Getting rid of acne scars?

Dear Alice,

What can be done about acne scars?

— Defacing

Dear Defacing,

Acne scars can certainly be frustrating, but it’s good to know that often, with time, they become less visible. However, if you’d like to see a smoother complexion sooner, there are a variety of ways to lessen the appearance of long-lasting acne scars. Your health care provider may recommend that you visit a dermatologist to help you weigh the risks of different treatments and choose the treatment that’ll produce the effects you desire.  

Before jumping into treatment options, it’s helpful to first understand that there are two types of acne scars: depressed (atrophic) and raised (hypertrophic). The most common acne scars may cause depression or pits to appear in the skin; they usually appear on the face and may be due to a lack of collagen in the skin. Raised scars, on the other hand, are usually the result of too much collagen production and tend to be more common on the back and the chest. Raised scars are more common in people of color and those who have inflammatory acne, don’t treat their breakouts right away, or pick at their acne.

The type of acne treatment may depend on the type of scar and could include adding fillers, skin tightening, injections, freezing, resurfacing, or surgery. 

For depressed scars:

  • Skin fillers: Skin fillers are injections of collagen, a person’s own fat, or another substance that safely and effectively plump the scars. Keep in mind, skin fillers aren’t always permanent and may require additional injections to maintain the plumping effects.
  • Skin tightening: Skin tightening, a newer treatment, uses radiofrequency to tighten the skin, thereby flattening depressed scars.
  • Collagen-induction therapy: Collagen-induction therapy uses a roller with small needles attached to try to stimulate the face to make more collagen, which helps plump the face and reduce depressed scars. 

For raised scars:

  • Injections: The injection involves injecting medicine that’s intended to soften thick, raised scars, allowing them to flatten. 
  • Freezing: Freezing, or cryosurgery, may also be used to reduce the appearance of raised scars. In cryosurgery, the scar tissue is frozen, causing it to die and gradually fall off.

For either type of scar:

  • Laser skin resurfacing: In laser resurfacing, an intense ray of light energy (the laser) is used to "heat and treat" the affected skin. Essentially, the laser burns off the epidermis, or top layer, of damaged skin while also warming the dermis layer underneath. The heat sparks the growth of new collagen fibers, resulting in smoother, tighter skin. 
  • Chemical peels: Chemical peels use a high-potency acid to remove the top layer of skin which helps minimize deeper scars. 
  • Dermabrasion: Dermabrasion similarly helps to minimize deeper scars and may eliminate surface scars through the use of a rapidly rotating wire brush that removes the top layer of skin.
  • Surgery: Acne scar surgery is a minor reconstructive surgery that requires anesthesia and can used for both atrophic and hypertrophic scarring that's noticeable. Depending on the size and shape of the scarring, a dermatologist might use different techniques to pinch together a deep pin-like scar or shave off an area of rough uneven skin. Alternatively, a skin graft with healthy skin from another area of the body can be used to replace scarring.

It’s worth noting that each of the resurfacing procedures has risks. For example, laser resurfacing may result in the lightening or darkening of your natural skin color, particularly in people with darker skin tones. During the healing process, you may also notice: redness, mild swelling and discomfort, itching, and a sunburn-like sensation. These symptoms may arise with the other resurfacing procedures as well. Less common but more serious risks of laser resurfacing include: infection, acne breakouts, dermatitis, and scarring.

These treatments may help to reduce the size and visibility of scars, and some may be combined or repeated to be most effective. Depending on the type of treatment, there might be specific steps to follow before, during, and after use, so speaking with a dermatologist will help you determine the best course of action for your needs. If you haven't been meeting with a dermatologist already, consider asking your health care provider for a referral. If you aren’t interested in any procedures, they might be able to prescribe or suggest an over-the-counter (OTC) medicated cream to help promote healing. If you choose to use an OTC cream, try to avoid ones with vitamin E as it may delay the healing process. It’s also good to remember that with time, many acne scars fade on their own, making them barely noticeable. Prevention is easier than treatment, so before acne scars become a problem, you might consider wearing sunscreen to avoid sun damage and resisting the temptation to pick at the offending zits.

Here’s to hoping your scars fade to memories!

Last updated May 03, 2019
Originally published Feb 24, 1995