Acne scars can be a real concern.
Below are the best treatments in the world. At least there is now great options. Growing up, I saw so many teens that had no options but to suffer through scarred faces.
Summary of steps:
Step 1:
1. See a board certified dermatologist with good pedigree: went to great schools, ideally has published something or is at a good center.
2. PREVENTION IS Key! Avoid Sun at all cost for skin. Do not pop or burst pimples ever. Never smoke as can affect facial collagen in long term.
3. Drink at least 8-9 glasses of water always.
4. Eat well: eat many green leafy veggies; consider gluten free & low carb diet if acne breakouts are uncontrollable: there are no great studies to prove this is a must yet, but can be easily tried for 3 months to see if it helps in particular patients.
5. Treatment options: see below. Read & be prepared to talk about options with dermatologist.
Sincerely,
Sandy Lora Cremers, MD, FACS
Acne scars: Treatment and outcome
Sandy Lora Cremers, MD, FACS
Safe and effective treatment for acne scars begins with a consultation. During the consultation, a dermatologist will examine your skin, playing close attention to your scars. A dermatologist will also ask you some essential questions.
To get the most from your consultation, many people find it helpful to answer the following questions BEFORE meeting with a dermatologist:
Why do I want to treat my acne scars?
Treatment is not for everyone. Some people feel that the scars are not so bad. Others feel that the scars affect their everyday life. Dermatologists often recommend treatment when someone answers “yes” to one or more of the following questions:
- Do I often wish that I could get rid of my acne scars?
- Do I feel that my scars limit my opportunities to date, get a job, advance my career, or perform well in school?
- Am I less social now than before I had acne scars?
How do I want to look after treatment?
Some people want less noticeable scars. Others wish to eliminate wavy skin texture.
What can I afford to spend on treatment?
Medical insurance does not cover the cost.
How much downtime can I afford?
Some treatments require downtime.
How much time will I devote to getting treatment and caring for my skin?
Your answer will help determine which treatments will be best for you.
How do dermatologists treat acne scars?
If you and your dermatologist believe that treatment is right for you, your dermatologist will create a treatment plan tailored to your needs. In creating this plan, your dermatologist will consider many things, including scar types and where the scars appear on your body.
If you have taken isotretinoin to treat acne, be sure to tell your dermatologist BEFORE treatment for acne scars begins.
If you have taken isotretinoin to treat acne, be sure to tell your dermatologist BEFORE treatment for acne scars begins.
To obtain the best results, your dermatologist may recommend more than one treatment. For example, if you have a deep boxcar scar (often looks like a large pore), laser therapy and a type of acne scar surgery called “subcision” may be necessary to give you the results you want.
The following tables list the treatments that a dermatologist may use. Your dermatologist relies on in-depth medical knowledge to determine which treatments are best for you.
| Treatment for depressed acne scars |
| Acne scar surgery |
| Resurfacing: Laser therapy, chemical peeling, dermabrasion, microdermabrsion |
| Fillers |
| Skin tightening |
| Collagen-induction therapy, aka needling |
| Electrodesiccation |
| Treatment for raised acne scars |
| Injections (corticosteroids, interferon, 5-FU, etc.) |
| Acne scar surgery |
| Laser therapy |
| Cryosurgery |
| Scar creams and gels, silicone (dressing and bandages) |
Depressed Acne scars: Many effective treatments
Best results often come from using 2 or more treatments. The treatments that a dermatologist may use to treat depressed acne scars include:
Acne scar surgery: This sounds scarier than it is. Dermatologists often perform this minor surgery to treat very noticeable acne scars. The goal is to create a less-noticeable scar. The remaining scar should fade with time.
To perform acne scar surgery, a dermatologist may lift the scar. Bringing a scar closer to the surface of the skin tends to make it less noticeable. Another type of acne scar surgery involves breaking up scar tissue.
A dermatologist or dermatologic surgeon can safely perform acne scar surgery in a medical office. Patients remain awake but numb so that they do not feel pain.
Best for: Treating a few depressed scars.
Resurfacing procedures: When a patient wants to diminish the appearance of widespread acne scarring, a dermatologist may recommend a resurfacing procedure. Resurfacing removes layers of skin, which allows the body to produce new skin cells.
Dermatologists use the following resurfacing procedures to treat depressed acne scars:
- Laser skin resurfacing
- Chemical peeling
- Dermabrasion
- Microdermabrasion (differs from kits bought for at-home use)
Resurfacing works well for treating acne scars that are nearly flat (not too deep). Even dermabrasion, which removes the top layers of skin and some of the middle layers, cannot effectively treat deep acne scars.
