Acne scars: Consultation and treatment

While you’ll find treatment for acne scars that you can use at home, getting the best results often requires in-depth knowledge of the skin and knowing what treatment works best for each type of acne scar. That’s why board-certified dermatologists develop an individualized treatment plan for each patient.

Before and after treatment for acne scars

To give this patient the best results, her dermatologist used more than one treatment to lessen the appearance of acne scars.

Safe and effective treatment for acne scars begins with a consultation

Treatment is not for everyone. Some people see no need to treat acne scars.

To figure out whether treatment is right for you, it helps to answer the following questions before making an appointment with a board-certified dermatologist for a consultation.

• Do I often wish that I could get rid of my acne scars?

• Do my scars limit my opportunities to date, get a job, advance my career, or perform well in school?

• Am I less outgoing and social now than before I had acne scars?

If you answered “yes” to one or more of these questions, talking with a dermatologist about treatment can be helpful.

Know what you expect from treatment for acne scars

To get the most from your consultation, many people find it helpful to answer the following questions before they meet with their dermatologist. Doing so helps you explain what you expect from treatment.

• How do I want to look after treatment? Some treatments can make scars look less noticeable. Others can eliminate wavy skin texture. Be sure to tell your dermatologist what's important to you.

• What can I afford to spend on treatment? Medical insurance does not cover the cost.

• How much downtime can I afford? Some treatments require downtime.

• How much time will I devote to getting treatment and caring for my skin? Your answer will help determine which treatments will be best for you.

What happens during an acne scar consultation with a dermatologist?

During this consultation, your dermatologist will:

• Examine your skin, paying close attention to your scars. Effectively treating scars requires knowing the types of acne scars on your skin and where they appear. For example, to get the best results, ice pick scars require different treatment than rolling scars.

• Ask you some questions. These questions help your dermatologist understand how the scars affect your life, the results you expect, and more.

How do dermatologists treat acne scars?

If you and your dermatologist decide that treatment is right for you, your dermatologist will create a treatment plan tailored to your needs. Before creating this plan, your dermatologist will consider the type of acne scars you have, how many scars you have, your age and skin tone, your budget, and many other considerations.

If you have acne breakouts, your plan will likely begin with acne treatment. Stopping acne breakouts can reduce inflammation and prevent new acne scars. Treatment for scars typically begins after you have acne under control and are applying acne medication to prevent new breakouts.

Before you start treating acne scars, tell your dermatologist about all acne treatments that you are using or have used within the last two years

Starting some scar treatments while using (or soon after stopping) certain acne medications can cause unwanted side effects.

When it’s time to treat the scars, your treatment plan may include one or more of the following.

Treatment for depressed (sunk-in) acne scars: These scars may be treated with a procedure, acne scar surgery, or medication applied to the skin. To give you the best results, your dermatologist may use more than one treatment. For example, your dermatologist may perform acne surgery to lift some sunken scars and then inject a filler to give the treated scars more volume.

Treatment for depressed scars includes the following:

• Chemical peel: Applying a chemical peel to the skin helps the body produce more collagen and elastin. When the skin has more of both, depressed acne scars tend to be less noticeable.
  
  Peels are available in strengths ranging from mild to strong. Your dermatologist will determine which strength best meets your needs. Mild and medium peels often require more than one treatment session. For example, if you have a mild peel, you may need 3 to 5 treatments, which are given every 2 to 4 weeks.
  
  Before getting a peel, your dermatologist may give you instructions for pre-peel priming. Patients typically follow pre-peel priming at home for 2 to 4 weeks. It can help you get the best results and reduce possible side effects. Pre-peel priming can include taking an antiviral medication or applying a retinoid.
  
  You’ll also need to protect your skin from the sun before getting a chemical peel. Doing so helps prevent discolored skin from developing after treatment. Be sure to follow all your dermatologist’s pre-peel priming instructions.

• Fillers: This treatment adds volume to depressed scars. Fillers can also help your body produce more collagen and elastin to fill in the scars. Dermatologists use different fillers, which last for varying amounts of time. Most fillers give temporary results, ranging from 3 months to 2 years. A filler can also be permanent.
  
  Most fillers require a series of treatments, so you may need more than one office visit for this treatment. To retain your results, you’ll also need touch-up visits. Even with a permanent filler, you may need touch-up treatment as your skin ages.

• Laser treatment: Dermatologists use lasers to resurface skin with acne scars. As your skin heals after laser resurfacing, it produces collagen and elastin, which can diminish the appearance of scars. Your dermatologist may also use a laser to contour skin around acne scars, which can also diminish the appearance of scarring.
  
  Some lasers require more treatment sessions than others.

• Medication applied to the skin: If you have mild acne scarring, a retinoid or salicylic acid can make scarring less noticeable.

