Most of us have experienced having occasional labor scars at some point in our lives. Scar tissues, which are the outcome of function of skin’s repair system, are filled mainly with collagen. They don’t follow all skin injuries but the ones seem to be more serious than a simple cut or scratch. This injury at epidermal level could be result of burn, acne , persistent inflammation and accidents. Excess collagen is also associated with haphazard arrangement of collagen and elastin bundles which gives scarring an appearance different from that of surrounding epidermis, see scar pathology for more detail.
Recognized as a chronic inflammatory disease, acne vulgaris does not seem to culminate in acne scars unless a prolonged course of the disease is experienced or severity comes to the level of formation of cysts or nodules. Acne scar treatment may become a source of disappointment for most patients with acne scars as their expectation of complete eradication of acne scars does not seem to be met by current available modalities.
Severe acne which leads to scarring and importance of early acne scar treatment
Time is a key element. Many of these marks fade away or very minimized in time. This in particular applies to scars and post inflammatory pigmentation.Therefore any consideration for an invasive procedure for acne scar treatment such as a laser treatment should be delayed for sometime, maybe two to three months, considered a timeframe for natural fading of acne scars. For those that stay longer, allow about six months which is the best time to start treatment for aged acne scars, there are many available procedures and skin care solutions such as creams or serums that can help minimize appearance of scar tissue. Although fresh lesions respond better to laser and some of them totally disappear, response of old scar tissue to treatments is not insufficient. We follow treatments later in this page. Let’s see how preventive acne strategies may aid decreasing the appearance and development of these disfiguring marks.
Many studies indicate that covering a wound help flatten lesions, especially the scarring types, which are more raised such as keloids. Most , not the ones resulted from adult acne, benefit from applying constant pressure on the wound with special bandages or silicone sheets.
External stitches that remain on the skin for long time cause more epidermal/dermal irregularities. So it is advisable to remove stitches after the first week. Wounds should be covered. The more moisture reaches a surface of a wound, the more likely formation of new scar tissue. Applying an ointment of antibiotic under a bondage is a good way of preventing infection. Infection is the worst enemy for wound healing.
How about cleaning a wound? Major reason to delay healing of a wound is infection. So disinfecting a wound is the most crucial measure in its care. Use of hydrogen peroxide to disinfect a wound is quite common. Although, some studies suggest that hydrogen peroxide may destroy the new skin cells that immediately begin to grow.
What to do with acne to avoid scarring? Seek treatment early as untreated lesions tend to grow to more severe forms over time. An untreated mild acne may lead to more serious nodules and cysts, more challenging to treat, some turn into recalcitrant acne. Avoid manipulation of lesions or attempt to release the pus out of pustules, these maneuvers lead to more skin damage and more wound healing processes to work to heal the ruptured epidermis. While cleansing is a vital part of any acne treatment regimen, avoid getting the skin overdried as it makes it more prone to tearing. When it comes to vitamins which one really help? One study suggest that vitamin E has been shown to impair wound healing and works best as an acne scar treatment. Instead vitamin C helps dubiously with collagen synthesis and wound healing. Always watch an allergic reaction, for example due to the bandage. This should be detected by noticing redness or itchiness over a lesion.
Mild to moderate forms of acne scars could be well treated with topical acne scar creams or resurfacing scar serums such as acne treatment, advisable for people who still have active breakouts, or acne scar serum, suggested for those who stopped having breakouts for at least six months. These acne scar management modalities provide you with a moderate peeling that may be incorporated into your skin care regimen at home.
Nevertheless, extreme care must be exercised in use of these high-potency serums , because they are highly potent with therapeutic effects, however, very safe with no side effects. Serums are also more advisable to patients whose skin is still acne prone and are likely to develop blemishes from time to time. This approach will efficiently help with acne scar treatment without any side effects.
In addition, you will be enjoying a nourishing retexturizing scar creams, which not only root out acne scar but also revitalize and protect your skin against free radicals and aging process, implicated in aging scars. It is also to note that many available modalities in the present market are fundamentally ineffective, an example is onion extract for treatment of acne scars.
The first thing one think of when it comes to a hypertrophic or atrophic scar is that whether his/her skin tissue be returned to its original state. If you have gone through our pages you might have realized that there are invasive and non-invasive approaches to facial scars resurfacing. Among invasive scar treatment methods subcision and punch graft could be named. Dermatological procedures such as laser treatment typically cost more than other methods such as at-home regimen for acne scar treatment. Let’s first take a look at the costs and recovery time, which basically are two important factors when considering any of these acne scar treatment solutions. Recovery time for various procedures is largely a variant of type and subtype of equipment used.
Now another factor comes into play, that is efficacy of each acme scar treatment approach, which one is best treatment. This is highly dependent to scar type and depth. For instance, laser does not improve an ice-pick scar (see image) to a great extent. In contrast, its effect on a hypertrophic scar is significant. None of these methods seem to eliminate deep lesions completely. Yet, all improve damaged skin’s appearance and make acne scar more superficial. There are some other considerations when you are to decide which one works for you such as skin color and type. Although, you should first decide whether you want to go for an invasive or non-invasive procedure. If your decision is an invasive office procedure then a plastic surgeon can help you with the rest of your question.
Among this group of treatments there are two main categories. Silicon sheets and cell turnover accelerators. Silicon sheets are only indicated for either a hypertrophic scar (see image) or the one remained as an outcome of a surgery. They may not have any effect on an atrophic scar (see image). Among cell turnover accelerators or exfoliants alpha hydroxy acids or AHA’s, beta hydroxy acids or BHA’s and retinoids can be named. AHA’s is a compound found naturally in many common fruits such as pineapple, berries, grape, sugar cane. Among them glycolic acid, found in sugar cane and sugar beets, have been used more prominently in cosmetics.
