Despite being incredibly common—”acne is the most common skin condition in the United States, affecting up to 50 million Americans annually”—developing acne scars can feel like a big setback.1 The good news is that there are acne treatments that can help reduce the appearance of scarring and prevent pimples from popping back up.
To determine what those are, we chatted with a few of the industry’s leading dermatologists and estheticians for the 411 on all things acne scars. By the end of this article you’ll be able to identify which type of acne scar you have, how to prevent them from appearing in the first place, and how to diminish them if they do pop into view.
Types of Acne Scarring
Since permanent scarring is never a desired outcome, it helps to know which type of scar your face or body is forming so that you can get ahead of caring for it. In general, there are four main types of acne scarring: ice pick, rolling, boxcar, and hypertrophic.
- Ice Pick Scars: “Just as the name suggests, ice pick scars are deep and look like sharp indents,” Vargas says. “The scar is created by a deep cyst that rose to the surface, creating a loss of skin tissue.” According to Green, ice pick scars are the hardest acne scars to treat due to their depth.
- Rolling Scars: “Rolling scars typically appear in patients that have suffered from inflammatory acne for a long time,” Green explains, noting that these scars are thin with a wavelike pattern and smooth edges. Vargas tacks on to this, noting that rolling scars make the skin look textured. “They are caused by fibrous bands of tissue that develop between the skin and the subcutaneous tissue below the skin,” she says. “They literally pull on the skin from below creating the uneven appearance.” According to Green, rolling scars are often barely visible, however, they become more pronounced as the skin loses its elasticity.
- Boxcar Scars: Green says that boxcar scars are very similar to chickenpox scars. “Boxcar scars are shallow, indented scars with sharp edges,” she explains. Vargas adds that boxcar scars are bigger (albeit shallower) than icepick scars and look (as the name suggests) more boxy, thanks to the inflammation under the skin that forms as a result of the breakout and loss of collagen.
- Hypertrophic Scars: “These scars are a result of an overgrowth of fibrous tissue which results in an elevated lesion,” Green explains. Vargas expands, noting that these scars feel thick and raised, and often occur from any trauma—like picking—that the skin suffers. “The most common type of hypertrophic scar is keloids,” she explains. “You see it more on the body than the face, but you can get them anywhere.”
What Is a Keloid?
Keloids are raised, shiny scars that can occur as a result of cuts, burns, piercings, tattoos, and acne. According to the AAD, they appear as though a liquid spilled on the skin and then hardened.2
Causes of Acne Scars
There isn’t one clear-cut source of acne-scarring—there are several.
- Ruptured breakouts: According to Green, acne scars occur as the result of ruptured pimples, pustules, whiteheads, and cysts, which cause the skin to break when the infected pore ruptures. “When infected acne ruptures the skin, it can often cause a bacterial infection which also destroys healthy skin cells,” she explains. “As the skin repairs itself from an acne breakout, the wounds that are formed as a result of broken skin starts to heal. As the skin heals, our body produces collagen which is the fibrous tissue that repairs the skin. In some instances, our bodies produce too little or too much fibrous tissue resulting in uneven texture in the skin, also referred to as a scar.” The loss of collagen will lead to those concave or “pitted” acne scars, not unlike a pock mark.3
- Skin-picking: Scarring may also form as a result of picking at a pimple—just another reason to be sure to take a hands-off stance when it comes to treating your breakouts.
- Diminished pigment: Celebrity esthetician Joanna Vargas points out that some scars are simply due to a loss of pigment as a result of the pimple existing in the first place.
- Cystic acne: At the end of the day, whether you’ve picked at your face or simply are witnessing a new breakout, scars are a possibility. That said, Dr. Levin says that the risk of acne scars increase when the acne is inflammatory—think: swollen, red, or painful—as this type of acne penetrates deeper into the skin. Due to its deep-reaching nature, inflammatory acne (like cysts) require more pressure to pop (which you definitely shouldn’t) and more time for treatments to effectively sink in (which requires patience), both of which make for longer breakouts and a stronger likelihood for scarring. “In general, if the acne breakouts penetrate the skin from inflammation or trauma from self-imposed trauma, scar tissue forms… as part of the healing process,” Levin explains.
How to Prevent Acne Scarring
The number one thing you can do to prevent acne scarring from ever happening in the first place is keeping your hands off your breakouts. Let’s be clear: No matter how tempting it may be, you should never, ever pick at or pop your pimples. “It is most important that you do not attempt to pop your pimples or pick at any scabs, as this can result in permanent acne scarring,” Green emphasizes.
If you have incessant whiteheads or severe cystic acne, this can be especially tricky, as the breakouts seem visually persistent. Fortunately, there are OTC products to help make dealing with these breakouts less of a trigger.
For cystic breakouts, Vargas touts Renee Rouleau’s Anti-Bump serum as a means for reducing inflammation.
When it comes to pus-tipped pimples, try Starface’s Hydro-Stars, which employ a 100-percent hydrocolloid dressing meant to effectively suck all the gunk out of your zits so you don’t have to pick and prod to do so yourself.
