What to use for acne scars

What are the types of acne scars?

Scars form when skin repairs damage with new tissue, mainly collagen, a protein that gives skin structure. Acne can leave changes in color as well as changes in texture. Postinflammatory pigmentation means a change in skin color after inflammation; pigmentation and scars can occur together.23

• Depressed, or atrophic, scars sit below the surrounding skin. They can look like pits or small indentations. Ice pick and rolling scars are examples seen after acne.
• Raised, or hypertrophic, scars stay within the original damaged area. They can get smaller over time without completely flattening.
• Keloids are raised scars that grow beyond the original damaged area.
• Flat scars can start slightly raised, then flatten during healing. Their color can become lighter or darker than the surrounding skin.

What can you use to reduce acne scars on your face?

For skincare you can use at home, options include retinoids, alpha hydroxy acids, lactic acid and salicylic acid. These can improve scar appearance through exfoliation and support for collagen production. A serum is one option for improving scar appearance, not a miniature dermatology department with a dropper.1

For darker scar color, ask a clinician whether a skin lightening cream containing hydroquinone is appropriate. For pink or red scars, some lasers target small blood vessels to reduce the color. Laser treatment can also cause skin darkening or lightening in darker skin, so discuss that risk before choosing it.2

Aloe vera, honey, tea tree oil and other natural ingredients are not a way to remove established acne scars at home. Products marketed for scars can also contain ingredients that cause allergic skin reactions.1

How to choose your next step

1. 1Address ongoing acne first. Fewer breakouts mean fewer opportunities for new scars.
2. 2Have the scar's texture, color and size assessed. Treatment depends on its type, location and age.
3. 3Choose a treatment that addresses the main problem: color, a depression or raised tissue.
4. 4Before a procedure, discuss side effects, recovery and whether repeat treatment will be needed.

Which procedures treat which scars?

Microneedling usually needs four to six treatments, with redness lasting a couple of days afterward. Subcision can cause minor bruising for one to two weeks. A dermatologist can combine treatments when different scars need different approaches.1

What should you expect from a chemical peel?

Peels range from superficial to deep. Superficial alpha hydroxy acid peels, including glycolic and lactic acid peels, are the mildest options. They can improve uneven pigmentation and skin texture, but the first changes can be subtle. Repeated treatments can produce further texture improvement. A provider can schedule these peels weekly or at longer intervals.5

Trichloroacetic acid, or TCA, is commonly used for medium depth peeling, including treatment of pigment problems and superficial blemishes. More than one treatment can be needed. Deeper chemical peels require longer recovery than superficial peels; recovery commonly takes one to two weeks, depending on depth. The choice between a chemical peel and laser treatment belongs in a consultation about your skin and goals.5

A provider can prescribe tretinoin before a peel to help the treatment penetrate more evenly. Retinol or an alpha hydroxy acid is sometimes used instead when tretinoin is not tolerated. Hydroquinone is sometimes included for pigmentation problems. Preparation can take a month or more. Use the preparation plan given for your procedure rather than assembling one yourself.5

Are fillers a lasting solution?

Fillers are injected below the skin surface to add volume, including in acne scars. Collagen and hyaluronic acid fillers are absorbed over time, typically within three to twelve months, so maintaining the correction requires repeat treatment. Other filler materials can last months to years. Ask which material is being proposed and how long that specific correction is expected to last.4

Filler risks include tenderness, bleeding, bruising, lumps, allergic reactions, infection and injury to blood vessels. Some inflammatory lumps can appear weeks to years after injection. Training in injection technique and knowledge of facial anatomy reduce risks. Tell the clinician about bleeding disorders, blood thinning medicines or supplements, and any history of cold sores before treatment. A history of cold sores can require preventive antiviral medicine.4

What should you use for a raised scar?

For a keloid, treatment options include silicone gels or dressings, steroid injections or cream, freezing treatment and laser therapy. These can improve appearance and reduce irritation. Surgery is not usually recommended because a keloid can grow back bigger. Different scars need different treatments, so 'for acne scars' is a product category, not much of a decision.6

A keloid can develop weeks to years after acne and continue growing for months or years. It is usually raised, hard, smooth and shiny, and can itch or hurt while growing. See a doctor if a suspected keloid bothers you; early treatment can help stop further growth. Pregnancy, a previous keloid, and some ethnic backgrounds increase the likelihood of developing keloids.6

Are acne scars permanent?

Established scar tissue does not completely disappear, but scars can fade and become much less noticeable. The change depends on the scar's type, size and location. Treatment aims to reduce its appearance, not restore completely unscarred skin. Scars that cause pain or interfere with movement deserve medical assessment, even if their appearance is not your main concern.2