What Are Acne Scars?
The term “acne scarring” can be used to refer to a multitude of different marks that a breakout may leave behind. “After pimples heal, the skin remembers that there was inflammation there before,” says Joshua Zeichner, MD, a board-certified dermatologist in New York City. “Inflammation can stimulate pigment production and cause blood vessels to dilate, which leads to leftover brown and red spots after the pimples heal.” Although it’s true that acne scars look different for everyone, there are two primary categories of marks that develop on the skin after pimples resolve. “Brown and red spots are temporary, post-inflammatory pigmentation that fades over weeks to months,” says Dr. Zeicher. “When the inflammation leads to collagen damage, permanent structural changes can occur in the skin, which we call scars. True scars are permanent and are the results of structural damage to the skin.” It’s not always easy to tell the difference, but brown spots (post-inflammatory hyperpigmentation) and red spots (post-inflammatory erythema) are completely flat. Scars, on the other hand, tend to be either depressed or elevated from the skin. These markings aren’t impossible to treat once they exist, but it is mighty difficult, so dermatologists recommend employing practices to prevent them from happening in the first place.
How to Prevent Acne Scarring
“The best way to prevent scars or pigmentation is to treat acne quickly and effectively,” says Dr. Zeichner. “Less inflammation in the skin means less collagen damage. I typically recommend treating the entire face if you are acne-prone. Spot treating means you are always playing catch-up. Treating the whole face can help prevent pimples from developing in the first place.” Those with cystic acne are most prone to acne scarring, so you should ask your dermatologist about prescription—topical or hormonal—medications to treat severe acne and reduce the risk of scarring. According to Hadley King, MD, a board-certified dermatologist in New York City, treatments like isotretinoin and cortisone injections can help decrease inflammation within individual acne lesions (aka those giant whoppers) that are more likely to cause potential scarring. And of course, as everyone and their mother will tell you, it’s important not to pick at your pimples (as tempting as it is). Touching and squeezing damage small veins, glands, and tissues surrounding the spots, increasing the risk of inflammation and future discoloration, and even leading to potential infection.
How to Treat Acne Scarring at Home
There are scores of options available—both in-salon and at-home—to speed up the process of getting rid of acne scars and pigmentation. The key is in stimulating collagen to help remodel areas where there is damage or depressed skin. If you’re mainly dealing with pigmentation and slightly uneven skin texture, dermatologists recommend these post-acne treatments.
Chemical Peels
You can get a potent chemical peel at a dermatologist’s office—but you can also achieve a pretty effective at-home facial peel with products in your bathroom vanity. The combination of alpha hydroxy acids (e.g., glycolic, lactic, and malic acid), beta hydroxy acids (e.g., salicylic acid), and gentle exfoliants, like fruit enzymes, act like chemical sandpaper to smooth the edges of your scar over time. Try Peter Thomas Roth Peptide 21 Amino Acid Exfoliating Peel Pads ($52; revolve.com), which pairs phytic acid with salicylic acid to exfoliate and tone uneven skin.
Topical Retinoids
While retinoids can help prevent acne scars, they’re also a great option for treating them if you’re already dealing with them. Employing a retinoid in your regular skincare routine will stimulate collagen production to fill in concave scars and even improve the appearance of wrinkles. Dr. Zeichner loves Neutrogena Rapid Wrinkle Repair Serum Capsules ($19; ulta.com). Dr. King recommends OTC adapalene (Differin Gel, $18; ulta.com), or if needed, prescription topical retinoids with stronger levels of adapalene, tretinoin, tazarotene, or trifarotene. If your skin is sensitive to retinol, you can also opt for gentler retinol alternatives like bakuchiol, a botanical extract that exerts similar collagen-stimulating effects on the skin. Dr. Zeichner recommends InnBeauty Project Slushy ($22, sephora.com), a light moisturizer with bakuchiol that can be used on even the most sensitive of skin types.