• Microneedling: During this procedure, your dermatologist uses tiny needles to puncture the skin with acne scars. Puncturing the skin causes the body to produce new collagen and elastin. Also called “collagen induction therapy,” the new collagen helps diminish acne scars.
  
  Microneedling is safe for all skin tones.
  
  To improve the results that patients see, microneedling is often used along with another treatment like radiofrequency, chemical peeling, or platelet-rich plasma.

• Platelet-rich plasma (PRP): Your dermatologist may use this treatment to enhance the results of another treatment like microneedling. PRP involves having a small amount of your blood drawn. This blood is placed into a machine that separates the blood so that your dermatologist can use your platelets.
  
  Your dermatologist will inject your platelets into the treated area. Studies show that using PRP along with another treatment like microneedling can lead to less visible scarring.

• Microdermabrasion: This non-invasive treatment gently exfoliates your skin.
  
  While it won’t treat acne scars, dermatologists use it to even out skin tone, which can improve the results you see from another treatment for acne scars.

• Radiofrequency: This procedure uses radiofrequency waves to help your skin produce collagen and elastin. When your skin has more of these, acne scars are less noticeable.
  
  A type of radiofrequency called radiofrequency microneedling combines radiofrequency with microneedling, a procedure that punctures your skin with tiny needles. Using both can produce less noticeable acne scars than either radiofrequency or microneedling alone.
  
  Both radiofrequency and radiofrequency microneedling are safe for all skin tones.

• Scar surgery: Dermatologists can perform minor surgery to diminish noticeable acne scars. Surgery may involve removing a scar and closing the area with stitches or a skin graft. Sometimes, your dermatologist surgically lifts the scar from the underlying tissue. Once freed, the skin rises, which diminishes the appearance of the scar.
  
  As the skin heals from the surgery, your body produces collagen and elastin that also help make the scar less noticeable.
  
  Another procedure like laser resurfacing or platelet-rich plasma may be used after acne surgery to improve results.

• Dermabrasion is a surgical procedure that dermatologists use to deeply exfoliate the skin. This minor surgery helps your body produce new collagen and elastin. Dermabrasion can also smooth out your skin making acne scars less noticeable.
  
  Acne scar surgery is usually performed in a medical office or outpatient treatment center. Patients are given local anesthesia to numb the area, so they don’t feel pain but remain awake.

Treatment for raised acne scars: When treating depressed scars, the goal is to get the body to produce more collagen to fill in the depressed areas. Raised scars develop when the body produces too much collagen, so they require different treatment.

To diminish raised acne scars called hypertrophic scars, your dermatologist may recommend laser treatments, injections of corticosteroids or another medication, or applying a prescription medication to the scar(s).

Dermatologists use lasers to treat raised acne scars called papular scars.

Treatment for keloids scars: To give their patients the best results, dermatologists often recommend treating a keloid with more than one type of treatment. These scars can be difficult to get rid of, and some return after treatment. Using two or more types of treatment often improves results.

Treatment for a keloid can include injecting a corticosteroid or other medication into the scar, laser therapy, keloid surgery, or freezing the keloid. You’ll find more information about these treatments at Keloids scars: Diagnosis and treatment.

After treating acne scars, dermatologists recommend proper skin care. Following these skin care tips can help you see the best results from treatment. To see what dermatologist recommend, go to: Acne scars: How to care for your skin after treatment.

Images

• Images 1,2: J Am Acad Dermatol 2019;81:313-24.

• Image 3: Getty Images

References
Abdel HR, Shalaby K, et al. “Interventions for acne scars.” Cochrane Database Syst Rev. 2016 Apr 3;4(4):CD011946. 

Del Rosso J, Harper J, et al. “Acne and rosacea debate.” Presented at: 2023 Fall Clinical Dermatology Conference: October 19-22, 2023; Las Vegas, NV.

Jennings T, McLarney M, et al. “Acne scarring-pathophysiology, diagnosis, prevention and education – Part 1.” J Am Acad Dermatol (2022) [journal pre-press].

Renzi M, McLarney M, et al. “Procedural and surgical treatment modalities for acne scarring – Part 2.” J Am Acad Dermatol (2022), [journal pre-press].

Salameh F, Shumaker PR, et al. “Energy-based devices for the treatment of acne scars: 2022. International consensus recommendations.” Lasers Surg Med. 2022 Jan;54(1):10-26.

Sarah A. Ibrahim, BA. “Poster 26353: Comparative effectiveness of acne scar treatments: A systematic review and network meta-analysis.”J Am Acad Dermatol. 2021;85(3) suppl AB17. Commercial support: None identified.

Soliman YS, Horowitz R, et al. “Update on acne scar treatment.” Cutis. 2018 Jul;102(1):21;25;47;48.

Written by:
Paula Ludmann, MS

Reviewed by:
Kesha Buster, MD, FAAD
Sandy Marchese Johnson, MD, FAAD
Desmond Shipp, MD, FAAD

Last updated: 12/8/23