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How to Treat Acne Scars

From major breakouts of red, inflamed acne to the occasional pimple, dealing with acne is never an enjoyable experience. 

Luckily, a wide range of medications are available to treat even the most severe acne and bring breakouts under control. 

While getting rid of acne can feel like a victory in itself, the unfortunate reality is that many types of acne can leave behind scars — a major annoyance that can affect both your appearance and your confidence even after you’re no longer prone to breakouts.

From pitted scars to hyperpigmentation, acne scar can vary in size, type and severity. Just like with acne itself, numerous treatments are available that can help you make acne scars smaller, less visible and, in some cases, get rid of them completely. 

Below, we’ve explained how you can treat acne scars, from over-the-counter products available from your local drugstore to prescription medications, fillers, surgical procedures and more. 

Acne Scars: What They Are and Common Types

Acne scars are an annoying, stubborn souvenir left behind by certain types of acne, particularly inflamed and infected acne.  

Scarring from acne develops when inflamed acne lesions cause your skin to become damaged. As part of its healing process, your body forms new skin tissue to replace areas that have been damaged by the inflammatory effects of certain types of acne.

Just like it’s normal for skin to grow back differently after a scratch or surgical incision, the skin that grows back after a major acne breakout doesn’t always look the same as the skin that was there before.

Types of Acne Scarring

Acne scars come in a variety of types, with the specific type depending on how your skin grows back after an acne breakout.

The most common types of acne scars are referred to as atrophic scars. These develop when the dermis (the thickest layer of your skin) in areas affected by acne grows back with a smaller amount of collagen than the surrounding skin.

Atrophic scars are depressed or indented. The skin tissue that grows back after your acne goes away sits slightly below the normal layer of skin tissue, giving it a pitted, uneven appearance.

There are three main types of atrophic acne scarring: ice pick scars, boxcar scars and rolling scars. Each type differs slightly in appearance:

  • Ice pick scars are the most common type of atrophic scarring, accounting for about 60 percentto 70 percent of atrophic acne scars. These scars are narrow and shaped like the letter V, with an appearance similar to the wound left behind by a sharp ice pick.
  • Boxcar scars are a slightly wider type of scar that make up 20 percent to 30 percent of atrophic acne scarring. These scars measure up to 4mm across and have a round or oval shape with sharp, obvious edges.
  • Rolling scars have a broad, undulating appearance with a sloping edge. This type of scarring is less common than other atrophic scars, accounting for about 15 percent to 25 percent of all atrophic acne scarring.

Sometimes, acne scarring is referred to as hypertrophic scarring. This type of scarring develops when the skin that grows after a severe acne breakout has a larger amount of collagen than the surrounding skin.

Hypertrophic scars are also known as keloid scars. They’re less common than atrophic scars, accounting for about 10 to 20 percent of all acne scarring. Most hypertrophic scars are raised from the surrounding skin, pink in color and firm to the touch.

Although both types of acne scarring can affect people of all races, people with dark skin tones typically have a higher risk of developing hypertrophic acne scars.

If you’re prone to acne scarring, you may notice a variety of different scar types on the parts of your skin that have been affected by acne. It’s normal to have a mix of ice pick, boxcar, rolling and other acne scars, even within small areas of your skin.

Our guide to acne scars goes into greater detail about the different types of acne scarring and the simple methods that you can use to tell acne scars apart. 

Acne Scarring Severity

Just like acne breakouts can vary hugely in severity, acne scarring can range from very mild to very severe. Acne scarring is usually scored using a four-level grading system:

  • Grade 1. This grade covers acne scarring that’s macular, or flat. It includes changes in your skin pigmentation caused by acne (for example, small darker or lighter spots), but doesn’t include atrophic or hypertrophic scarring.
  • Grade 2. This grade includes mild atrophic or hypertrophic scars that are visible only at a distance of 50cm or less. Scarring in this category can usually be covered up by short facial hair or makeup.
  • Grade 3. This grade includes moderate atrophic or hypertrophic scars that are obviously visible at a distance of 50cm or more. Scarring in this category usually can’t be covered up by facial hair or makeup, but flattens when the skin is stretched (if atrophic).
  • Grade 4. This grade includes severe atrophic or hypertrophic scarring that’s visible at a distance of 50cm or more. These scars aren’t easily covered up by facial hair or makeup and can’t be flattened by stretching the skin.

Generally speaking, the lower the grade of your acne scarring, the easier it will usually be to get rid of the scarring (or at least minimize its appearance) with treatment. 

The Best Treatments for Acne Scarring

Acne scars can be annoying, unsightly and the source of a hit to your self-confidence, especially when they develop on your face and parts of your body that other people can easily see.

Luckily, most types of acne scarring are treatable. Although treatments can’t always fully get rid of acne scars, most can reduce their appearance so that they’re less obvious and blend in more easily with the surrounding skin. 

Because acne scarring can vary in type and severity, there’s no “best” treatment for all types of acne scarring. A range of different treatments are available, ranging from over-the-counter scar treatments suitable for light scarring to cosmetic procedures ideal for heavier, deeper scars. 