Vitamin C
Vitamin C, the poster child ingredient for brighter skin, is a potent antioxidant that lightens dark marks and promotes collagen production. Dr. Zeichner recommends Solara Suncare Juice Boost Defense Boosting Serum ($42; neimanmarcus.com), which contains stabilized Vitamin C along with botanical extracts to protect the skin from free radical damage and block abnormal pigment production.
Hydroquinone
Hydroquinone is a depigmenting agent that can bleach dark patches on the skin. Hydroquinone works by limiting melanin production in the skin which leads to discoloration, causing brown spots to gradually fade. Try something like VI Derm Skin Lightening Complex Hydroquinone ($90; dermstore.com), which contains a 2 percent concentration (the most effective OTC amount).
LED light therapy
Don’t expect these masks to transform your skin overnight, but light therapy—red light in particular—has been shown to be effective on acne scarring and pigmentation over time. The red light therapy, which has anti-inflammatory properties, works deep below the surface of your skin to help soothe and repair tissue, helping to prompt cellular repair and promote healing. Like many beauty trends, light therapy started out as a treatment you could only get in a dermatologist’s office, but today there are tons of luxurious light therapy masks that you can use at home. Try Dr. Dennis Gross Skincare SpectraLite Faceware Pro ($435; sephora.com), which offers blue light in conjunction with red light to target bacteria and prevent future breakouts.
When to Turn to In-Office Treatments
If you are not seeing results after trying OTC options, it may be time to see a dermatologist. To diminish rolling (sloping edges that make skin appear wavy), boxcar (box-like depressions with sharply defined edges), or ice-pick (narrow indentations that point down into the skin’s surface) scarring, the solution likely lies at the doctor’s office. According to Dr. King, optimal results are typically achieved using a battery of treatments, over the course of at least a year. Post-inflammatory hyperpigmentation will fade on its own over time, but the unfortunate truth is that once an acne blemish has scarred, it’s permanent. At this point, it’s best to use topicals in tandem with professional in-office treatments to be effective. “The earlier you treat the marks, the better the outcomes,” notes Dr. Zeichner. “When it comes to true acne scars, no topical can compare to the effect of a laser to resurface the skin and create new, healthy collagen.” Take note that keloid scarring, which darker skin pigmentation can be prone to, should not be used with treatments that work on the basis of inducing a mild trauma to the skin, such as microneedling. Depending on the severity of your scars, your doctor may utilize steroids or surgery to help flatten scar tissue.
Microneedling
Although at-home microneedling can be effective, you can achieve faster results with medical-grade options. Performed by a professional, microneedling is the process of making minuscule micro-wounds in the skin (don’t worry, you can’t see them), forcing it to produce new healthy collagen and elastin as they heal.
Lasers
According to Dr. King, longer-term benefits are most achievable from resurfacing with laser treatments (like Fraxel or Resurfx). Pulsed dye lasers or IPL (intense pulse light) are frequently used to improve post-inflammatory pigmentation, while non-ablative and ablative resurfacing lasers are ideal for indented skin. Your dermatologist may also recommend pairing the resurfacing lasers with topical cortisone or cortisone injections to reduce the scar’s appearance.
Microdermabrasion
Think of microdermabrasion as a more intensive chemical peel (which can also be done in-office). The minimally invasive procedure essentially sands down the skin with an exfoliation tool, taking away the top layer and renewing overall skin tone and texture. Because it’s minimally invasive and safe for all skin colors, it’s a good beginner in-office option, although you may need multiple treatments to start seeing results.
Fillers
If you only have a few residual scars, fillers are a good temporary fix. The procedure’s effects don’t last forever, but having your dermatologist inject hyaluronic acid into your scars will fill the divot for a few months. The hyaluronic acid will act like a micro sponge to plump the injection site with moisture. “I believe fillers offer the most immediate improvements, but these are not a long-term solution and may only help with some of the acne scars,” says Dr. King.
