No, Your Acne Scars Don’t Have To Last “Forever”

As if dealing with breakouts wasn’t painful and vexing enough, those zits often leave behind scars that last long after your pimples have flattened and healed. And unlike other marks and bumps, acne scars—both their discoloration and their indents—seem to permanently stick around, no matter how consistently you slather on your vitamin C serums, retinoids, and peels.

The permanence of acne scars is not only physically difficult to cope with, but can also lead to a significant negative impact on mental health, body image, and social behaviors. A 2023 study published in Clinical, Cosmetic and Investigational Dermatology found that most patients perceive their acne scars as a permanent form of disfigurement and may experience depressive symptoms, as well as increased levels of anxiety and socially avoidant behaviors. 

Even though acne affects the majority of us at some point in our lives, antiquated stigmas about breakouts still prevail in 2024. As we do our best to start more positive conversations about skin concerns, skincare technology has been rapidly advancing over the past decade, giving birth to powerful in-office treatment options for acne scars. Ahead, we spoke to board-certified dermatologists Y. Claire Chang, MD; Jeaneen A. Chappell, MD; and Hope Mitchell, MD, to share exactly how acne scars form, how to identify what kind you have, and the best ways to decrease their appearance if you’re not feeling yours.

Experts in this article

What are acne scars? 

To put it simply, acne scars are “scars that form after a deep pimple or acne breakout clears,” says Dr. Chang. They are most common in patients with cystic acne and those who are genetically predisposed to scars, as well as those who tend to pick, pop, or squeeze their zits, she adds. A true acne scar might appear as a raised lesion or sunken indentation—not a patch of discoloration.

However, people commonly refer to all acne marks as acne scars (think: pink, red, brown, and purple marks), even though they’re technically hyperpigmentation (more on that in a few). Luckily, hyperpigmentation tends to be significantly easier to get rid of via exfoliation, laser treatments, microneedling, and even time. But true acne scars—the bumpy, indented, pitted kind—require more specialized approaches due to their formation.

What is the difference between acne scars and hyperpigmentation?

Hyperpigmentation, which appears on the skin as flat brown or red marks, is not technically a scar, Dr. Chang says. Because of this, hyperpigmentation can fade over time, especially with treatments, she adds. The process may take months or even years, but both topical and laser treatments can effectively make hyperpigmentation eventually disappear. Conversationally, you may hear people refer to hyperpigmentation as acne scars, but the two aren’t the same.

What causes acne scars?

“Acne scars are typically caused by the skin’s response to inflammation during the healing process of acne,” Dr. Mitchell says. If the inflammation is severe enough—typically common with cystic nodules—it can inflict major damage upon the collagen fibers in the middle layer of the skin, which are what give your skin structure, elasticity, and firmness, says Dr. Chappell.

As a result, collagen may be lost in the area where the acne was, leading to pitted scars, says Dr. Chang. In some cases, collagen may actually overgrow instead, culminating in raised, keloid-like bumps. Popping, squeezing, and picking at your pimples can also cause acne scars, since messing with your breakouts can exacerbate inflammation.

Types of acne scars 

Not all acne scars are the same. They can take on several forms—each with their own characteristics which can determine the best treatment options for you, Dr. Mitchell says. The best way to figure out which type of acne scar you’re dealing with is to “carefully examine your skin in good lighting,” she says. “Look for areas on your skin where the texture is uneven, raised, or depressed.”

Once you have a visual on your scars, you can assess if you’re working with atrophic scars or hypertrophic scars. Here’s a quick breakdown of each:

Atrophic scars

If you notice indented, hole-like scars along the surface of your face, you’re probably dealing with atrophic acne scars, Dr. Chang says. These occur when collagen is lost during the healing process. Studies have found that atrophic scars are so common that they make up more than 80 percent of all acne scars. Atrophic scars are categorized into three types, depending on their shape and depth:

• Ice pick scar: The deepest, narrowest kind of atrophic scarring. They tend to have a V-like shape and can delve down to the bottom-most layer of skin, making them the most difficult atrophic acne scar to treat. 
• Boxcar scar: Oval- or rectangular-shaped indentations with clearly defined vertical walls and a flat base, just like an open box.
• Rolling scar: The widest, shallowest kind of atrophic acne scars. They have a wavy, sloped appearance along the upper dermis (the layer right below the skin’s surface).

Hypertrophic scars

If you have raised, keloid-like bumps, you’re likely dealing with hypertrophic scars, says Dr. Chang. Studies have found this overgrowth of collagen to be less common than atrophic scars, but tend to be most prevalent among people with deeper skin tones. Although they look like keloids—i.e., raised and bumpy scars—hypertrophic scars aren’t the same. According to a study published in Cells, excess scarring that forms only where the pimple or breakout originally was is considered hypertrophic scarring, while keloids can extend beyond the original area.

Do acne scars go away?