We’ve listed all of your options below, along with information on how each treatment works and the type of results you can expect.

Treating Acne Before Scars Develop

Although it’s of limited use if you already have significant scarring, the most effective way to get rid of acne scars is to prevent them from developing in the first place.

If you’re prone to acne and want to avoid scarring, you should make treating your acne your top priority. Simply put, fewer acne breakouts means fewer chances for all types of acne scarring to develop. 

You should do this even if you already have acne scars, as further breakouts may worsen your scarring and make it more difficult to treat in the future. 

When you do get acne, avoid popping or picking at your pimples. Popping pimples on your own can introduce bacteria into your skin and cause an infection — something that’s closely linked to obvious, permanent acne scarring.

We’ve covered methods of treating acne in our guide to science-backed acne treatments. If you have severe acne, it’s often worth contacting a dermatologist or talking to a medical professional online to learn more about the treatment options that are available to you. 

Over-the-Counter Acne Scar Treatments

Numerous over-the-counter products are available to treat acne scars, including exfoliants and silicone gel strips. Although these products usually aren’t enough for moderate or severe acne scarring, they may be effective if you only have a few mild acne scars.

Scar Strips, Gels & Patches

A range of silicone strips, patches and gels are available to treat scars, including certain types of acne scarring. These products are typically easy to use and can be purchased from a wide range of stores, making them a readily available, simple treatment option.

Most scar strips are designed to treat hypertrophic scars rather than the more common atrophic acne scars. Research shows that they’re fairly effective. For example, a study from 2009 noted that a silicone gel treatment produced improvements in keloid and hypertrophic scarring.

An article published in the journal Advances in Wound Care also noted that although the exact mechanism by which silicone sheets work isn’t known, their ability to improve hypertrophic and keloid scarring largely is largely agreed upon in the scientific community.

If you have recent acne scars that are hypertrophic (raised from your skin), applying scar strips may help to make them less obvious. However, there’s limited research on the effectiveness of silicone products for atrophic scars, such as ice pick, boxcar or rolling acne scarring. 

Topical Over-the-Counter Treatments

Several over-the-counter topical treatments are available to treat acne scarring, including mild, non-prescription retinoids and exfoliants. These include:

  • Salicylic acid. Salicylic acid is an exfoliant, or peeling agent, that’s found in numerous over-the-counter acne products. It’s generally used as an acne treatment for its effects on skin cells and the substances that can clog pores and cause acne breakouts.

    As well as treating acne, salicylic acid is also effective at treating acne scars. In fact, it’s widely regarded as one of the best peeling agents for managing acne scarring.

    While high-strength salicylic acid is only used in a clinical setting, you can find a variety of mild salicylic acid products in most drugstores. Try starting with a low strength, then adjust based on your tolerability and results.
  • Other topical exfoliants. Other acid-based exfoliants, such as citric acid, glycolic acid and lactic acid (known as alpha-hydroxy acids), are also used as peeling agents to get rid of acne scars.

    While full-strength alpha-hydroxy acid peels are only available in a clinical setting, you can purchase skincare products containing low concentrations of many alpha-hydroxy acids from many drugstores and online retailers.

  • Over-the-counter retinoids. Although the most powerful retinoids are only available with a prescription, some over-the-counter retinoids may help to improve skin texture and lighten certain types of acne scarring.

    For example, one study from 2018 found that the over-the-counter retinoid adapalene (available as Differin® cream or gel) produced improvements in atrophic scarring and skin texture over the course of 24 weeks of treatment.

Prescription Medications for Acne Scarring

Tretinoin, a prescription retinoid that’s often used as an acne and anti-aging treatment, may be an option worth considering if you have atrophic acne scarring. 

Tretinoin is a topical medication. As an acne treatment, it’s applied directly to affected areas of skin, where it works by speeding up the production of new cells. Most research into tretinoin as an acne scar treatment looks at its effects on atrophic acne scars. 

Several studies have found that tretinoin can help to treat acne scars when it’s delivered using a process called iontophoresis, which involves the use of electrodes to deliver medication into the deeper layers of the skin. 

For example, one study from 1999 found that a 0.025% tretinoin gel delivered via iontophoresis produced a significant decrease in scar depth in 94 percent of patients with atrophic acne scars, all without significant side effects.

Another study from 2004, which involved the use of 0.05% tretinoin gel by iontophoresis, found that 79 percent of patients with atrophic acne scarring experienced improvements.

We’ve talked more about how tretinoin may be helpful for acne scarring and how you can use it in our guide to topical tretinoin for acne for acne scars.  

Surgical and Cosmetic Procedures for Acne Scarring

A range of cosmetic treatments are available to treat acne scarring. Some of these treatments, such as dermal fillers, involve filling in areas of skin with atrophic scars. Others involve injuring or stimulating the skin to encourage the growth of new skin cells. 

