Is it a scar or a mark?
A flat red, brown or pale mark is a colour change rather than a change in skin shape. Colour changes after acne often improve over time, although this can take months or longer. A true scar changes the skin's texture, leaving a dent or raised tissue. A scar can have both a colour change and a dent, so a single spot can require more than one job description.34
| Type | What it looks like |
|---|---|
| Ice pick | A narrow, deep depression that extends down into the skin. |
| Boxcar | A wider round or oval depression with distinct edges. |
| Rolling | A broad depression with sloping edges that gives skin a wavy texture. |
| Hypertrophic | Raised scar tissue within the area of the original acne lesion. |
| Keloid | Raised scar tissue that grows beyond the original lesion. |
Depressed acne scars and keloids do not simply fade away without treatment. Sunken scars can become more noticeable as skin loses firmness with age. Treatment aims to make scars less noticeable, not erase every trace of them. Different scars need different treatments, which is inconvenient for any bottle claiming to handle the entire department.56
Where should you start?
- 1Get ongoing acne treated before starting scar procedures. Acne medicines and scar treatments can interfere with one another.
- 2Have a dermatologist identify the scar types and severity. Mixed scar types are common, and a visual examination usually establishes what needs treating.
- 3Discuss the scars' age, location and your goals. Some scars need time to finish healing and remodelling before treatment.
- 4Agree on a course of treatment, including repeat sessions and recovery. Ask about the full course before booking, because a treatment menu is not a treatment plan.
Which acne scars can skincare improve?
Creams and serums containing retinoids, alpha hydroxy acids, lactic acid or salicylic acid can reduce the appearance of acne scarring. Choose the product with a dermatologist based on your skin type and scar type rather than treating every dent with the same acid. These are options for improving appearance, not substitutes for lifting deep depressions or treating substantial raised tissue.12
Silicone gel or silicone sheets can improve the appearance of raised scars. They belong to a different treatment category from facial exfoliants. Raised scars that are thick, painful or itchy deserve assessment rather than another round of ordinary creams.6
Honey, aloe vera and natural oils cannot get rid of true acne scars at home. Products marketed for scars can also cause allergic reactions, so discuss new treatments with a healthcare provider rather than assuming that natural means suitable.2
Which procedures treat dents and raised scars?
| Treatment | What it does | Where it fits |
|---|---|---|
| Chemical peel | Removes surface layers so smoother skin can grow. | Resurfacing acne scars, particularly more superficial texture changes. |
| Laser resurfacing | Treats damaged tissue and stimulates collagen production. | Texture changes; certain lasers also treat redness. |
| Dermabrasion | Removes upper skin layers with a specialist tool. | Smoothing acne scars. |
| Microneedling | Uses tiny punctures to stimulate collagen. | Reducing the appearance of acne scars. |
| Fillers | Add volume beneath a depression. | Sunken scars. |
| Subcision | Releases tissue holding a scar down. | Bound down depressions, sometimes before resurfacing. |
| Punch excision | Removes an individual scar and closes the opening. | Selected persistent pits; leaves a smaller scar. |
| Steroid injections | Soften and flatten raised tissue. | Raised acne scars, including hypertrophic scars and keloids. |
Treatment depends on scar depth, size, location, skin type and budget. Resurfacing is often better suited to superficial scars; deeper depressions can need lifting or removal. Combining treatments can address colour, texture and lost volume separately. Raised scars can recur even after successful treatment.3
What about TCA CROSS for deep pits?
TCA CROSS uses tiny amounts of concentrated trichloroacetic acid directly on individual depressed scars to stimulate collagen. It can treat ice pick, boxcar and rolling scars. This is a clinic procedure, not a home acid treatment: the concentration used is typically 70% to 100%. Complete removal of scars with TCA CROSS alone is unlikely.4
Most patients need three to six treatments, spaced two to eight weeks apart over about six months. Treated areas are usually red and sore for 24 to 48 hours; small scabs develop after two to three days and fall off after three to seven days. Sunscreen reduces the chance of pigmentation. Risks include persistent irritation, colour changes and adjacent scars joining into a larger scar.4
How long does microneedling take to work?
Professional microneedling can treat all skin tones. Improvement appears gradually over weeks, with full results usually taking several months. A course can involve three to five sessions every two to four weeks. Results can fade as collagen is lost, and a dermatologist can suggest maintenance treatment.7
Avoid microneedling if you heal poorly, have a history of keloids, have a weakened immune system, are receiving radiation, or have skin cancer treatment in the area. Treatment should wait until infection, recent tanning or painful, deep or pus filled pimples have cleared. Tell the dermatologist about isotretinoin: microneedling requires at least one month after the last pill. Waiting periods differ by procedure; TCA CROSS requires a separate assessment of systemic retinoid use.47
Follow the preparation and aftercare plan. You may need to pause retinoids for a few days beforehand and protect skin from sunlight. After microneedling, wait 24 hours before makeup. Redness or darkening, burning and swelling usually settle within a few days to a week. Home devices produce less noticeable results and can cause infection, further scarring or lasting colour changes.7
How much recovery time should you plan for?
Recovery differs by procedure. Chemical peels can cause redness and swelling for up to seven days. Laser resurfacing can leave skin swollen, red or bleeding for up to five days, and can require three to five sessions. Dermabrasion healing can take a couple of weeks. Subcision can cause bruising for one to two weeks. Discuss the specific treatment's recovery before scheduling.2
When should you see a dermatologist?
Seek treatment promptly if acne is leaving new scars. Do not pick or squeeze lesions, which increases scarring risk. Arrange assessment for scars that hurt, itch, feel thick or remain bothersome despite creams. A dermatologist can distinguish scar types, assess whether they have finished healing and choose between topical treatment, procedures and scar revision when other treatments have not worked.136
Where this answer comes from
- 1Acne Scars: Causes, Diagnosis, Types & Treatmentmy.clevelandclinic.org
- 2How To Get Rid of Acne Scars: 11 Solutionshealth.clevelandclinic.org
- 3Acne Scarringdermnetnz.org
- 4TCA CROSSdermnetnz.org
- 5Scars: Will my scar go away?aad.org
- 6Get Treatment for Scarsmy.clevelandclinic.org
- 7Microneedling can fade scars, uneven skin tone, and moreaad.org