Finally, a derm-loved favorite for acne, retinoids, are a great way to heal existing breakouts and prevent incoming acne lesions as retinol helps to exfoliate dead skin cells out of pores; “They also work to normalize skin cell turnover and act as an anti-inflammatory, says Levin. “Furthermore, [they] have been proven to improve skin discoloration and texture and, therefore, restore the skin from prior outbreaks.” Retinoids also boost collagen production which is great for plumping the pitting caused by scars.4
Treating acne scars can be as simple as addressing the root cause of your breakout and proceeding accordingly; however, many of the most effective methods are costly in-office treatments, which is why prevention of acne is key (more on that later). “In addition to prescribed topical and oral antibiotics to treat acne, patients can also do chemical peels, Fraxel laser treatments, microneedling with PRP (platelet-rich plasma), Ematrix laser, and subcision surgery,” Green says.
For icepick scars, try dermal fillers or subcision surgery.
When you’re working with ultra-deep acne scars, Green and Vargas agree that fillers are the best choice for diminishing their appearance and creating an even complexion.
“Juvederm is a hyaluronic acid-based dermal filler which can be used to treat depressed acne scars such as icepick scars and boxcar scars,” Green says, noting that since hyaluronic acid is a substance that is naturally found in the body, there is no downtime and patients see an immediate improvement thanks to the way the formula promotes collagen regrowth.
If, however, fillers don’t effectively diminish the appearance of your icepick scars, Green says to turn your attention towards subcision surgery. “The procedure is performed by inserting an 18-gauge needle at an acute angle adjacent to the scar with the bevel upwards and parallel to the surface of the skin,” she explains. “Using a fanning motion horizontally, the fibrous bands are severed. As this occurs, blood containing collagen and elastin fibers rushes into the depressed scar replacing some of the lost collagen.” For best results, she says that you should repeat the subcision process monthly in conjunction with lasers until the scarring fully disappears.
For rolling scars, try Fraxel and Ematrix Lasers.
Since rolling scars create a wavy, textured complexion, using lasers to help resurface the skin is an effective treatment.
“The Fraxel laser—also coined the ‘Magic Eraser’— uses fractional laser technology that utilizes a scanning device to apply highly-concentrated tiny laser pulses to your skin and create thousands of microscopic wounds,” Green explains. “As the skin heals and repairs itself, it creates new collagen repairing the skin from the inside out.”
Then there’s Ematrix, which is a sublative laser resurfacing treatment that’s equally as effective for rolling scars: “Ematrix works by stimulating collagen formation and healthy skin cells,” Green says. “Ematrix releases heat energy in the dermis of the skin to stimulate collagen production. It’s ideal for all skin types, including Asian, Latino, and African American skin.”
For boxcar scars, try subcision surgery, Fraxel laser, microneedling, and chemical peels.
Despite being shallower than icepick scars, Green says that boxcar scars can greatly benefit from subcision surgery. However, before booking the minimal procedure, Levin says you should consider laser skin resurfacing, chemical peels, microneedling, radiofrequency with microneedling, or even dermal fillers. “Fillers can be used to effectively even out the texture of depressed acne scars by filling acne scars with hyaluronic acid or more permanent fillers,” she explains.
For hypertrophic scars, try steroid injections.
“Steroid injections are the best treatment for hypertrophic scars,” Green says point blank. “The injections break up the fibrous tissue beneath the skin, reducing the size of the scar.” In addition to steroid injections, Green says that VBeam pulsed-dye lasers can also be used to treat hypertrophic scars in addition to any residual redness from the scar.
Visit a dermatologist.
“First and foremost, seeing a board-certified dermatologist is crucial if you are concerned about whether you are developing acne scars,” Levin says. “Your dermatologist will create a treatment plan in order to treat the acne first in order to prevent outbreaks in the first place.”
Try LED light therapy.
“LED Light grows collagen in quantifiable percentages,” Vargas explains. “In my salon, we do several different treatments that involve LED light, but by far the most popular is my patented RevitaLight Bed which gives a client a full body treatment of healing LED…It’s sort of like having a magic wand.”
Book microdermabrasion with a professional.
“In the salon, acne scars and hyperpigmentation benefit from microdermabrasion,” Vargas explains. “I use a diamond peel—there are diamonds in the tip of the wand that I use. It’s adjustable for your skin type, even if you have super sensitive skin. Regular exfoliation is key to getting more even skin tone and even surface. We do something called a Power Peel which is a fruit acid peel/LED light combo that really helps with scars over time.”
It’s no secret that SPF is a daily must to protect the skin and prevent premature aging. However, according to Levin, slathering up also helps prevent acne scarring from worsening as the sun can lead to damaging hyperpigmentation and general skin degradation. Be sure to layer on a sunscreen with at least SPF 30 before exposing yourself to any direct sunlight.5
Create an all-encompassing anti-scarring approach.
“Depending on the type of scars, there are different treatments available,” Levin reminds us. From topical treatments like retinoids and antioxidants (meant to diminish dark scars and resurface texture) and oral medications to control further breakouts (like Spironolactone, Isotretinoin, oral antibiotics, and birth control pills) to in-office treatments including lasers, microneedling, chemical peels, and injectable fillers, there’s an option out there that could totally change the the fate of your skin post-breakout. If you’re unsure which is the right option, Levin says to consult a dermatologist.