Acne Scars

How to treat Acne Scars?

Acne scars are very common and some scars are easier to treat than others. Acne scarring and the treatments associated with it depend on your skin type and skin colour.

There are many techniques and medical procedures you can ask your dermatologist to help you get rid of these scars.

When acne is formed on the skin, they damage the skin and the tissue beneath it, when the acne goes away, our body produces collagen to repair the damaged skin. If the body produces no collagen or little collagen, it leaves a scar.

Acne Scars can be divided into two types:

  • Atrophic Scars
  • Hypertrophic and keloid scars

Atrophic Scars can be divided into:

1. Boxcar scars: They are wide 2-4mm. Boxcar scars are relatively easy to treat. It will take time. Treating these scars will depend on two factors the person’s skin type and the scars on the convex areas of the cheeks. Boxcar scars are round-oval with clear-cut edges. They are formed when acne breaks out and the tissue is lost, the body is not able to produce enough collagen to repair the lost tissue, resulting in depression.

2. Ice Pick scars: They are wide <2mm. These scars are also really easy to treat. Ice pick scars are deep, narrow scars that go deep into the dermis. These scars are formed when clogged oil glands leading to inflammation and then explode.

3. Rolling scars: They are wide 4-5mm. These scars cause wave-like depressions across the skin. They will look uneven. Rolling scars occur when fibrous bands of tissue are formed between the skin and subcutaneous tissue below. These bands then pull the epidermis. This pulling creates an irregular rolling on the skin.

4. Hypertrophic and keloid scars: Hypertrophic scars are raised scars. Keloids are also raised scars but will be much larger than the original wound. These scars are caused due to the overproduction of collagen.

These are the different types of Acne Scars and treatment for each of these scars can be different depending on your skin type, skin color, and the depth of these scars.

How to treat Acne Scars?

The best way to treat acne scars is to see an expert in the revision of acne scarring. This means a Specialist Doctor who has done training in medicine, then in Dermatology or Plastic Surgery, then training in the sub-specialty of acne scar revision. Treatment of acne scars will depend on your doctor.

Top specialists will always use manual methods such as subcision with Nokor Needles, or Cannula subcision. They will know how to use fillers to help with atrophic scars and stimulate collagen. More skilled specialists will know how to use all fillers ranging from Restylane, Captique, Juvederm, Radiaesse, Sculptra, and many other collagen-stimulating fillers in various concentrations according to your skin type.

If a specialist does not know how to perform Nokor subcision, point subcision, multilevel subcision, fat grafting, filler subcision, filler augmented filler subcision they may not be skilled In the total art of scar revision. Scar dissection, excision, surgical elevation, and TCA CROSS are other manual methods of scar revision.

These specialists are all well-versed in the use of erbium and CO2 fractional lasers. They will also how to use Pico lasers, and fully ablative CO2 and erbium.

Treatment for Atrophic scars:

Rolling scars:

  • Subcision: This is a very common method to break down acne scars that form underneath the skin. This is mainly used for atrophic acne scars.
  • Fractionated laser: these lasers help to stimulates the tissue to remove the pigmented cells underneath the top layers of the skin.
  • Microneedling: promoting collagen.
  • Chemical peels: these peels help to improve the texture and appearance of the face. It acts as an exfoliater and helps to remove dead skin cells. Glycolic acid and Salicylic acid are some examples.
  • Fillers: also helps with promoting collagen.

Boxcar scars:

Sometimes a combination of treatment is required.

  • Scar excision
  • PRP (Platelet-rich plasma)
  • Factional laser
  • Microneedling
  • Chemical peels

Icepick scars:

  • Punch excision
  • Non-ablative and fractional laser
  • Microneedling
  • Fillers

Treatment for Hypertrophic and keloid scars:

Silicone gel/sheets:

  • Silicone gel sheeting can help to reduce the appearance of hypertrophic scars in prone individuals.
  • There is limited evidence on silicone gel sheeting preventing keloids.


  • Steroid injections are the first in line: a series of injections are needed, and can be paired with other treatments.
  • Botulinum toxin has been used off-label, but there is limited evidence.


  • Pulse dye and fractioned laser are used.
  • They are often paired with injections and other topical treatments.

Other procedures:

  • Surgery is helpful but recurrence is high. It is often paired with localized radiation or injection.
  • Cryotherapy, chemotherapy, and other immunomodulating treatments are also used.

Note: for deep scarring, the treatment of choice is subsicion.

Acne scars can take time to heal. Each type of acne scar will have its ideal treatment.

Quick tips on how you can avoid acne scars:

1. Treat acne early and effectively to reduce acne scars.

2. Retinoids can increase collagen production.

3. Vitamin A in the form of retinol can help acne.

4. Ascorbic acid or Vitamin C can help with collagen repair.

5. A 0.25 mm derma roller can help with mild scars.

6. Use sunscreen to reduce pigmentation.

7. Stop picking or popping your pimples.

The main tip is to reduce your acne and you can reduce your scarring.