Acne Scars 101: A Complete Guide to Getting Smooth Skin Again

Are acne scars making you self-conscious or embarrassed about your skin?

While some people are fortunate enough to have blemishes that come and go without leaving a mark, others are left with visual reminders of their past breakouts, which can take a real emotional toll.

As if acne isn’t bad enough, a scar that develops after a pimple can take weeks or months to fade — if it fades at all. (1)

If you think there’s no hope for stubborn scars, think again. The upside is that many treatments can remove or fade these scars, making them less noticeable and helping you regain your self-confidence.

Why do some people have acne scars, while others don’t?

The reasons vary, but genetics is one risk factor for scarring. If a blood relative struggles with acne scarring, you might, too, according to the American Academy of Dermatology (AAD). (2) Also, scarring tends to happen more as the skin loses collagen with age. (3)

Because collagen plays a role in the healing process, your skin produces new collagen as it repairs itself after a breakout. But sometimes, it produces too little or too much, resulting in a scar. (2)

Keep in mind that acne is an inflammatory condition. Scar development has a lot to do with the extent and duration of skin inflammation, so delaying acne treatment raises the risk of scarring. (2)

“Acne scars result from a complex and abnormal inflammatory response, which results in poor wound healing,” says Kara Shah, MD, a board-certified dermatologist and medical monitor at Medpace in Cincinnati, Ohio.

Because scarring is a complication of acne, anyone who experiences a breakout can have temporary or permanent scars — yet scarring is most common in those who suffer from inflammatory acne characterized by numerous pimples and cysts, says Dr. Shah. (4)

“The types of scarring seen in acne include keloids or hypertrophic scars, which appear as red, firm, raised papules [bumps],” Shah says. Atrophic scars appear as depressed or “sunken in” areas and may be larger, broad scars (boxcar scars and rolling scars) or small pits (ice pick) scars. (4)

Identifying an acne scar from other types of scars isn’t too difficult, because an acne scar occurs in the spot where a pimple was.

Not all acne scars look the same. They can take various forms. For example:

Rolling Scars

According to Schweiger Dermatology, this is the most common type of acne scar. They’re shallow, wide, and have sloping edges. These scars tend to get more noticeable with age. (5)

Red Spots

These are flat, red (or brownish) spots that form in the spot of a previous acne lesion. They usually fade without leaving a permanent mark. (1)

Dark Spots

Sometimes, healed acne leaves a temporary dark spot on the skin, known as post-inflammatory hyperpigmentation. (6)

Boxcar Scars and Ice-Pick Scars

Acne scars caused by a loss of tissue are called depressed fibrotic scars (sometimes called boxcar scars) and ice-pick scars. They tend to appear sunken and look like pits in the skin, though ice-pick scars are deeper than boxcar scars. (6)

Hypertrophic Scars and Keloids

Some types of acne leave scars that appear as enlarged, raised growths of tissue. These acne scars are caused by too much scar tissue. Hypertrophic scars and keloids look similar, but the latter are more raised than the former. (6)

“The best prevention for acne scarring is to optimize acne treatment with a good skin-care routine, a healthy diet, and an appropriate treatment regimen,” says Shah.

Since reducing skin inflammation can lessen scars, don’t ignore an acne problem — even if it’s mild. (2)

You should treat acne with over-the-counter creams or facial washes containing active acne-fighting ingredients such as salicylic acid or benzoyl peroxide. If these don’t work, see a board-certified dermatologist, the Mayo Clinic advises. (7)

“Regular use of a topical retinoid like tretinoin (Retin-A), adapalene (Differin), or tazarotene (Tazorac) has been shown to both prevent and reduce the appearance of acne scars, and these are commonly prescribed by a dermatologist as part of an acne skin-care regimen,” says Shah.

Prevention also involves being gentle with your skin and avoiding practices that could irritate your skin and exacerbate inflammation.

“Don’t pick at your acne, and avoid using any skin-care products that are abrasive, like scrubs and loofahs or washcloths,” warns Shah. She also encourages daily sunscreen use to reduce hyperpigmentation and dark spots. (2)

But while certain measures can help prevent new scarring, what are your options for minimizing the appearance of existing scars?

Common procedures to remove or improve acne scars include:

Dermabrasion This effective scar removal treatment uses a high-speed brush or other instrument to resurface your skin and remove or reduce the depth of scars. It can take up to three weeks for the skin to heal. (1)

Microdermabrasion For this less-intensive type of dermabrasion, a dermatologist or aesthetician uses a handheld device to remove surface skin. More than one treatment may be required, but there’s no downtime. (8)

Chemical Peel During a chemical peel, a chemical solution is applied to the skin. It removes the outer layer of your skin, resulting in a smoother, more even appearance. You may experience redness and peeling for three to seven days after the procedure. (9)

Laser Your dermatologist can use a laser resurfacing treatment to remove the outer layer of your skin, contour areas of acne scars, or lighten redness around healed acne lesions. Healing may take between 3 and 10 days. (1)

Fillers A substance such as collagen, hyaluronic acid, or fat can be used to “fill out” certain types of acne scars. Since fillers are eventually absorbed into your skin, you’ll have to repeat filler injections, usually every few months, depending on the substance used. (8)

Punch Excisions This type of skin surgery removes acne scars by individually excising, or cutting out, the scar. The hole left by the incision can be repaired with stitches or a skin graft. A skin graft uses a small piece of normal skin (usually removed from behind the ear) to fill in an area of scarred skin. Bruising can occur for one to two weeks after the procedure. (8)

Microneedling Also called collagen induction therapy, this procedure involves pricking the skin repeatedly with tiny needles to stimulate the growth of new collagen. This can reduce the appearance of scars. Microneedling can improve the appearance of wrinkles, stretch marks, and fine lines. Skin redness may last a few days. (10)

Over-the-counter or nonprescription products may also help minimize the appearance of acne scars.

Even though dark spots may fade over time on their own, an over-the-counter medicated dark spot remover with hydroquinone may help these scars fade quicker, notes Yoram Harth, MD, a dermatologist and the medical director of MDacne in San Francisco.

In addition, acne treatments with alpha hydroxy acids can stimulate the growth of new skin, minimizing the appearance of old scars while simultaneously preventing the formation of new acne. When shopping for an acne treatment, look for products that contain alpha hydroxy acids like glycolic acid and lactic acid. (11)

If over-the-counter products don’t fade acne scars, concealer and foundation can help camouflage discoloration. (4)

Because acne scars result from changes in the amount and structure of collagen and elastic fibers in the skin, the use of natural remedies such as apple cider vinegar, lemon juice, coconut oil, and other products aren’t effective in reducing scarring once it develops, says Shah.

She suggests making an appointment with a dermatologist to discuss treatments for existing scars.

Some acne scars fade over time. For those that don’t, over-the-counter products and certain procedures might help.

But while dermatological procedures can help improve your skin’s appearance, your health insurance might not cover these cosmetic procedures, and treatment might not completely restore your skin. So be realistic about your expectations.