Best for: Depressed acne scars that are not deep, useful for contouring scar edges to make scars less noticeable. Deep scars often require skin surgery and resurfacing.
Skin fillers: Dermatologists use fillers to safely and effectively plump depressed acne scars. A dermatologist may fill acne scars with collagen, the patient’s own fat, or another substance. Many fillers give us temporary results, which last between 6 and 18 months. Some fillers are permanent.
Both temporary and permanent fillers have unique pros and cons. If this is a treatment option for you, be sure to ask your dermatologist about the pros and cons of the recommended filler.
Best for: Treating a few depressed scars, but not icepick scars.
Skin tightening: This is a newer treatment and tends to be more affordable. This treatment is safe for all skin colors.
Dermatologists often use a technology called radiofrequency to tighten the skin. As the skin tightens, depressed acne scars become less noticeable.
Radiofrequency requires repeat appointments. Most patients return once a month for 4 months. After a radiofrequency treatment, many patients say they feel a burning sensation for about 1 hour and their skin has a pinkish color for 2 to 3 days.
Radiofrequency treatments require some at-home care. For at least one week after each treatment, you will need to apply sunscreen every morning and a moisturizing cream at night. Dermatologists recommend wearing a sunscreen that offers UVA/UVB protection, an SPF of 30 or greater, and water resistance.
Best for: Depressed acne scars. Sometimes, skin tightening effectively treats deep icepick and boxcar scars.
Collagen-induction therapy: Also known as “needling” or “micro-needling,” this treatment encourages your body to make more collagen.
To perform this procedure, a dermatologist moves a sterile, handheld needle-studded roller across the depressed acne scars. This punctures your skin. As your skin heals, it produces collagen.
It takes time to see the results, sometimes as long as 9 months. Most people, however, notice gradual changes before 9 months. Many patients require between 3 and 6 treatments and return every 2 to 6 weeks for a treatment.
After each treatment, you may have some swelling and possibly bruising. These side effects usually clear within 4 to 5 days.
You will need to follow a skin care plan while undergoing treatment.
Research shows that this is a safe treatment for people of all skin colors.
Best for: Widespread depressed acne scars. Not a treatment for raised acne scars, which form when the body produces too much collagen.
Electrodesiccation: This treatment uses electric probes to heat the tissue, which causes the tissue to die. This treatment may be part of a treatment plan for boxcar acne scars. Electrodesiccation by itself is not an effective treatment for acne scars.
Best for: Shaping or reducing the edges of boxcar scars.
Raised acne scars: Treatment can ease pain, diminish scars
The treatments that a dermatologist may use to treat raised acne scars are:
Injections: Your dermatologist may recommend injecting medicine directly into the scars. This can soften and flatten raised, thick scars.
Getting the best results often requires repeat visits. These injections are usually given once every few weeks. How often you will need to return for treatment depends on the scar and many other considerations. You may need to return once every 2 to 6 weeks for a while.
Many patients receive injections of corticosteroids. A chemotherapy medicine known as fluorouracil (5-FU) can also be effective in treating raised acne scars. Some scars respond best when injections of both 5-FU and corticosteroids are used.
Interferon, which is also used to treat cancer, can be effective. Our bodies naturally produce interferon.
If the scar does not respond (or stops responding) after you receive the 4th injection, acne scar surgery may be recommended.
Best for: Painful, raised scars.
Acne scar surgery: Dermatologists perform acne scar surgery to reduce raised acne scars. This surgery can be performed in a dermatologist’s office.
To obtain the best results, acne scar surgery is often followed by another treatment.
- Acne scar surgery, followed by injections: After surgery, dermatologists often treat raised scars with injections of corticosteroids, 5-FU, or interferon.
Combining acne scar surgery with these shots remains one of the most effective treatments for raised scars. Most patients receive injections once a month for a few months.
- Acne scar surgery, followed by radiation: Studies show that radiation can prevent raised scars from returning after acne scar surgery. Due to the potential for radiation treatments to cause problems years or decades later, some doctors do not recommend radiation treatment.
Best for: Raised scars that need more than injections.
Laser therapy: Lasers and other light treatments can treat raised scars safely and effectively. Treatment with a pulsed dye laser (PDL) can help reduce the itch and pain, diminish color, and flatten a raised scar. For people with lighter skin, intense pulsed light (IPL) also may be a treatment option.
Best for: All types of acne scars.
Cryosurgery: This treatment freezes the scar tissue. Freezing the tissue causes it to die and gradually fall off. To improve the results, dermatologists recommend a series of cryotherapy sessions and corticosteroid injections. This combination often produces better results.
