What can I do about my acne scars? The types of acne scars & how to treat them

What can I do about my acne scars? The types of acne scars & how to treat them

As if acne isn’t frustrating enough, many acne sufferers are left with visible scars on their face, shoulders, and back after their breakouts have cleared—and these scars can even worsen with age. A number of treatments are available to help reduce their appearance, but there is no one-size-fits-all solution. Each type of acne scar requires a special approach, and a series of combination treatments are usually necessary for a satisfactory result from acne scar treatment. 

Below, we outline the different types of acne scars, as well as how board certified facial cosmetic surgeons approach treatment of each one.

The 5 types of acne scars

Most types of acne scars fall under the umbrella categories of atrophic acne scars. Atrophic scars include all indented scars: icepick, rolling, and boxcar scars. There are also raised scars that project out from the surface of the skin, which may be either keloid or hypertrophic scars. Before deciding on a treatment plan, your facial cosmetic surgeon will identify which type(s) of acne scarring you have:

  • Icepick scars — Icepick scars appear narrow and deep, as though an instrument was used to make them.
  • Rolling scars — Rolling acne scars appear as a generally uneven, hill-like skin texture, without isolated scars.
  • Boxcar scars — Boxcar scars are somewhat shallow and wide crater-like scars that appear as indented shapes, such as squares or ovals.
  • Keloid scars — Keloid scars are raised bumps on the skin, usually dark in color, that grow beyond the borders of the original skin wound or acne lesion.
  • Hypertrophic scars — Hypertrophic scars are thick scars that can be flat or raised. Unlike keloid scars, these do not grow past the area where the skin was originally wounded.

Acne scar treatment options

Many patients have multiple different types of acne scars, and it is common to have multiple forms of scarring on different areas of the face or body. Still, the treatment combination that will be most effective for you depends on the type of scar present. Here are the treatment options available for improving the texture of acne scars, as well as what kinds of scars they treat:

Dermal fillers

Fillers are injected beneath the skin to raise indented, or depressed, acne scars. Commonly used fillers for acne scars include poly-L-lactic acid (PLLA) fillers, hyaluronic acid (HA) fillers, calcium hydroxyapatite fillers, and polymethyl-methacrylate (PMMA) fillers. Patients interested in using their own fat as a natural dermal filler may also seek out a “fat transfer” procedure in which harvested fat from a donor area of the body is used as a dermal filler.

Which acne scars do dermal fillers treat? Deeper atrophic scars, particularly rolling or boxcar, usually combined with collagen-inducing skin treatments

Laser skin resurfacing

Laser skin resurfacing involves passing precise wavelengths of light across the skin to trigger the body to supply new collagen to the skin, helping to remodel the skin and diminish the edges of acne scars to make them less noticeable. There are many varieties of laser, including ablative and non-ablative, fractional and not fractional, available. The more intensive lasers among these require more downtime and should be chosen carefully, but they can achieve striking results with just one treatment.

Which acne scars does laser resurfacing treat? Atrophic scars (icepick, rolling, and boxcar)

Chemical peels

Chemical peels involve application of a solution that prompts the outermost layer of skin to peel in the course of the days following treatment. This stimulates new skin growth with a more even texture and appearance.

Which acne scars do chemical peels treat? Atrophic scars (icepick, rolling, and boxcar)

Microneedling (a.k.a. Collagen induction therapy)

Microneedling involves passing a device containing many very small, hair-like needles across the skin to promote collagen production (neocollagenesis) through micro-injury, prompting the body to “heal” the treated areas and creating smoother skin. To see best results, most patients require a series of 3-6 treatments.

Newer microneedling devices may combine microneedling with radiofrequency (RF), which is delivered via the needles deep into the epidermis and dermis to promote skin contraction and remodeling of deeper scars.

Another recent innovation involves combining microneedling with platelet-rich plasma (PRP). In this treatment, the patient’s purified blood platelets are applied to the skin as part of the microneedling treatment to promote healing and enhance the treatment’s effects.

Which acne scars does it treat? Atrophic scars (icepick, rolling, and boxcar)

Subcision

A needle is inserted below the scar and moved in a fanning motion to create a micro-wound in order to prompt the body to flood the area beneath the scar with collagen, ultimately raising the scar.

Which acne scars does it treat? Rolling and boxcar scars scars, usually combined with collagen-inducing skin treatments

Punch techniques (or, acne scar surgery)

Punch excision, punch elevation, and punch grafting are all surgeries performed on a very small scale to either remove an acne scar, reposition the tissues for an even skin texture, or replace the scar tissue with a graft.

Which acne scars do they treat? Very deep atrophic scars (i.e. icepick scars)

Steroid injections

Corticosteroid injections are placed directly into raised acne scars to soften the tissues and make them flatter.

Which acne scars do they treat? Raised keloid and hypertrophic scars

Cryotherapy

Cryotherapy involves freezing the scar to reduce its appearance.

Which acne scars does it treat? Raised keloid and hypertrophic scars

Surgical removal

Surgical removal is an option if you have a raised scar; however, the results are not guaranteed, as most patients have their keloid scars return or see more scarring after hypertrophic scars are removed. Surgical removal may be followed with complementary treatments in an effort to minimize the scar recurrence.

Which acne scars does it treat? Raised keloid and hypertrophic scars

The importance of repeated treatments for acne scars

It is very important for most acne scar patients to both use combination treatment methods and to undergo multiple treatments over a period of time. The results of skin treatments, like microneedling or laser skin resurfacing, improve remarkably and are optimized with multiple treatment cycles. And for most raised scars, it is necessary to combine two or more therapies to minimize their appearance.

Treating hyperpigmentation along with acne scars

While treating acne scar texture is a key part of minimizing their appearance, most acne scar patients also want to treat discoloration, caused by post-inflammatory hyperpigmentation (PIH). PIH can effectively be minimized with some of the same treatments used for acne scar texture, such as chemical peels and laser therapy. 

In addition to any of the above treatment modalities, avoid allowing hyperpigmentation to worsen by always wearing sunscreen and protecting your skin from sun exposure. 

What you should know before undergoing acne scar treatment

  • Your acne should be effectively cleared before scar treatment begins. This ensures that no new scars will form after treatment.
  • Your treatment will be personalized. Certain combinations are known to work on scars, but remember that your treatment will need to be fully personalized based on your skin and other factors. 
  • Complete “erasure” of significant acne scars is not usually realistic. Rather, treatment minimizes their appearance over time. Your facial cosmetic surgeon will help you to have realistic expectations for the degree of improvement possible with acne scar treatment.
  • Choose a credentialed provider. To receive individual, understanding treatment, choose an experienced facial cosmetic surgeon who can recommend a unique treatment plan just for you.

Looking for expert, effective care? Choose a board certified facial cosmetic surgeon for your acne scar treatment.

When it comes to seeking aesthetic care, trust your skin to a highly-qualified specialist. Facial cosmetic surgeons who are board-certified by the American Board of Facial Cosmetic Surgery (ABFCS) have devoted all or a significant portion of their practice to cosmetic concerns that affect the face, head, and neck, and they have extensive experience in dermal fillers, laser treatments, and a range of other non-surgical and surgical techniques for achieving your aesthetic goals. Find a facial cosmetic surgeon near you today.