Unfortunately, acne scars typically don’t go away on their own, Dr. Chang says. In-office treatments can greatly diminish their appearance to the point of being imperceptible, though. Depending on the severity of your acne scars, you may need multiple types of treatments over an extended period of time, but you will definitely see improvements by the end, which can be a game-changer for those dealing with mental-health struggles surrounding their acne scars.

What is the best treatment for acne scars?

The best way to tackle acne scars is to consult a board-certified dermatologist to determine the right in-office treatments for your specific acne scars and skin type. “Treatment modalities will differ depending on the type of scar present,” Dr. Chappell notes. The following in-office treatments for acne scars significantly improve the appearance of acne scars by stimulating collagen production, resurfacing the skin, and promoting even texture, Dr. Mitchell says. 

Laser treatments for acne scars

The most common treatments for both atrophic and hypertrophic acne scars involve some sort of laser, which typically falls into two categories: ablative vs. non-ablative, says Dr. Chang.

Ablative lasers

Ablative lasers resurface your face by rapidly heating up the skin, vaporizing several of its surface layers, and triggering a wound-healing response that boosts collagen production. Ablative lasers tend to be the most intense type of laser because the top layers of skin are essentially removed, causing major discomfort during the procedure (even with numbing), as well as scabbing, inflammation, and temporary hyperpigmentation for up to two weeks afterward.

The most common type of ablative laser that our experts recommend for acne scars is carbon dioxide (CO2) laser therapy. Studies have found C02 lasering to be the most effective procedure for fading acne scars—even after just one session. However, ablative lasers tout the most downtime at about two weeks.

Non-ablative lasers

Non-ablative lasers, like Fraxel Dual, emit beams of light energy into the middle layer of the skin, creating microscopic injuries within it. As a result, the tissue is triggered to repair itself by growing new collagen fibers, thus improving acne scars. Because this kind of laser treatment bypasses the surface of the skin, it has a faster recovery time (typically three days) than ablative lasers.

Microneedling 

Microneedling is another method used to create controlled micro-injuries that stimulate collagen production for both atrophic and hypertrophic scars. Microneedling is generally well-tolerated without any major side effects or downtime other than minor redness for a couple of days, according to experts.

Microneedling is usually more affordable than laser treatments, but keep in mind that this acne-scar treatment may take up to a year of sessions to yield significant results. Experts will most likely recommend a series of sessions spaced out a few weeks at a time, so it’s a time commitment, but one that can help if you’re consistent.

PRP

Several studies have found microneedling to be most effective when combined with platelet-rich plasma aka PRP. The pinpricks created by microneedling allow PRP to sink into skin and help it heal better. Reason being: PRP “attracts stem cells to the area that they’re used,” as Norman Rowe, MD, a New Jersey board-certified plastic surgeon, previously told Well+Good. As a result, brand-new collagen and elastin are created for smoother, clearer skin.

Subcision

Dr. Chang also recommends subcision to her patients dealing with atrophic acne scars. For those unfamiliar, subcision is a minimally invasive procedure that involves your plastic surgeon or dermatologist lifting the indented skin of the acne scar with a needle, cannula, or blunt blade to force the connective tissue to regrow and fill up the area. Studies have found subcision to be particularly effective for rolling scars (the wavy, shallow type of scar).

Injectables 

Another option for fading atrophic acne scars is dermal fillers. Typically made out of hyaluronic acid, injectables “help fill in depressed scars for a more even skin tone,” Dr. Mitchell says. Filler is the most temporary treatment, though, as hyaluronic acid-based dermal fillers tend to only last three to 18 months. For hypertrophic acne scars (the raised kind of scar), steroid injections can be done to help reduce the size of the scar, with or without laser treatments, Dr. Chang adds. 

How do you get rid of acne scars naturally?

Because acne scars don’t necessarily go away on their own, dermatologists say in-office treatments are your best bet for getting rid of them—especially if your scars are on the deeper side. If you would like to try out some at-home remedies, though, topical retinoids can help improve the appearance of acne scars, says Dr. Chang. You can also reach for gentle exfoliating products spiked with alpha-hydroxy acids (AHAs) to fade discoloration, adds Dr. Chappell. 

Final takeaways

Getting rid of acne scars isn’t a one-and-done process, though most people find it worth it in the end. The best way to get rid of acne scars is to seek out in-office treatments that boost collagen production to help “fill in” and smooth out your scars. They may be painful and take several visits to achieve your desired results, but patience and consistency are important to acne scar treatment, Dr. Mitchell says.

“It’s natural to want quick results, but addressing acne scars often takes time and dedication,” says Dr. Mitchell. “Don’t get discouraged if you don’t see immediate improvements, since results may vary depending on individual factors, such as skin type, scar severity, and chosen treatment methods.” Remember, your scars and skin might require a combination of different treatments to start seeing a change, so if you’re unsure of where to begin, a board-certified derm is a good place to start.

Hero Illustration by Janet Mac

Source: Well and Good