This article is aimed at helping you identify the type of acne scar or combination of acne scars that you may have on your face. Once you have identified the scar type, you will later come to know what dermatological treatment(s) are out there and what results you can expect. This article will also help you understand what your dermatologist will recommend as a treatment for you. You will also come to know if you really need a dermatologist, or you can use certain skin care products that can reduce the acne scarring. There are several anti-acne and acne scar treatment products out there that might help you based on your scar type. Finally, you will also learn about how to prevent further acne scars and treat acne scars at home.
There are different types of acne and they can be broadly divided into the one that is deep with big dents on the skin, and the ones that are not too deep with small scars or small open pores.
For the scars that are not too deep, the general treatment to reduce the appearance of the scar is to resurface the skin which involves getting rid of the top surface skin so the new healthy skin can grow.
The skin can be resurfaced using Dermatological treatments like Microneedling, Dermabrasion, Microdermabrasion, Laser or Chemical Peels. Skin can also be resurfaced using skin care products and active ingredients in the form of exfoliation, chemical peels, and serums.
Very deep scars require skin resurfacing as well as skin surgery.
Unfortunately, acne scar may not completely disappear. However, there are ways to make considerable improvements in the visibility and size of these scars so they are less or even barely noticeable in some cases. If there is any associated discoloration with your old acne scars, with time and ongoing sun protection, it can fade.
How we get Acne
4 things need to take place for you to have acne.
- Overproduction of Sebum
- Inflammation by thickening of the lining of the sebaceous gland (the oil gland in the skin)
- This creates an anaerobic environment with very little oxygen which invites P. Acnes (the bacteria) in to the space and start to grow
- The bacteria breaks down triglycerides into glycerol and free fatty acids. These free fatty acids are very irritating, they burst through the sebaceous gland and start to inflame that area.
The Inflammation triggers the melanocytes and leads to hyperpigmentation. We can modify all 4 factors and to prevent future acne.
Menstrual cycle and puberty can lead to acne as well. When you have a change in hormone production, the amount of sebum production from the sebaceous glands of your skin also increases, which clogs the pore and leads to acne.
How we get scars from Acne
Scars are formed in the dermis which is the deepest layer of the skin before you hit the hypodermis which is the fatty tissue. So you need products that work deeper into the Dermis layer if you want to get rid of a scar. A scar is basically your body’s attempt to form new skin. Unfortunately, sometimes the body does not form the new skin as it should. Sometimes it over reacts and you get a Keloid scar, and sometimes you get marks or red or black colored spots or scars that develop as hyperpigmentation.
Bigger the inflammation - bigger will be the scars. With regards to ethnicity, Asians have a particular form of scarring and they get worse acne which means worse scarring. Popping acne can lead to scars and hyperpigmentation as well.
Identify the type of your Scar
There are different types of Scarring, mainly the colored ones (brown, black, red, purplish) and the ones that are like dents on the skin.
Brown Scars (PIH)
PIH or Post inflammatory Hyperpigmentation is when you see dark spots (brown or black scars) that were left off when you previously had acne. These are the most common acne related scars that form after you have had acne. These are not the acne scars that are deep like Keloids, but these are essentially pigmentation (redness) that is caused after acne. PIH is common with dark skin and skin of color.
Red Scars (PIE)
PIE or Post-inflammatory Erythema are the red or purplish spots that may appear after the acne is gone. Acne comes when there is inflammation in the skin. Sometimes these inflammations can damage the capillaries that are very close to the surface of the skin.
With skin of color, these marks can turn into black marks i.e. PIH. That is why it is common to see a mix of PIH and PIE scars in a patient.
PIH is a pigmentation issue, while PIE is not a pigmentation issue but an issue of damaged capillaries. That’s why both of them require different treatments.
How to find if you have PIE or PIH scars?
Take a glass and put it on your cheeks. Try to see the scar through the glass. If the scar disappears, it is PIE. However, if you press it up against the skin and brown marks are still there, you have PIH.
- Ice-pick scars
A type of indented scar that is deep, narrow, pitted dents treated using TCA Cross. Deeper the scar, the better the results.