Since acne scars can vary in size, type and severity, there’s no one-size-fits-all procedure that’s most effective for removing acne scars. Because of this, it’s important to talk to a dermatologist or healthcare provider before you choose a specific procedure to treat your acne scarring.

We’ve listed the most common surgical and cosmetic procedures for acne scarring below, along with more information on how each procedure works.

Exfoliating Treatments

These treatments work by stripping away the outermost layers of your skin and encouraging the growth of new skin cells. Some use chemicals, while others use medical devices such as lasers and abrasive instruments. Exfoliating treatments for acne scars include:

  • Chemical peeling. Chemoexfoliation, or chemical peeling, involves the use of chemicals to remove damaged skin. It’s used to get rid of scarring and as an anti-aging treatment, as the new skin that grows back is typically smoother and younger-looking.

    Chemical peels are highly effective at treating acne scars. A scientific review from 2012, which looked at multiple studies, found that several chemical peeling treatments helped to reduce scarring and improve skin in Asian patients with atrophic acne scarring.
  • Laser resurfacing. Ablative laser therapy, or laser resurfacing, involves stripping away the external layers of skin using an ablative laser, allowing new skin to grow in its place without scarring and other imperfections.

    Laser therapy is effective for a variety of scar types, particularly hypertrophic scars and shallow boxcar scars. Some acne scars can be treated using non-ablative lasers , which have a faster and easier recovery period.

    Laser resurfacing can vary in price, with procedures available from $100 to thousands of dollars depending on the length and severity of the treatment.
  • Dermabrasion. Dermabrasion involves removing the top layers of skin using a special device to “sand down” the skin layer by layer, allowing new skin to grow in place of old skin affected by acne scarring and other damage.

    Like other exfoliating procedures, dermabrasion is effective at treating acne scars. One scientific review from 2015 noted that dermabrasion and microdermabrasion — a slightly milder procedure — are particularly effective at treating scarring, however dermabrasion does not improve ice pick or deep boxcar scars optimally.

    Dermabrasion and microdermabrasion procedures typically cost several hundred dollars per session. If you have deep or obvious acne scars, you may need to undergo several sessions in order to experience an improvement. 

Dermal Fillers

Although dermal fillers are often associated with anti-aging, they’re also used to treat scarring, including some types of acne scars. Dermal fillers such as Juvederm®, Restylane® and others can be injected into atrophic scars to raise them and better match the surrounding skin. 

A scientific review from 2015 looked at several studies of dermal fillers for acne scarring, noting that most fillers produced improvements in facial acne scars and achieved high levels of patient satisfaction.

Fillers can vary in price from a few hundred to several thousand dollars, depending on the type of filler and the amount that needs to be injected. Some dermal fillers only last for a few months, meaning you may need to repeat this treatment several times per year for lasting results. 

Punch Excision, Skin Grafting & Other Procedures

In addition to exfoliating procedures and dermal fillers, several other cosmetic procedures are used to treat acne scars. These include:

  • Subcision. Scar subcision is a minor surgical procedure that involves making tiny cuts in the scar tissue beneath an acne scar. These cuts break the connective tissue under the scar, lifting the scar upwards to match the surrounding skin.

    Subcision is an effective option for treating acne scarring. In a study of 40 people with rolling acne scars, 90 percent reported that their skin improved after they underwent a subcision procedure.

    Like with other surgical procedures, the cost of subcision can vary based on the extent and complexity of your acne scarring. Most procedures cost several hundred to several thousand dollars.
  • Punch excision. Punch excision is a procedure that involves physically removing skin that’s affected by acne scarring. Using a circular scalpel, a healthcare provider will cut into your skin and remove the area with acne scars, then suture the skin back together.

    Punch excision is typically used for deep scars, such as ice pick and boxcar scars. It’s often used before other punch techniques, such as punch grafting and punch elevation (both explained below).

    Punch excision can cost from a few hundred to several thousand dollars depending on the number of scars you need to remove.
  • Punch grafting. Punch grafting involves taking skin from an inconspicuous part of your body and using it to replace skin removed via a punch excision. This procedure is often used for deep acne scars that can’t be treated using other methods.
  • Punch elevation. Punch elevation is similar to grafting, but instead of taking skin from elsewhere on the body, the scarred skin is removed with a punch tool, then elevated to the same level as the surrounding skin.

In Conclusion

If you have acne scars that you’d like to treat, a variety of options are available, including some that you can purchase from your local drugstore. 

If your scarring is mild, an over-the-counter exfoliant or retinoid might be strong enough to make your scars lighter and less visible. However, if you have deep or obvious acne scarring, it’s best to talk to your healthcare provider or schedule an appointment with a dermatologist.

While many procedures for acne scarring can seem intimidating, they’re worth considering if you want to get rid of your scars for good. 

Finally, if you still get acne breakouts, make sure to get them under control before you focus on treating your acne scars. Our full guide to prescription acne medication goes into detail on your options for ending acne breakouts and enjoying smoother, pimple-free skin.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.