Acne, on its own, is extremely frustrating and can take a serious toll on our confidence. Unfortunately, even after active acne controlled and cleared with the right skincare products, we're often left with a long-term reminder of the pimples that were once there—acne scars. While post-acne dark spots and hyperpigmentation can be treated successfully with a dark spot remover, treating real, textured acne scars is challenging. That said, it is certainly possible! Read on to learn more.
What causes acne scars?
Acne scars result from active acne inflammation in the dermis (i.e., the thick layer of living tissue below the epidermis, which gives strength to the skin). The acne scar is actually created by the wound trying to heal itself, resulting in the overproduction of collagen fibers in the area where the pimple once was. While most pimples will heal independently without leaving a permanent scar, cystic acne lesions are more likely to leave behind a scar due to the more significant inflammation and damage to the dermis. Besides, popping and picking pimples dramatically increases scars' risk due to greater damage and disruption to the healing process.
What are the different types of acne scars?
Hyperpigmentation: the term "acne scar" is often misused when referring to post-inflammatory hyperpigmentation (PIH). These are post-acne marks that aren't technically scars but rather dark spots left on the skin after a pimple heals. They can range in color from dark brown to reddish, to pink, depending on skin tone and severity but tend not to be textured (pitted or raised).
Atrophic Scars: These depressed or raised scars can be divided into different groups;
Icepick scars: Deep, narrow scars that appear like pinpoint pits (deeper than they are wide).
Rolling acne scars: Broad, inconsistent depressions that give the skin a wave-like appearance.
Boxcar scars: Sharply defined, pitted scars that are depressed with steep borders. These are usually round or oval and tend to appear on the temples and the cheeks. Boxcar scars are more difficult to treat than another type of acne scar.
Hypertrophic scars: Raised, tough scars caused by overproduction of collagen during the skin healing process. Keloid scars are similar but extend beyond the size of the original wound.
What are the best office treatments for acne scars?
Unlike hyperpigmentation, which can be treated with prescription and over-the-counter creams, true scars require in-office treatments from a dermatologist. There are several treatment options to help minimize the appearance of acne scars and even remove them altogether.
Fractional Microneedle Radiofrequency for Acne Scars
Fractional Microneedle Radiofrequency (AKA Fractional RF Microneedle) is one of the most effective, non-surgical treatments currently available to treat depressed acne scars. This treatment combines two highly effective skin rejuvenation treatments—micro-needling and radiofrequency—for even greater efficacy with minimal downtime and side effects. It works by inserting very thin, ultrasharp, gold-plated needles into the skin's dermis (micro-needling). Once the needles reach a certain skin depth (variable—.25-5mm), they produce mild heat (radiofrequency), which stimulates new collagen production, ultimately filling out depressed scars. With minimal side effects (red skin for a few hours), patients can go back to school or work as early as the next day with no noticeable treatment signs.
Fractional Laser Skin Treatments for Acne Scars
Fractional Laser Resurfacing (also referred to as a "laser peel") is another treatment for acne scars that works by directing pulsating beams of light (lasers) at the skin. There are two main types of laser resurfacing, Ablative and non-ablative fractional lasers.
Ablative laser resurfacing:
How it works: This treatment works by resurfacing (or removing) the outer layers of skin. Non-ablative lasers create changes in the dermis without causing damage to the skin's surface. The most common ablative lasers used to treat acne scars are carbon dioxide laser (CO2 Laser Resurfacing). It works by creating micro burns in the skin that are intended to trigger new collagen buildup. Types of ablative laser resurfacing: Carbon dioxide (CO2) laser, Erbium laser
The results: The usual result of fractional ablative laser treatment is that "new" skin is smoother, atrophic scars are reduced in-depth, and the overall look of scarring is softened. The results and efficacy are usually similar to microneedle radiofrequency but with more pain, more downtime, and more risk for post-treatment hypo and hyperpigmentation.
The side effects: After ablative laser treatment, the skin generally heals within two weeks but can remain red for a period of time after healing. The redness fades over the course of several weeks to several months. More severe side effects (listed on this Mayo Clinic page) are possible but rare.