The main drawback is that cryotherapy can cause permanent light spots to form on the treated skin.
Best for: It can effectively diminish raised scars in people who have lighter skin. Not recommended for skin of color.
Scar creams and gels, silicone (dressings and bandages): Often available without a prescription, these can be used at home to treat raised scars. These products can help reduce the itch and discomfort as well as shrink, flatten, and fade raised scars.
Silicone dressings and bandages can be especially helpful. Although no one knows for sure how these work, one possibility is that silicone helps hydrate the skin. This may reduce the itch and pain as well as make the skin more flexible.
To be effective, these products must be used continuously. This can be difficult, especially for scars on the face. Many people are willing to do this because these treatments have little risk of side effects. Even so, with continuous use, some people develop itchy, irritated skin. This usually clears when the person stops using the product.
Best for: Reducing scar size and discomfort. None is likely to eliminate a raised scar.
What outcome can a person with acne scars expect?
Most treatments can reduce the size and visibility of acne scars. With time, many of the treated acne scars fade, making them barely noticeable.
Your results depend almost entirely on the knowledge and skill of the person performing the treatment.
Dermatologists and dermatologic surgeons perform these procedures frequently, so they have the skills and experience needed to perform these procedures safely and effectively.
While dermatologists offer safe and effective treatment for acne scars, there may be better solution: prevention. To find out what dermatologists recommend visit Acne scars: Tips for preventing.
Learn more:
- Acne scars
- Acne scars: Signs and symptoms
- Acne scars: Who gets and causes
- Acne scars: Tips for preventing
References:
Ramesh M et al. “Novel Technology in the Treatment of Acne Scars: The Matrix-tunable Radiofrequency Technology.” J Cutan Aesthet Surg. 2010 May;3(2):97-101.
Riveria AE. “Acne scarring: A review and current treatment modalities.”
Sardana K et al. “Which Type of Atrophic Acne Scar (
Thiboutot, D et al. “New insights into the management of acne: An update from the
Zurada JM et al. “Topical treatments for hypertrophic scars.” J Am Acad Dermatol 2006;55:1024-31.
https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a—d/acne-scars/treatment-and-outcome
Guide to Treating Acne Scars and Skin Damage
Reviewed by Debra Jaliman, MD
If you see signs that your acne is leaving a scar on your skin, you don’t have to grin and bear it. There are lots of ways to heal your scars and keep new ones from forming.
Cortisone and Fade Creams
If your scar is red or swollen, use a cortisone cream to calm your skin, says Tina Alster, MD, a Georgetown University professor of dermatology. The cortisone is absorbed by skin cells and reduces inflammation. You can buy skin creams with cortisone without a prescription.
Next, you’ll want to concentrate on lightening any dark areas left from the acne scar.
“Hydroquinone, a popular skin lightener, has recently fallen out of favor and is now being omitted from many fading creams due to irritation and carcinogenic concern,” Alster says. But there are other ingredients in skin creams sold without a prescription that can help lighten your dark spots. Kojic acid (a natural skin lightener derived from mushroom extract), arbutin (also called bearberry extract), and vitamin C (ascorbic acid) are great alternative ingredients to look for in lightening creams, Alster says.
Laser and Filler Treatments
If your acne scars don’t fade away on their own, it may be time to consider booking an appointment with your dermatologist. In one to three sessions, laser skin resurfacing using fractionated laser technology can even out the skin surface and increase the formation of new collagen. Collagen is a protein that’s a building block of the skin. The new collagen can help fill in acne scars.
Ablative lasers vaporize your scar, allowing smoother skin to take its place. Non-ablative lasers help activate the production of collagen without damaging the surface of your skin.
Filler injections can help fill in the indentations left behind from deep acne scars, says Ron Moy, MD, a former president of the American Academy of Dermatology. But the downside to fillers is that they need to be repeated every 4 to 6 months, as the product reabsorbs into the skin over time.
Patience
The main key to seeing acne scars fade is patience. A few weeks after you break out and scar, new blood vessels move into the injured area to give nourishment to the skin, which is why most early scars look pink, Alster says.
Months later, collagen starts to form, filling in the injured section of skin. Because cystic acne destroys skin and fat, it can take up to a year for the scars to fade, Moy says.
How to Prevent Scars or Help Scars Heal
Stay out of the sun. Exposing scars to the sun can cause them to darken and slow the healing process, Alster says. How? Ultraviolet rays stimulate melanocytes (pigment-producing cells), leading to further discoloration.
