The appearance of acne scars can be diminished, but you should have realistic expectations for the level of improvement. Acne scarring is common, and doctors have many methods for reducing the visibility of the scars, with the treatment method depending on the type of scarring and whether the patient has active acne that also needs treatment.
If you have mild acne, the risk of scarring is low and the best treatment may be a basic skin care regimen to prevent scarring to begin with: no rubbing or picking, but cleansing with a mild soap that contains either a hydroxy acid (e.g., glycolic or salicylic acid) or benzoyl peroxide.
If you have existing acne scars, treatment options may include resurfacing (facial chemical peels, dermabrasion, laser therapy), use of fillers, subcision or excision (surgical procedures) and combination therapies. Resurfacing techniques remove thin layers of skin and smooth out scars. Fillers may be injected to lift the base of a deep scar and improve the skin’s appearance. Surgical methods are effective at removing recessed scars. A procedure called skin needling is another alternative for some types of recessed acne scars.
Macular acne scars are a problem of pigmentation and may be easiest to treat. The scars are red typically and flat. Superficial chemical peels and microdermabrasion can yield good results. Persistent redness may be treated with lasers.
More severe acne can produce a variety of scar types: Icepick or pitted scars are small and deep. Boxcar scars are wider indentations that can be shallow or deep, but with clear edges. Rolling acne scars have sloping edges and produce the appearance of uneven, wavy skin. All of these types of scars may be difficult to remove completely and more than one treatment step and procedure may be needed (e.g., excision or subcision or filler injections, followed by laser resurfacing).
Raised acne scars (called keloids) are less common and require surgery to remove the scar.
With so many options for acne scar treatment, the best course of action is to have an honest discussion with a dermatologist about your acne; your expectations for desired results; the doctor’s skill in different procedures, including the latest developments in scar treatment, for maximizing your treatment options; and what you can endure in terms of cost and length of treatment, since it may take weeks for some treatments to achieve full effect.