Non-ablative laser resurfacing for acne scars
How it works: non-ablative laser resurfacing works by heating the underlying skin tissue to stimulate new collagen production without causing damage to or removing the top layer of skin.
Types of non-ablative laser resurfacing: Intense Pulsed Light (IPL), Pulsed Dye Laser, Fraxel, CoolTouch, N-lite
The results: While non-ablative lasers can improve acne scars, they are less effective than both microneedle radiofrequency and ablative lasers at treating acne scars. That being said, Pulsed Dye Lasers (one form of non-ablative lasers) can be used to improve raised scars and keloids.
The side effects: Fractional lasers have a few probable side effects. That being said, treatments are usually significantly more painful than other treatment options.
The popular "Fraxel" laser skin resurfacing comes in both ablative and non-ablative formats.
Chemical Peels for Acne Scars:
Moderate and deep chemical peels improve acne scars' appearance using a chemical solution to remove the old skin's outer layer. The new skin that replaces it is usually smoother with improved, more even color and texture.
The results: Superficial peels with glycolic acid, lactic acid, or other alpha and beta hydroxy acids can improve skin texture and fade dark spots but will not provide a significant effect on depressed acne scars.
The side effects: Light, superficial chemical peel: After a light chemical peel, patients typically experience a reaction similar to sunburn in the treatment area with mild redness lasting from 3-7 days. Moderate to severe chemical peels: After moderate and severe peels, patients can expect significant swelling, blisters that will crust, turn brown and peel off within seven to 14 days.
Additional risks: Temporary or permanent change in skin color is possible following a chemical peel. (particularly for people with darker skin tones) These treatments can also cause reactivation of cold sores and, in rare cases, cause more scarring
Dermal fillers for depressed acne scars
Dermal fillers, similar to the ones used for wrinkle reduction or lip plumping, can also be used to treat depressed acne scars, which do not respond to the above treatments for acne scars.
How it works: dermal fillers help reduce the appearance of depressed acne scars by inserting a needle underneath the scarred area and depositing the fluid of choice until the scar depression is filled. The amount of filler used will vary and depend on the number of scars being treated and the scars' severity. The type of filler will depend on the recommendation by your provider.
Types of dermal fillers for acne scars: Hyaluronic acid fillers such as Juvederm or Restylane are commonly used in this application.
The results of acne scars dermal filler treatment are temporary and typically last for 3-4 months. In addition to the immediate, short-term benefits in the appearance of acne scars, dermal fillers also have long-term benefits as they can help break up the scar tissue and stimulate collagen production, minimizing the appearance of scars long-term.
The side effects: Injection site swelling, redness, and bruising is possible but typically subsides. While allergic reactions are rare with dermal fillers used today, they are possible. Another risk that is rare but possible is included infection at the injection site.
What is the best surgical treatment for acne scars?
Subcision (cutting under the scar with a scalpel): One of the causes of depressed scars is collagen fiber that pulls down the skin's surface. In Subcutaneous incision (AKA subcision), a needle or small scalpel is inserted to run parallel to the skin's surface. Once these bands have been released, the skin's surface lifts, smoothing the skin surface's appearance. This procedure is invasive, requires local anesthesia, and is more costly than the microneedle or laser treatment.
What are the best treatments for hyperpigmentation?
While the acne scar treatment list above can also help with dark spots and hyperpigmentation, they are usually unnecessarily invasive and costly for those most worried about dark spots and less about textured scars.
The gold standard prescription formula for the treatment of hyperpigmentation is the Kligman formula, which includes hydroquinone (to fade dark spots) hydrocortisone, (to reduce the irritation associated with higher percentages of hydroquinone), and retinoid (to enhance the penetration of the hydroquinone).
While this formula has been the #1 dark spot treatment for decades, it does have its drawbacks. Due to the high % of hydroquinone in the formula, it can (in rare instances) result in the skin's darkening. Also, due to the inclusion of hydrocortisone, it is not suitable for long-term use. Finally, as a prescription product, it requires a dermatologist visit, which can be cost-prohibitive and difficult.
