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 true, textured acne scars is a more challenging process. That said, it is certainly possible! Read on to learn more.
What causes acne scars?
Acne scars are the result of active acne inflammation in the dermis (i.e., the thick layer of living tissue below the epidermis, which forms the true 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 on their own without leaving a permanent scar, cystic acne lesions are more likely to leave behind a scar due to the greater inflammation and damage to the dermis. In addition, popping and picking pimples dramatically increases the risk of scars 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 what is post-inflammatory hyperpigmentation (PIH). These are post-acne marks 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).
True 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 in shape 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 that are 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 or licensed esthetician. There are several treatment options to help minimize the appearance of acne scars and even remove them altogether.
- Fractional Microneedle Radiofrequency (Microneedle RF)
- Fractional Laser Treatments
- Chemical Peels
- Dermal Fillers
Read more on each of these treatments below!
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 2 highly effective skin rejuvenation treatments—microneedling and radiofrequency—for even greater efficacy with minimal downtime and side effects. It works by inserting very thin, ultrasharp, gold-plated needles into the dermis of the skin (micro needling). Once the needles reach a certain skin depth (variable—.25-5mm), they produce mild heat (radiofrequency), which stimulates new collagen production, which ultimately fills 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 signs of treatment.
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 2 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 is a carbon dioxide laser (CO2 Laser Resurfacing). It works by creating micro burns in the skin that are intended to trigger the buildup of new collagen.
- 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:
- 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 provide improvement to 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 the appearance of acne scars by using a chemical solution to remove the outer layer of old skin. 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 as well 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 severity of the scars. 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: 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 include 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 surface of the skin. In Subcutaneous incision (AKA subcision), a needle or small scalpel is inserted to run parallel to the skin's surface. The surface of the skin lifts once these bands have been released, 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 who are 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 retinoic acid (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 darkening of the skin. In addition, 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.
Pro tip: stick to ingredients that are clinically proven to prevent and treat acne, such as salicylic acid and benzoyl peroxide in the right potency for your skin type, sensitivity, and acne severity. "Natural" skincare products may seem like a good idea and can be a great added benefit to your products and routine but will
Consider an oral medication: for those with severe acne, effective topical treatment can help but may not be enough for full clearance of the acne. In these cases, it is important to consult your dermatologist or OB/GYN about options for oral medication such as Accutane, Spironolactone, or Birth Control Pills (for women) to help control acne before it results in additional scarring.
Do not pick touch or squeeze: This applies to everyone, everywhere, with every skin condition! Touching, picking, and squeezing the skin (especially active acne!) can result in more breakouts that heal improperly and leave behind scars. Simply... don't. Touch.
Use hydrocolloid pimple patches:
These small patches are a skin saver for those with active acne. They help heal individual pimples, prevent secondary infection, and protect the blemish from outside bacteria as well as compulsive picking and touching.
If you have any other questions about acne treatment, acne scars, or hyperpigmentation, please feel free to email us at firstname.lastname@example.org