Is it a dent or a flat mark?
Indented scars are called atrophic scars: pits or depressions left after acne heals. Flat red, brown or pale marks change skin colour rather than its contour. Treating a flat mark and treating a dent are different jobs, even if both get filed under the impressively vague word 'scars'. Azelaic acid can fade dark marks after acne, but fading colour is not the same as raising an indentation.234
What can skincare actually do?
Retinoids and facial acids can improve the appearance of acne scarring by removing dead skin cells and supporting collagen production. Collagen is the protein that gives scar tissue much of its structure. Think less noticeable texture, not complete removal. Scars can fade with time, but treatment does not make scar tissue disappear entirely.25
What should you do first?
- 1Get ongoing acne under control before starting scar procedures. Treatment usually begins with preventing more breakouts and new scars.
- 2If treating mild acne at home, choose one acne treatment and follow its directions for frequency and time of day. Apply a thin layer across the acne prone area, rather than only individual pimples. Give it 6 to 8 weeks without adding another acne treatment.
- 3Cleanse gently with a mild, nondrying cleanser. Avoid scrubbing, repeated washing and picking pimples, which can delay healing and cause scarring.
- 4For persistent dents, book a dermatologist consultation. Bring the names of all acne treatments used during the past two years, because some medicines affect the safety of scar procedures.
Which treatments change the indentation?
Scar depth, type and age affect treatment choice; old and new scars respond differently. A scar cream is not a tiny pot of filler: fillers add volume by being injected into the depressed area. Other procedures stimulate new collagen, release tethered scars or remove individual pits.57
| Treatment | What it does | Practical expectation |
|---|---|---|
| Microneedling | Uses tiny needles to stimulate collagen. | Often needs 4 to 6 treatments; redness typically lasts a couple of days. |
| Laser resurfacing | Treats damaged scar tissue and stimulates collagen. | Often needs several sessions, with recovery depending on the laser. |
| Fillers | Add volume to sunken scars. | Most give temporary results lasting 3 months to 2 years. |
| Subcision | Releases a scar attached to deeper tissue. | Can be combined with resurfacing; bruising can last 1 to 2 weeks. |
| TCA CROSS | Applies concentrated trichloroacetic acid to individual depressions to stimulate collagen. | Usually needs 3 to 6 treatments; complete resolution with this treatment alone is unlikely. |
How long does improvement take?
Fewer acne breakouts can appear after 4 to 8 weeks, with clearing around 16 weeks; those are acne treatment timelines, not deadlines for dents to fill. Scar procedures often involve repeated visits. TCA CROSS improvement is assessed over about six months. Your dermatologist can also decide whether a newer scar needs time to mature before treatment.347
When should you get medical advice?
See a dermatologist if acne is deep, painful or leaving new scars. If you are pregnant or trying to become pregnant, ask before starting acne treatment. Acne products can cause redness, dryness and excessive peeling; seek advice rather than adding more products when irritation becomes troublesome. Darker skin needs particular attention to pigment changes after laser treatment. TCA CROSS belongs in a clinic: complications include lasting pigment changes and larger scars if neighbouring scars merge.2346
Where this answer comes from
- 1Acne scars: Consultation and treatmentaad.org
- 2Scars: Treatment and Causemy.clevelandclinic.org
- 3TCA CROSSdermnetnz.org
- 4Adult acne treatment dermatologists recommendaad.org
- 5How To Get Rid of Acne Scars: 11 Solutionshealth.clevelandclinic.org
- 6Acne: MedlinePlus Medical Encyclopediamedlineplus.gov
- 7Get Treatment for Scarsmy.clevelandclinic.org