Before heading outdoors, put on a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher. Broad-spectrum sunscreen protects against both ultraviolet A (long-wave) and ultraviolet B (shortwave) rays. Ingredients with broad-spectrum protection include benzophenones (sulisobenzone and oxybenzone), cinnamates (octylmethyl cinnamate and cinoxate), salicylates, titanium dioxide, zinc oxide, avobenzone (
How to Prevent Scars or Help Scars Heal continued…
Limit your time in the sun, especially between 10 a.m. and 2 p.m. Wear protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat.
Don’t pick and squeeze. Scars, which are made mainly of collagen, are your body’s way of repairing itself. Acne scars are typically indented because of collagen loss from intense inflammation, Alster says.
Picking leads to more inflammation and injury of your skin, which add to the discoloration and scarring. Squeezing or trying to pop a pimple causes pus and bacteria to filter deeper into the skin, bringing on more collagen damage, Moy says.
Don’t use vitamin E on scars. You may have heard that applying vitamin E to a scar will help it heal faster. But according to a study from the University of Miami , applying the nutrient directly onto a scar can actually hinder its healing. In the study, vitamin E either had no effect or made matters worse for 90% of the patients, and 33% who put vitamin E on the skin developed a contact dermatitis.
Clearing Up Embarrassing Acne Scars
Years after outgrowing acne, the aftermath of acne scars persists. Advances in acne therapy and dermatologic surgery have made it unnecessary for acne patients, both current and past to endure acne scarring.
Prevention may sound like a glib answer to how to handle acne scars. But since an estimated 10 million Americans become scarred to some extent by acne each year, intervention is by far the best solution.An Ounce of Prevention
Who will develop acne scars and how severe will scarring be? Short of a crystal ball, much of that is left to chance. What we do know is that genetics play a definite role in the likelihood of acne severity and consequent scar formation. Also, the severity of preteen acne lesions is linked to a more severe form of scarring later in adolescence or adulthood.
Because 95% of acne patients will develop scarring to some degree, the earlier the treatment appropriate for the severity of the outbreak is initiated, the better the odds are that scar formation will be mild. Delaying acne therapy by 3 or more years is likely to increase one’s risk of more significant acne scarring.
For the lucky majority, acne scarring is a minor annoyance, obvious to the one affected yet difficult for others to see. For some, however, acne scarring can cause devastating long-term emotional suffering. Teens may deal with depression, become withdrawn and lose self-confidence. (In fact, acne scarring has been cited as a risk factor for male suicide.)
Newer acne therapies make it needless for anyone to suffer from severe acne or develop scarring. Early medical intervention is key to preventing unnecessary disfigurement. While this doesn’t mean that everyone suffering a solitary blemish or minor premenstrual flare-up should rush to schedule an appointment with a dermatologist, I can’t stress enough that acne unresponsive to over-the-counter therapies should be evaluated by a specialist.
PIH: The Great Fake Out
I lost count long ago of the number of acne patients returning for their initial 6 to 8 week follow-up concerned about their new acne scars, when, in actuality, there wasn’t a scar in site. What they were really noticing was color change. This post-inflammatory hyperpigmentation (PIH) is not an acne scar. It is the normal remnant of the skin’s inflammatory process.
For those with pale skin tones, this aftermath color change is usually pink, red or purple in color. Patients with darker skin tones may notice brown or black spots where their acne once was.
PIH can fade unassisted, usually within 6-12 months. Unfortunately, the darker the PIH, the longer it may take to resolve. It may also require some intervention in order to hasten the process. While PIH is not a true scar, when it lasts past a year, it certainly may feel “permanent.”
For areas that are brown in nature, the use of a skin bleaching agent can be very helpful in speeding up the clearing process. Both prescription and over-the-counter options can be effective.
Sun avoidance is crucial as ultraviolet light will darken the skin, preferentially darkening areas of abnormal discoloration. Sun protection prevents this process, allowing bleaching treatments to work without interruption.
Cause and Effect
As an acne cyst forms, the neck of the sebaceous gland expands, filling with bacteria, cells and sebum that are unable to pass through to the skin’s surface. Eventually the cyst ruptures this “foreign matter” deep within the dermis, quickly attacked by white blood cells responsible for fighting infection.
Topical vitamin A creams and gels can both prevent and clear blemishes before they lead to scar formation, making them an important tool in acne therapy. Many excellent prescription options are available. While not recognized by the FDA for acne therapy, over-the-counter retinol in the 0.4-1.0% range can have a beneficial effect by helping to clean out debris from clogged pores.
All acne scars are not alike. A forceful inflammatory response can have two results. The most common outcome is loss of tissue as collagen is destroyed. Skin overlying the collapse of the area is provided no support and a soft saucer-shaped depression (aka pock mark) or jagged ice pick scar is formed. This is more typical on the face and is seen in both men and women.