TCA Cross for Ice-pick Scars
A type of indented scar with flat, thin scars or depressed scars (anetoderma)
Hypertrophic or Keloid scars
Thick lumpy scars
broad depressions with sharply defined edges. They are dents like a box. These scars are all on the same level and usually treated with a resurfacing laser treatment.
broad depressions with a sloping edge that give a rolling shape to the skin or wavy skin shape.
Dermatological Treatments for Acne Scars
Type of Scar
Vascular V BEAM Lasers
Brown / Dark / Early Acne Scars
Little Downtime, treats spots as well as boosts collagen production. 2-3 sessions. Perfect treatment for skin of color.
Fat Grafting (injecting patients fat into bumps) or
Dermal Fillers (injecting gel-like substance to fill the gaps)
Not permanent and prone to appear back after successful treatment.
Boxcar Scars/small open pores
Resurfacing Laser Treatment
Deeper the scar, the better will be the result. Delivered using a toothpick.
To get the best results from an acne scar treatment is to first clear your acne as new acne breakouts can potentially cause more scarring. Furthermore, active acne and acne breakouts signal to you that there is inflammation in the skin and an inflamed skin will decrease the effectiveness of any treatment for acne scarring.
Cost: $500 per session
Needling is done using Skin Needling rollers like Derma Rollers, and or a skin stamping device and is called collagen induction therapy which could encourage your skin to make more collagen and fill up any depressed scar tissue that you might have. A tool is used to create micro-injuries with micro-needles. As these tiny punctures heal, the skin produces new collagen within the scar promoting collagen and skin regrowth.
It takes some time to see results - sometimes as long as 9 months before you notice any difference. 3-6 treatments every 2-6 weeks. You can notice bruising and swelling during the treatment which heals in 4-5 days. This procedure is best for widespread depressed acne scars. This is not a treatment for raised acne scars.
In terms of the tool used for needling the skin, it is better to use a skin tamping tool rather than a roller as it is much more gentle with less tearing of the skin and better results with less trauma.
There are different types: CO2, fraxel, Picosecond etc for different types of scars. Some are for resurfacing the skin to cause your acne scars to become even. Resurfacing removes some layers of the skin in a very controlled fashion, allowing the body to produce new healthy skin tissue.
Picosecond Laser Treatment Device
It is a Vitamin A derivative that takes the top layer of the skin off and lets the new layer of skin to grow back. It is only available as a medical prescription.
AHA (light peel) and TCA peels are used for resurfacing the skin (i.e. peeling the surface layer of the skin so new healthy skin can grow)
TCA CROSS is the chemical reconstruction of skin scars (CROSS) using trichloroacetic acid (TCA) which is white in color, as you can see in the image above. It is a common treatment for Ice Pick scars that stimulates collagen production.
This works by breaking down old collagen and laying down new collagen. This raises up the scar which makes the scar much more shallow. The whiteness will fade within 3 hours and the skin will be red for approximately 5-7 days.
A tool is used that goes over piece by piece over your face and takes off the top layer of your skin, making way for the new layer of skin to grow. Removes top layers of the skin and some middle layers of the skin. Not effective in treating very deep scars.
Cost: $200 per session
Very different from Dermabrasion. A tool is used over the face which shoots little tiny crystals into your face and sucks them back up into the vacuum with the same goal to promote a new layer of skin to grow.
Fat Grafting (injecting patients fat into bumps) or Dermal Fillers (injecting gel-like substance to fill the gaps). Fillers are effective to bring up the scar and essentially bring it more to the surface of skin making it less noticeable. However, fillers only give temporary results that last only 6 to 18 months and are prone to appear back after successful treatment.
Skin Care Routine for Acne Scars
First of all, when you get an acne scar you have to be protected from the sun. Exposure to the sun creates most of the problems within our skin and exposure to the sun while having an acne scar can make your skin worse. Use sunscreen daily.
Our skin cycles every 30 to 60 days so we’re getting a new skin layer every single month or 2 months (depending on how old you are). When you have acne scarring, that shows a level of damage is deep in the pores of your skin. Exfoliation is key to getting rid of any type of scarring as it helps remove dead skin cells from your face and helps assist your skin create new skin cells.
