It doesn’t matter if you’re a fresh-faced teenager or a confident adult — acne is an equal opportunity offender. The unfortunate truth is that even if you’ve gotten your breakouts under control, there’s a chance that they’ve left one last “gift” behind: acne scars and hyperpigmentation. Luckily, there are a wide range of options available (both at home and at the doctor’s office) for treating these annoying marks. We’ve consulted with board-certified dermatologists, who can help you narrow down the treatments that may be the most effective for your post-acne concerns.
What kinds of acne scars are there?
It’s important to recognize that not all acne scars (or treatments) look the same. According to Lisa Guidry Pruett, MD, board-certified dermatologist in Carrollton, Texas, acne scars can be divided into three categories: atrophic (depressed), hypertrophic (raised), or keloidal (significantly enlarged and raised). “Atrophic scars are the most common, and these can be subdivided into ice pick, boxcar, or rolling scars,” she says. (Learn more about the types of acne scars here.)
That said, all acne scars have one thing in common, and that’s normal skin tissue has been replaced with scar tissue. “One of the main reasons scars are visible is because these post-acne marks catch shadows or reflect light differently than surrounding skin,” explains Janet Allenby, MD, board-certified dermatologist in Delray Beach, Florida. “In many cases, scar treatments don’t technically restore normal tissue, but rather, make the skin look better by addressing the surrounding skin to camouflage scar tissue.”
Is what I have actually an acne scar?
Before you dive into treating an acne scar, make sure it is one and not something else. A lingering spot after a pimple has healed may not be an acne scar at all. In fact, what many people believe to be scars is often post-inflammatory hyperpigmentation, or PIH. “These red or brown spots that follow an active acne lesion are not [always] permanent, and [may] resolve with time or with different treatments,” Dr. Pruett shares. According to Dr. Allenby, PIH tends to appear brown in deeper skin tones and red in lighter complexions.
Above all, Dr. Pruett and Dr. Allenby both agree that prevention is key for minimizing acne scars, as well as PIH. “My advice for preventing scars is to get a treatment plan in place with a board-certified dermatologist,” says Dr. Pruett, who points out that it’s essential to avoid picking, as it can worsen scars. You should also wear sunscreen on a daily basis. This can help reduce PIH’s lifespan, as SPF will block the over-production of melanin, the naturally-occurring pigment responsible for your PIH’s color.
If it’s too late for prevention, the good news is that it’s not impossible — or too late — to improve the visibility of acne scarring and achieve a clear complexion once and for all, regardless of the type of marks that your blemishes have left behind.
Post-Acne Scar Treatment Option #1: Topicals
There are several over-the-counter and prescription-based topical options for improving PIH, as well as atrophic scars. “[Some of] the best over-the-counter ingredients for fading discoloration that remains after an acne blemish has healed are kojic acid, arbutin, and glycolic acid,” explains Dr. Pruett.
Kojic acid, a by-product of fermented malted rice used in sake, works to help brighten skin by blocking the production of an amino acid called tyrosinase. In order for your body to produce melanin, it needs tyrosinase. By preventing tyrosinase from forming, kojic acid thus stops your dark spot from darkening, and lightens it over time. Arbutin functions in the same way, but is derived from the bearberry plant. You can find both ingredients, plus brightening licorice root, in PCA Skin® A&C Synergy SerumTM ($103). Glycolic acid is an alpha-hydroxy acid, which works to exfoliate away the top level of skin and improve tone (learn more about glycolic acid here).
Looking for something stronger? See if you’re a candidate for any prescription treatments. “The ideal prescription topical for improving post-inflammatory hyperpigmentation is hydroquinone, with or without a retinoid,” explains Dr. Pruett. Consult with your doctor to see if this one-two punch is the right choice for you and your skin.
[Editor’s note: Hydroquinone has not been FDA-approved. Retinol shouldn't be used by women who are pregnant, considering getting pregnant, or nursing. As always, talk to your doctor before starting or stopping any new treatment.]
Post-Acne Scar Treatment #2: Intense Pulsed Light (IPL)
IPL is a professional treatment that uses pulses of multiple wavelengths of light to improve discoloration. Dr. Allenby believes IPL is especially effective for red post-acne marks, which can be more difficult to treat with topical solutions. The discomfort of this treatment varies from patient to patient, with most comparing the sensation to the snap of a rubber band.
There is very little downtime with IPL: typically, you’ll look like you just did an hour of cardio with the flushed face to match (which can easily be covered with makeup). Keep in mind, however, that brief downtime means you’ll have to book more appointments. “The treatments that require the least number of [sessions] typically have the most downtime,” emphasizes Dr. Pruett. “If patients want zero downtime, they are going to need many more in-office treatments to achieve results.”
Post-Acne Scar Treatment #3: Laser Skin Resurfacing
If you’re ready for a slightly more intense option with more downtime (and, thus, more dramatic results), consider laser skin resurfacing. “These treatments can help improve acne scars by inducing collagen remodeling and growth,” says Dr. Pruett. Many people have heard of laser resurfacing by one of its brand names, such as Fraxel®. It creates controlled injuries where it’s administered, forcing your complexion to heal and regenerate new skin. According to Dr. Allenby, more aggressive procedures, such as CO₂ resurfacing, can also help reduce the depth of acne scars by smoothing out the skin’s surface and “lowering it,” bringing it closer to the level of the scar.
However, keep in mind that these types of procedures come with considerably more downtime than a treatment like IPL. You can expect, at the very minimum, a long weekend’s worth of downtime to heal. Many report that a full week is needed to let the side effects — including redness, swelling, itching, and peeling — to subside. (Note: If you have skin of color, you may want to look elsewhere, as resurfacing lasers have been known to cause hyperpigmentation in deeper complexions.)
Post-Acne Scar Treatment #4: Microneedling
Microneedling is yet another way to increase collagen production to help smooth the appearance of acne scars. This minimal-downtime treatment uses a roller or pen with small needles that penetrate the skin, creating micro-injuries that prompt the skin’s natural wound-healing response.
It’s regarded as an excellent option to treat challenging pitted scars, and (even better!) microneedling is said to be safe for skin of color. Furthermore, the procedure typically only takes about 20 to 30 minutes. Just be sure to stay out of the sun as your skin recovers — otherwise, you’ll be putting yourself at risk for PIH. Common side effects from microneedling include bruising and redness, which you can learn how to diminish here.
Post-Acne Scar Treatment #5: Radiofrequency
Similar to laser resurfacing, radiofrequency treatments deliver heat into the deeper layers of the skin. This helps stimulate collagen production to help elevate depressed scars from below. Radiofrequency can be performed as a stand-alone treatment, although it can also be combined with other collagen-stimulating modalities to enhance skin-smoothing results.
Depressed acne scars in particular can be challenging to correct, and a combination of treatments may be necessary to obtain the best improvement. “For example, combining microneedling, radiofrequency, and laser resurfacing can help build collagen from below, while reducing scar depth,” says Dr. Allenby.
Post-Acne Scar Treatment #6: Excision
If you’re dealing with a specific type of depressed scar known as an ice pick scar (these present as small, deep, vertical punctures in the skin), you have a surgical option. Dr. Allenby’s preferred treatment for these scars is excision. “This procedure essentially involves cutting out the actual scar and closing the wound with stitches,” she explains. Basically, you’re creating a new wound in the place of the old wound, which your provider will monitor to ensure it heals favorably. “However, it’s best to only do a few scars at a time since stitches must remain in place for a week,” she adds.