Acne Scarring
Acne scarring is the permanent change in the surface of the skin left behind after inflamed acne heals. It is a texture problem rather than a color one, and the flat brown or pink marks people often call scars are something else entirely.
Key facts
Acne Scarring at a glance.
Typical signs
Indented or raised scars
Common locations
Face, chest, back
Expected course
Lasting; appearance can improve
Treatment options
Scar-specific resurfacing, release or injections
What is it?
Top things to know about Acne Scarring
- It follows inflammatory acne. Inflammation can damage tissue around a follicle.
- Scars can be sunken or raised. Lost support causes depressions; excess tissue causes raised scars.
- Several types often coexist. Lighting also changes how visible depressions look.
- Marks and scars differ. Pigment or redness can fade separately from true contour change.
What it looks like
What Acne Scarring looks like
Acne scars form when deep breakouts damage the skin as they heal. Most acne scars are indented, sitting below the surface, because collagen is lost. They often appear on the cheeks, temples and jawline. Some people develop raised scars instead, especially on the chest, back and jaw. Flat red or brown marks after acne are not true scars and usually fade with time.
Acne scars are grouped by their shape. Each type responds to different treatments.
Ice-pick scars
Narrow, deep pits.
Boxcar scars
Wide with sharp edges.
Rolling scars
Wave-like dips with soft edges.
Hypertrophic and keloid scars
Raised scars.
Where it shows up
Location varies
Scars follow previous acne, commonly on the face or trunk. Their location depends on where the acne occurred.
On different skin tones
Acne Scarring on different skin tones
Acne scars look similar in shape on all skin tones. On brown and Black skin, scars are often surrounded by dark marks, which can make them look worse, and raised keloid scars are more common. Darker skin needs careful laser and peel settings to avoid new dark marks.
What happens in Acne Scarring?
Deep acne inflammation can damage the supporting tissue in the dermis. Healing may leave too little collagen, tethered tissue or excess collagen, producing indented or raised scars.
- Uneven repair changes the surface: Collagen loss or tethering can leave depressions.
- Extra collagen can raise a scar: Some scars heal with excess tissue.
- Inflammation damages support: Deep acne can injure dermal tissue.
Causes and triggers
What causes Acne Scarring
Causes
Why it happens
Acne scars form when deep, inflamed breakouts destroy collagen as they heal. Most scars are indented, from collagen loss.
The tendency to scar runs in families.
Risk factors
Raise the odds
- Severe or cystic acne
- Delayed acne treatment
- Family history of scarring
Triggers
Bring it on or make it worse
- Picking and squeezing (Well established)
- Untreated deep acne (Well established)
When it usually starts
When it usually starts
Acne Scarring
Develops after inflamed acne, often beginning in adolescence or young adulthood.
Daily care
Daily care for Acne Scarring
Daily sunscreen
Keeps redness and pigment around a scar from deepening.
Treat the acne first
Nothing holds if new spots keep arriving.
Subcision
Cuts the fibrous bands tethering a rolling scar.
TCA CROSS
A drop of strong acid heals an icepick scar narrower.
Silicone gel or sheets
Cheap, slow, months of daily use.
Give each treatment months
Collagen remodels for a year afterward.
Avoid: Picking and squeezing
Ruptures the pore wall, spreading inflammation into healthy skin.
Avoid: Home extraction tools
Same damage as fingers, more force.
Avoid: Scrubbing and stacking actives
Adds inflammation and pushes people off treatment.
Avoid: Sun exposure on a healing scar
Darkens the mark and slows settling.
Avoid: Picking scabs
Reopens the wound and deepens the mark.
Avoid: Assuming flat marks are scars
Sends you away from what stops the next one.
Avoid: Deep spots left untreated
Every extra week inflamed damages more tissue.
Avoid: Waiting to see a doctor
Risk rises every year acne goes untreated.
Avoid: Aggressive treatment too early
Lasers or peels on active acne add marks.
Avoid: Stopping acne treatment early
Acne that returns starts it over.
Treatments
Treatments for Acne Scarring
Silicone gel or sheets
The best-evidenced thing you can buy for scars, and only for raised and keloid ones. It has to be worn most of the day, every day, for two to three months before it is worth judging. It does nothing at all for an indented scar.
