When a pimple goes away and leaves a permanent scar in its place—one that appears as an imperfection in the skin—it can be devastating to imagine yourself dealing with it indefinitely. When it comes to healing acne scars, it’s important to get a few opinions—and know what you’re dealing with.
Ultimately, there are two categories. First up: textural irregularities. These are permanent divots that can take various forms on the surface of your skin.
Acne causes inflammation, which destroys the collagen in your skin, says Benjamin Garden, M.D., of Chicago Laser Dermatology. “These irregularities can be very difficult to treat, and there’s nothing that’ll make them fully disappear.” But they can be minimized.
The second type of scarring is “residual hyperpigmentation,” or dark spots (brown or red) that embed themselves in the skin and take months or even years to heal. They can go away on their own, though the process can be expedited with the right regimen or additional treatment.
Regardless of which type of scarring you’re looking to heal, “the first step is to stop all active acne breakouts,” says Gabriel Martínez-Díaz, M.D., of M.D. Aesthetics & Dermatology. “I try to maximize the combination of medical therapies, such as Accutane (aka isotretinoin, an oral retinol treatment), with numerous minimally invasive procedures. (Read on for examples of some, and visit your dermatologist for the best treatment plan for you, as some drugs like isotretinoins may have adverse side effects.)
Once your existing acne is gone—or if you’re just targeting individual scars with otherwise clear skin— it’s time to address how to minimize the appearance of dark spots and divots. We spoke with numerous board-certified dermatologists for the methods they most often prescribe to their patients.
How to Treat Residual Discoloration
Retinol: “My first line of defense is topical retinoids,” says Susan Bard, M.D., of Vive Dermatology. “In addition to combating active acne, it also helps fade any dark marks left behind by the acne and also stimulates collagen production to help fill in some of the depressed scars.” Apply a prescription-strength topical retinoid to your face every night. This should be part of the skincare regimen you use for the rest of your life.
Chemical Peels: “Chemical peels help control acne and help fade dark marks as well as stimulate collagen deposition,” says Bard. Sometimes, the fastest way to a smoother complexion is to “resurface” your face altogether. Chemical peels help “shed” the older surface layer of the skin with a chemical agent. The younger skin underneath is brighter, more youthful, and often smoother in complexion. In theory, you’re getting rid of that dark spot by surfacing healthier cells.
SPF + Patience: While it’s not helpful to hear, your dark spots just need time to heal. However, Sara Moghaddam, M.D., of Vive Dermatology Surgery & Aesthetics, stresses the importance of using SPFs daily, in order to shield the dark spots from the sun. While it may seem like a nice tan will “mask” the dark spot, it’ll only worsen the discoloration. By shielding the skin from UV rays, you’ll heal faster.
Lasers: “For those patients who don’t wish to wait the months (or even years) for the color to fade, there are a variety of laser systems that can help diminish the color quicker,” says Benjamin Garden, M.D., of Physicians Laser and Dermatology Institute. “These lasers target the blood vessels that leave a red spot, or target the pigment in the skin that makes a dark mark. These laser systems are very powerful and should only be performed by a doctor who has the proper training.”
How to Treat Textural Irregularities (Boxcar, Rolling, or Ice Pick Acne Scars)
Sunscreen + Retinol: “Sunscreen and retinols are baseline,” reminds Avnee Shah, M.D., of The Dermatology Group in New Jersey. Add these habits into your daily regimen, and never abandon them. They work to thwart further damage from the sun, and smooth and firm the skin over time by stimulating collagen (while preventing additional acne, too).
Microneedling With or Without Platelet-Rich Plasma (PRP): “Microneedling works by creating micro-injuries a few millimeters into the skin,” says Shah. “This promotes collagen remodeling, which allows scarring to improve.” (More on this in a bit.)
“I love microneedling for acne scars,” adds Lilly-Rose Paraskevas, M.D., of Rose Dermatology. “With every treatment, the scars are shallower and less noticeable. Even the redness within the scars can be improved. Unlike some laser treatments, there’s no risk of burns or discoloration from microneedling.”
Many doctors will combine this with platelet-rich plasma (PRP), which involves the extraction of your own plasma (by first drawing the blood and separating the plasma in one session), and injecting it into the area to stimulate healing. (PRP can be paired with laser therapy, too.)
“Lately I’ve been stunned by the combination of microneedling with radiofrequency, when used alone or in conjunction with PRP,” says Martinez-Diaz. “I’ve been using the device Secret RF by Cutera with outstanding results. The device enables me to treat a wide variety of acne scars in different depths.” Just note you’ll need a series of treatments, so it can get a bit pricy, but it’s worth it.
“PRP heals the acne scars even faster and leads to reduced inflammation and overall improvement of skin tone,” adds Matthew Elias, D.O., of Elias Dermatology. “It’s by far one of the most popular treatments in our office.”
Lasers: Lasers are another frequently used solution for permanent scars, and they penetrate the skin much like a microneedle to stimulate collagen production and smoothness. “When looking at lasers, I like either a Fraxel or something like an Erbium for deeper scars (Sciton Joule is the class leader here),” says Dhaval Bhanusali, M.D. Ask your own dermatologist about these options for his or her feedback on your specific condition. “Fraxel has a 3-4 day downtime and patients usually need 3-5 treatments, whereas the Erbium laser has more like a 7-10 day downtime and patients see significant improvement in 1-2 sessions,” Bhanusali says.
Certain fractional lasers, such as the Erbium, can often target just the damaged skin, while leaving healthy cells intact. The CO2 laser is another option: “If you have ‘ice pick’ scars, as in the deep, narrow kind, then Fractionated CO2 laser treatments are best,” says Anne Marie McNeill, M.D., of Newport Beach Dermatology & Plastic Surgery. “It gives a permanent improvement in scars and also in general skin texture.”
Fillers: You can inject collagen into the skin, and these fillers will “lift” certain areas so the skin appears more smooth, plumping up some of those indentations. This works best for wider scars, called “rolling” scars, says McNeill. For this, she says to ask your dermatologist about fillers, such as Bellafill. In many cases, Bellafill treatments can last 5-10 years.
“Bellafill affords a long-term solution to acne scars by adding volume to the scar and keeping it at the same level as the surrounding tissue,” adds Elias.
Speak to your dermatologist about the type of scarring you have, and the best type of treatment available.
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