Acne Scarring

Acne scars form as a result of deep inflammation within the skin. When a pore becomes clogged with oil, bacteria, and dead skin cells, it can swell and rupture the follicle wall. If the rupture occurs near the surface of the skin, the resulting lesion typically heals with minimal damage. However, deeper breaks in the follicle wall can cause the infected material to spill into the surrounding tissue, triggering a more intense inflammatory response.

To repair this damage, the skin produces new collagen fibers. When too little collagen is produced, a depressed scar may form. When too much collagen is produced, it can result in a raised scar. The severity of scarring often depends on the depth and duration of the inflammation, the type of acne (such as cystic or nodular acne), and individual genetic factors. People who tend to develop more inflammation or have a family history of scarring are more likely to develop permanent marks.

Discoloration (hyperpigmentation or residual redness) following an acne outbreak is not true scarring, and can be cleared with topical treatment, chemical peels, and laser treatments.

There are several distinct types of acne scars, each characterized by unique appearances and textures:

Atrophic scars

Atrophic scars are depressions in the skin caused by the loss of tissue during the healing process. They are further categorized into three main types:

1. Ice pick scars: These are deep, narrow, sharply defined scars resembling small punctures. Ice pick scars penetrate deep into the skin and are among the most difficult types to treat.
2. Boxcar scars: These scars are broader, with sharp, defined edges and a flat bottom. They resemble chickenpox scars and often appear on the temples and cheeks.
3. Rolling scars: Characterized by wavy, undulating depressions, rolling scars give the skin an uneven, bumpy appearance due to underlying tissue bands pulling at the skin surface.

Hypertrophic scars and keloids

Hypertrophic scars and keloids are another scar type, characterized by raised tissue growth. Hypertrophic scars remain within the boundaries of the original acne lesion, while keloids extend beyond the original acne site and can continue to grow over time. Both result from excessive collagen production during the skin’s healing process.

The most effective way to prevent acne scars is to treat acne early and aggressively. Prompt treatment reduces inflammation and the likelihood of deep, cystic breakouts that can damage the underlying skin. Over-the-counter options may be helpful for mild acne, but moderate to severe acne often requires prescription medications or in-office treatments.

It is equally important to avoid picking, popping, or squeezing pimples. These actions dramatically increase the risk of scarring by introducing bacteria and worsening inflammation. However, even if you do everything right, unfortunately, scars can form.

Using sunscreen daily is also a key preventive step. Sun exposure can darken scars and interfere with the skin’s natural healing process. Applying a broad-spectrum SPF 30 or higher every morning helps protect healing skin and prevents post-inflammatory hyperpigmentation.

• Chemical Peels: Gently exfoliate and stimulate new cell turnover, softening superficial scars and discoloration.
• CO₂ Laser (Fractional Ablative): Precisely vaporizes tiny columns of damaged skin, triggering robust collagen remodeling for deeper scars.
• Fraxel Dual (Non-ablative Fractional Laser): Heats beneath the surface to improve texture, pigment, and early scarring with minimal downtime.
• Pulsed Dye Laser (PDL): Targets redness in fresh or healing scars and reduces inflammation that can worsen scarring.
• Intense Pulsed Light (IPL): Evens skin tone by fading red or brown marks left behind after acne.
• Microneedling: Creates controlled micro-injuries that stimulate collagen and elastin to smooth shallow scars.
• PRP (Platelet-Rich Plasma): Enhances healing and boosts collagen production when combined with microneedling or lasers.
• RF Microneedling: Adds radiofrequency energy to tighten and remodel deeper layers of collagen, improving atrophic (indented) scars.
• Sofwave (Ultrasound): Stimulates collagen and elastin in the mid-dermis to improve skin firmness and texture over time.
• Laser Skin Resurfacing (General): An umbrella term for ablative and non-ablative laser treatments that refine texture, even tone, and restore smoother, healthier-looking skin.