Less frequently, excessive scar tissue (keloid) is formed as fibroblasts (the dermal cells which produce collagen) are triggered. This is more commonly seen on the male torso.
Patients are often surprised to discover that another skin change is in fact a form of acne scarring. Tiny firm white bumps surrounding hair follicles on the upper arms or upper torso are known as follicular macular atrophy. These scars can last indefinitely.
Aging can affect scar visibility. After the age of 40, 1% of the dermal collagen is lost annually. With this additional loss of collagen combined with reduced skin tone, scars can become far more noticeable.
Treatments
Nobody wants to miss out on the “best” treatment. But when it comes to treating acne scars, there is often no single “best” solution that applies to an individual or to every acne scar. Differences in location, depth, size and number of scars all affect treatment decisions. What is your perception of the scars? Do they cause great anxiety or is this something that you’d simply like to improve if possible? These questions along with cost, your expectations and the amount of effort you plan to devote to the treatment will also be factored into the decision making by the physician.
Luckily, there are a number of new procedures now available that compliment or surpass previous scar-revision techniques. Individually designing a program aimed at the patient’s unique situation will help maximize improvement.
Laser Treatments
There are two major categories of lasers used in acne scar therapy. They are the resurfacing (aka ablative) lasers and the non-ablative lasers.
Ablative lasers literally remove the outer layers of the skin, burning away scar tissue and stimulating the dermal collagen to tighten, reducing the amount of scar visibility. The ultrapulsed carbon dioxide laser and erbium YAG laser are most frequently used in laser resurfacing. The recently introduced Fraxel Dual combines an erbium laser with a more superficial light to simultaneously improve both acne scars and the associated discoloration. Downtime from these types of treatments is approximately one week. Typically, three to five treatment sessions are necessary.
Because the skin is injured and unprotected tissue exposed, great effort must be put into wound care and infection prevention. The skin may remain reddened for several months or a year afterwards.
Non-ablative lasers trigger changes within the dermis without injuring the epidermis. Smoothbeam is an approved laser for this treatment. Smoothbeam targets and heats the sebaceous gland, helping reduce oil production and acne formation. Heating the collagen helps tighten the dermis, resulting in less visible scarring.
Injectable Fillers
Fillers work best on shallow, saucer-shaped acne scars. The market has seen an increase in the number and ever-improving quality of filler substances used to help “plump up” acne scars. They have immediate results and last anywhere from three to 12 months depending upon the filler used.
Fat transplantation utilizes a patient’s own fat removed by a small liposuction cannula, prepared and reinjected into the dermal defect. While none of these methods are permanent, results tend to last between three and six months.
Punch Excision
Ice pick acne scars have hard, irregular jagged borders and often the depth is irregular as well. Simple excision of these scars with a sutured closure allows the dermatologist to bring the dermis back together, get rid of the ragged margins, and close the area with a fine, uniform line.
The tiny linear scar may be allowed to fade on its own or the procedure may be performed before a more generalized resurfacing is performed such as dermabrasion, microdermabrasion, chemical peel or laser resurfacing.
Subcision
In this procedure, the dermatologist undermines the acne scar with a sharp instrument such as a tiny scalpel or needle. Subcision helps break fibrous bands of scar tissue that are creating tension between the epidermis and deeper structures and also helps induce new collagen formation.
Dermabrasion
In dermabrasion, the skin is anesthetized and frozen and an extremely sharp rapidly rotating blade sheers away damaged tissue. This procedure, the equivalent of deep sanding, has fallen out of favor with the availability of newer, easier techniques.
Chemical Peels
A chemical peel involves the application of a high-potency acid upon the skin. The more potent the acid, the deeper the penetration into the skin. Personally, I find this more beneficial for post inflammatory skin color changes and the most minor of acne scars.
Topicals for Atrophic Scars
Everyone always wants to know what topicals can help resolve acne scars. Certainly anything that has been shown to help stimulate collagen bundle formation, such as the use of a topical vitamin A creams (which help with exfoliation as well as stimulate collagen) or antioxidant-packed rejuvenating creams (often containing vitamin C), seem like logical choices.
These are certainly options I do encourage those with acne scars to take. I do think that the reality is that a procedure is going to maximize your results, whether done alone or incorporated with a topical agent.
Acne scarring is no longer a problem without a solution. All of the techniques I described have become invaluable treatments for patients seeking to eradicate acne scarring. But never forget, scarring is preventable. Don’t put off acne therapy. The earlier it’s dealt with, the less likely acne scars will be in your future. Prevention is the best and most effective form of treatment.