That's why we created the MDacne Dark Spot Remover, which contains both hydroquinone, retinoids, and hydroxy acids combined with plant-based botanicals making it an excellent treatment for post-acne hyperpigmentation. However, like most other topical treatments, it will not have much of an effect on true acne scars.
How to prevent acne scars from forming?
Commit to effective topical acne treatment: The best way to prevent new scars and hyperpigmentation from forming is to prevent the inflammation (i.e., acne breakouts) in the first place. This means you need to start a medical-grade acne treatment program ASAP. Do not wait until you are desperate or settle for mild acne. You can use a program like MDacne to identify the best acne treatment products for you or visit your local dermatologist.
What is the best cleanser for people with acne scars?
The best cleansers for people with acne scars are cleanser with a low % of salicylic acid (BHA) or alpha hydroxy acids (AHA). This type of medicated acne cleanser has a mild exfoliating effect that improves skin brightness and glow.
What is the best moisturizer for people with acne scars and post-acne dark marks?
Cleansing the skin should've always followed by a moisturizer, preferably an active one. One of the best active ingredients for people with acne-prone skin and post-acne scars is niacinamide. Niacinamide is regarded as one of the top skincare treatment ingredients. It minimizes and tightens enlarged skin pores, strengthens the skin's natural protective layer, and helps balance oil production. Also, it improves uneven skin tone, reduces skin redness, and diminishes skin dullness.
Applying Niacinamide around the eyes reduces the appearance of under the eye dark circles and wrinkles on the eyes' sides (crow's feet). Niacinamide based moisturizers are great for all skin types, including sensitive or rosacea-prone skin.
Niacinamide hed has been shown to increase the production of ceramides. Ceramides, found in our skin's outermost layer, help the skin form a healthy barrier that keeps water in and toxic environmental elements out. Clinical studies have also shown applicating over several months can reduce skin sallowness and lead to fresher, younger-looking skin. In one study, researchers found that skin treated with a moisturizer containing 5% Niacinamide showed a significant reduction in hyperpigmentation with lightening of dark marks and age spots.
What are the best treatment creams for people with scars?
Retinoids, derivatives of vitamin A, are known to exfoliate and remove the dead skin cells from the top layer of the skin and increase the cell turnover in the epidermis. Using retinoids can also help slow the loss of collagen fiber and promote new collagen production in the dermis, increasing the skin's strength and elasticity. Bonus, retinoids can also make your epidermis thicker, which improves skin texture.
What are the best sunscreens to prevent hyperpigmentation and dark marks?
Unprotected sun exposure increases the amount of pigment in the skin and can cause pigmented acne scars and post-acne dark marks. To prevent those dark marks from forming, one needs to control active acne with an effective topical or oral anti-acne treatment. In parallel, it is recommended to use an oil-free sunscreen with SPF 30. The best sunscreen for acne or post-acne dark spots is also water-resistant, which will stay on your skin when sweating. Some of the new sunscreens contain, in addition to SPF, plant extracts with anti-oxidants like green T and vitamin E and ingredients that help fade post-acne dark spots like licorice and vitamin C.
What are the best clay face masks for people with scars?
Using a pink clay mask 1-2x per week can be a good addition for people with acne-prone skin and a tendency for acne scars. By absorbing the dead cells and excess sebum from enlarged skin oil glands, these masks can help with acne breakouts, reduce skin redness, and improve overall skin texture and brightness. MDacne's pink clay mask contains, in addition to the pink clay, a few ingredients that can help calm the skin and reduce the appearance of post-acne dark marks and scars. By mildly exfoliating the skin, pink clay masks are a great way to provide a fresh, natural glow for acne scars' skin.
These ingredients include, among others, a non-irritating retinoid that is converted in the skin to potent, active retinoic acid, rosehip that helps build healthy new collagen fibers to enhance skin regeneration and reduce the appearance of scars. MDacne's pink clay acne masks also include hyaluronic acid that enhances moisture content, keeping the skin hydrated while revitalizing its outer surface layers for a smoother, healthy, radiant appearance.
If you have any other acne treatment questions, acne scars, or hyperpigmentation, please feel free to email us at email@example.com.
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