Retinol
Used nightly over months it gradually improves surface texture and the tone around a scar, and it keeps treating the acne that would cause the next one. It will not lift an established dent. Think of it as the background treatment that procedures are done on top of.
Vitamin E
The most commonly recommended scar remedy there is. It has been studied properly for exactly this and did not help, and it causes an itchy rash in a fair number of people. Silicone is the option with real evidence behind it, and only on raised scars.
Tretinoin
The prescription retinoid, stronger than retinol, used nightly over months. It improves surface texture and the marks around scars, and it keeps the acne that makes new scars under control. It does not fill an indented scar, and it is usually paused before resurfacing procedures.
Hydroquinone 4%
Aimed at the flat dark marks sitting alongside the scarring, not at the scar itself. Clearing the pigment first makes it much easier to see how much true texture is there, which is why it usually comes before any texture treatment. It is used in courses rather than indefinitely.
Accutane
This prevents scars rather than treating them, and on this page that is the most valuable thing on the list. It is the most reliable way to shut down the deep, inflamed acne that is still making new scars, and no texture treatment holds while spots keep arriving. Resurfacing is usually delayed for a period after the course ends — that timing is a conversation with your prescriber.
Cortisone Injection
The mainstay for raised and keloid scars. Steroid injected into the scar flattens and softens it, usually over a series of injections four to six weeks apart. It does nothing for indented scars, and too much in one place can leave a dip or thinned, pale skin.
Fractional CO2 Laser
The most effective single option for indented scarring, and the one with the most downtime — about a week of raw, swollen skin and months of strict sun avoidance afterwards. It does most for boxcar and rolling scars; icepick scars need something aimed at them separately. Settings are dialled back on deeper skin tones because of the pigment risk.
RF Microneedling
Morpheus8. Needles carry heat below the surface, so it builds more collagen than needling alone while doing less to the top layer. That lower surface injury is why it is often the first choice for boxcar and rolling scars on deeper skin tones. Usually three or four sessions about a month apart, with the result still building for a year.
Microneedling
Fine needles injure the skin just enough to trigger new collagen. It does most for rolling and shallow boxcar scars, and very little for icepick ones. It is the gentlest of the resurfacing options, which also makes it the slowest — expect four to six sessions and judge it at a year, not at a month.
Subcision
A needle is passed under a rolling scar to cut the fibrous bands tethering it down, so the floor lifts. It is aimed at rolling scars specifically and does nothing for icepick or boxcar ones. Bruising for a week or two is normal, and it is often done in the same visit as needling or filler.
Fraxel
Fraxel. Resurfaces without removing the surface, so recovery is a few days of redness and swelling rather than a week of raw skin. It gives less improvement per session than CO2 and needs more sessions to get there. It is the sensible middle option when the downtime of ablative laser is not workable.
TCA Peel
TCA Peel and TCA CROSS. In the CROSS technique a single drop of strong acid is placed into the opening of an icepick scar so it heals narrower. It is one of very few things that reaches a scar this deep and this narrow. Several rounds are usual, and acid outside the pit can leave a mark, so the result depends heavily on who is doing it.
Dermal Fillers
Filler placed under a shallow rolling or boxcar scar lifts the floor of it straight away, which makes it the only option here with a same-day result. It is temporary, lasting months to a couple of years depending on the product. It works best as a top-up alongside collagen-building treatment, not instead of it.
Scar Revision
A single deep, narrow scar is cut out and closed, or punched out and grafted, trading a pit for a fine line that resurfacing can then blend. It suits a handful of stubborn icepick or deep boxcar scars, not a whole cheek. It is normally done before laser rather than instead of it.
Chemical Peel
Repeated medium-depth peels smooth the edges of shallow scars and even out the tone around them. The effect on texture is modest next to laser or needling. On this page peels earn their place mostly for the flat marks sitting alongside the scars rather than for the scars themselves.
V-Beam
Targets the blood vessels rather than the texture, so it calms the redness in and around a fresh scar and helps flatten raised ones. It will not lift a dent. It is most useful in the first year, when the color is what makes a scar stand out.