While exfoliation takes care of cleaning up dead skin and gunk within your pores, you also need something that heals your scarring within the pore. That’s where Retinol comes in. A Retinoid decreases the amount of acne and inflammation. Retinoids stimulare fiberglass which are cells in your dermis (middle layer of skin) that produce collagen and help diminish scars. Retinol is a very powerful ingredient to reverse damage within your skin. Retinol can be very sensitizing, but if you use it correctly, you can see a lot of really good benefits.
The other treatment that you can use to reduce the scarring is an active ingredient called Niacinamide. It helps reduce the appearance of blemishes, dark spots and acne scars and smoothes the uneven texture of the skin.
If you have Pigment Scarring, the first step to getting rid of acne scars will be to use a brightening ingredient like Vitamin C. It is a great brightening agent and also has powerful anti-aging abilities. Vitamin C also helps to mop up the free radicals from the skin which could cause further inflammation to the skin
A recent paper in 2019 shows that 0.3% Adapalene + 2.5% Benzoyl Peroxide show significant improvement in Atrophic Acne Scars. Benzoyl Peroxide can modify the inflammation markers.
You can also include Alpha Arbutin in your skin care routine which is a derivative of hydroquinone without the side effects.
A 2015 study found that Tamanu Oil has anti-bacterial and wound healing properties against P.acnes and P.granulosum so it helps in treating inflamed acne. Numerous studies also found that Tamanu Oil has skin regeneration properties that promote the production of collagen and glycosaminoglycan (GAG) that are important in the healing of scars.
How long does acne scars last
Our skin cycles every 30 to 60 days so we’re getting a new skin layer every single month or 2 months (depending on how old you are). When you have acne scarring, that shows a level of damage is deep in the pores of your skin.
Unfortunately, not every acne scar will not completely disappear. However, there are ways to make considerable improvements in the appearance and size of these scars so they are less or even barely noticeable in some cases.
How acne scars can be removed
Yes, there are surgeries that you can have to get rid of your acne scar. Acne scar surgeries do exist and are effective. It sounds a lot scarier than it actually is. It is a minor procedure performed under local anesthesia put into the skin so the dermatologist can actually lift the scar up and make it flat with the surface of the skin. By bringing the scar up to the surface of the skin, it makes it less noticeable.
How to prevent more pigmentation from happening
Once you have cleared your pigmentation or other forms of acne scarring, you may wonder what you should do if you get another spot?
Once your skin has healed from acne, apply your after-care cream on straight away. What that will do is stop the pigmentation in its tracks. The quicker you put on a very high tyrosinase inhibitor onto that area, the better your chances of not getting pigmentation on that spot.
Recommended Skin Care Products
- Differin® Gel Adapalene Gel 0.1% Acne Treatment ($12 | 15g)
Dermatologists recommend Differin® Gel which used to be available only with medical prescription but is now readily available. Use a 0.1 to 0.37% Benzoyl Peroxide with it to make it even more effective.
- Exfoliation: Herbivore BlueTansy Mask ($48 | 70ml)
This is great for resurfacing your skin and when you use it, you will feel that all the texture is gone and you literally feel dead skin cells being taken off of your skin. Use 2 times a week for 15 minutes.
- Exfoliation (option 2): Krave Beauty Kale-Lalu-yAHA Resurfacing AHA exfoliator ($25 | 200ml)
- Exfoliation Option 3: The Ordinary 2% Salicylic Acid ($7 | 30ml)
Exfoliation Option 4 : Paula’s Choice 2% BHA Liquid Exfoliant ($29 | 118ml)
- Retinol: Drunk Elephant A-Passioni Retinol ($80 | 30ml)
- Retinol (Another Option): The Ordinary Retinol 0.2% in Squalane ($8 | 30ml)
- Niacinamide: The Ordinary Niacinamide 10% + Zinc 1% ($8 | 30ml)
- Vitamin C: Caudalie VinoPerfect Serum ($48 | 30ml)
- Vitamin C (second option): Drunk Elephant C-Firma Serum ($80 | 30 ml)
- Moisturizer: The Ordinary Natural Moisturizing Factors + HA ($9 | 100ml)
- Sunscreen: CeraVe Mineral Sunscreen SPF 50 ($12 | 75ml)
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