an acne scar treatment or procedure, working with a board-certified dermatologist can help you find the best way to combat acne scars safely and effectively to smooth and even your complexion.
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