Microdermabrasion
Polishes the very top layer of skin, which is nowhere near deep enough to reach the collagen that makes a scar. It can leave skin looking brighter for a few days. It is widely sold for acne scarring and it does not change acne scarring.
Outlook
What to expect with Acne Scarring
Scars appear as the acne settles and look their worst in the first few months. Some of that fades over the first year. Treatment improves the picture after that, but it does not reset it.
- 1
First few months · 0-3 months
Redness in and around a new scar makes it stand out.
- 2
Six to twelve months · Redness fading
Redness fades over six to twelve months, so a scar looks better at a year than at three months with nothing done to it.
- 3
One to two years · Raised scars
Hypertrophic scars often flatten over one to two years on their own. Keloids do not, and can keep growing slowly for years, so treat them early.
- 4
Long term · Indented scars
Indented scars do not fill in. What changes is how visible they are: skin loses firmness with age, so shallow rolling scars look deeper in the forties and fifties than in the twenties. One more reason for daily sun protection.
- 5
After treatment · Over six to twelve months
Most procedures give partial improvement, most need a series of sessions, and the result builds over six to twelve months as collagen matures. The aim is a scar that is harder to see, not skin that looks as though the acne never happened.
Complications
Complications to know about
Keloid scars
A raised scar that grows beyond the spot that caused it, into skin that was never involved. They form most often on the chest, shoulders, upper back and jawline, and they are more common on deeper skin tones. They rarely settle on their own and can keep growing slowly for years, so they are worth treating early rather than watching.
Dark marks after treatment
Lasers, deep peels and aggressive needling all inflame the skin, and skin with reactive pigment cells answers inflammation by making more pigment. The result can be darker than what you started with, and it can take a year to settle. Conservative settings, a test patch and a provider who treats deeper skin tones regularly all lower the risk.
Confidence and mood
Scarring is permanent, visible, and usually arrives at the end of years of dealing with acne, and the effect on confidence and mood is well documented. It does not track with how bad the scarring looks to anyone else. It is a reason to be seen rather than to wait, because most scars can be made considerably less noticeable.
When to get help
When to get help
When to seek care
Seek care early for acne that is leaving scars. Have active breakouts controlled before choosing scar procedures.
Lookalikes
What else could it be?
Post-Inflammatory Hyperpigmentation
Brown marks after acne are flat and can fade. Acne scars leave a dent or raised area, so texture matters more than color.
Post-Inflammatory Redness
Pink or red marks after acne can be completely flat and gradually fade. A scar changes the skin’s surface, even when redness surrounds it.
Enlarged Pores
Enlarged pores usually form an even field of small openings. Acne scars leave separate dents where individual spots healed.
Questions
Questions you might be asking.
Can acne scars be removed completely?
No, and anyone saying otherwise is overselling. Most scars can be made much less visible, often hard to see in ordinary light, and a good plan usually combines two or three treatments.
How do I tell a scar from a mark?
Touch it, and look at it in side lighting. A scar has texture - you can feel a dent or a raised lump, and it casts a shadow. A mark is flat and differs only in color, and flat marks fade on their own.
Will my scars fade over time?
Redness fades over six to twelve months, so scars look better at a year than at three months. The dent does not fill in. Raised scars often flatten over one to two years; keloids generally do not.
When can I start treating my scars?
Once the acne is controlled and the skin is calm, usually a few months of stable treatment. If you have taken isotretinoin, most dermatologists wait a period after finishing before resurfacing - ask the doctor who prescribed it.
Which treatment is best for my scars?
It depends on the shape. Icepick scars respond to TCA CROSS and punch excision, rolling scars to subcision and needling, boxcar scars to laser resurfacing and radiofrequency needling, raised scars to steroid injections and silicone. Most people have a mixture, so most plans combine treatments.
Why does picking cause scars?
Squeezing forces the pore's contents sideways through its wall into surrounding skin instead of out through the surface. That spreads inflammation into tissue that was never involved - the exact injury the body repairs with a scar.
Sources
Sources and further reading
Related
Keep exploring.
Post-Inflammatory Hyperpigmentation
Fraxel
Microneedling
Post-Inflammatory Redness
Fractional CO2 Laser
Subcision
Microdermabrasion
Scar Revision
Accutane
Cortisone Injection
RF Microneedling