AHA main action is to accelerate shedding of skin cells in the topmost layers of the epidermis by decreasing their cohesiveness. Continued use of glycolic products may lead to a smoother epidermis and to some extent elimination of comedones (blackheads and whiteheads). In doing so AHA generally can enhance the penetration of other agents and nutrients such as Vitamin C, Zinc, amino acids, essential fatty acids and ceramids. Simultaneously it helps to restore the barrier function of the skin, thereby increasing tissue own moisture content.
There are evidences that suggest increase in collagen production in dermis layer with use of AHA. Glycolic creams can make the skin more sensitive to the effects of the sun’s UV rays; therefore use of effective sunscreen is essential. Having said all that can AHA alone be used for acne scar treatment or does it have a significant effect in reducing the appearance of these lesions? The answer is pH and concentration of AHA determine success of glycolic formulations. Nonetheless, these products in their highest concentration available and in lowest pH tolerable by skin can not improve acne scar by themselves.
Beta hydroxy acids are another modality among non-invasive scar treatment methods. BHA’s, are another group of cell turnover accelerators which are derivative of aspirin and naturally can be found in willow bark. The most well-known BHA is salicylic acid. Some authors claim that BHA’s are stronger exfoliants than AHA’s and interestingly more gentle to the skin. A salicylic cream is also pore-clearing and can help with treatment of comedones. Use of BHA’s alone is not very promising, even though overall somewhat smoother skin is the net product of using a salicylic preparatioins for at least three months.
Retinoids are derived from Vitamin A. Retinoids could be found in alcohol form (retinol or acid form of retinoic acid- Retin-A cream). Unlike their close structures, retinol and retinoic acid seem to act very differently on epidermal tissue. Retinol by helping to restore the barrier function of the skin is very hydrating to the skin. On the contrary, retinoids are very drying and irritating to the skin. Interestingly, keratolytic effect of retinoic acid is different from that of retinol.
How retinoids improve atrophic acne scars is a valid question for anyone seeking treatment. Long researched by dermatologists, retinoic acid causes desquamation of skin, so dead cells get separated more readily (smoother skin ) and its various cream formulations for long have been suggested as most effective cream for fading mild acne scars. It also appear to help collagen synthesis (firmer skin and fewer wrinkles), as well as redistribution of melanin (skin pigment) by which even-tone the skin. Effect of retinol treatment creams sounds very limited.
Use of anti oxidants such as alpha lipoic to treat a hypertrophic or atrophic scar is very questionable. It is very skeptical to assume alpha lipoic creams or bioflavanoids, known anti oxidants, can change the collagen rearrangement in dermal layer of the skin. This more sounds like a cancer patient taking vitamin pills to cure its cancer. Vitamins will help immune system but hey will never be able to cure any form of cancer.
Effect of lipoic acid on oxidative damage could be perceived as a protection against any new damage. However, skin damages already taken place in the epidermal and dermal layers could not be altered by oral or topical application of this substance. Lipoic acid is a substance with strong anti oxidant activities, however, its effect in dermal repair remains undetermined.
Scar revision using an at-home treatment is a lengthy treatment requires patience. However, Hippocrates has developed an skin care tailored for body and facial scars lesions using high-potency treatment serums. This skin regimen changes your skin dramatically within one month and may be used as treatment for acne scars while still breaking out. What will be more noticeable is the glow and smoothness in your skin rather than facial scars. Areas of damage might never disappear completely, yet, your skin will divert into a skin strikingly different in terms of overall smoothness and radiance. Read also frequently asked questions.
Retinol serum for acne pitted scars takes six to twelve months to smooth away skin damages, depends on their depth. Acne scar serum works on the surface of the skin, epidermis, as well as deep within the dermis layer by stimulating collagen remodeling. As AHAs have long been criticized for their role in skin rejuvenation, many researchers in dermatology questioned whether AHAs help acne scars? Various preparations have been demonstrated that alpha hydroxy acids can help fade acne scars with a number of considerations, often overlooked in most available acne scar products.
The scar treatment kit also benefits from retexturizing properties of retinol, hydroxy acids, AHAs and beta hydroxy acids, BHA’s. This serum, formulated to provision the nutrients the skin needs the most to make up for lost nutrients while the epidermis involves with skin renewal and dermal repair. The outcome is a new skin, where damaged skin is hardly recognizable because overall smoothness of the skin overwhelms the gradually-disappearing scars. Acne treatment works on scar lesions in a slower rate, targets acne lesions and aims to clear the skin. If you still have active acne and you are concerned about your scarring as well, your best choice would be acne kit.
How to start dealing with my scarring, where to seek treatment? First thoughts when dealing with disfiguring scars.
I have these scars for a while , what are my choices? Is there a real cure out there? Can they be removed permanently? How effective present modalities work on different type of scars? Do they work only on the surface or do they work deep within my skin? These are the type of questions you may have on your mind. Here we try to address them on this page and throughout this site.
First identify your scarring? What type of acne scars you have? Is it a hypertrophic or a ice-pick scar or only some pigmentations (skin discolorations)? Acne is involved? (You can find out more about scar types on our homepage). Is it the consequence of acne lesions or consequence of an injury or some accidents? Acne scar is mostly limited to lesions with decreased skin tissue (atrophic scar lesions), which means there is nothing raised or lobulated (tissue formation increased) there; it’s more of a pitted appearance like an orange surface.
Increased in collagen fibers type I and type III with topical treatments
The second question you should have an answer for is where it ‘s located? Are acne lesions on your face or your body? Body scars tends to respond more slowly to most resurfacing procedures. One obvious reason is that microcirculation of skin in face region is more likely to be robust compare to that of rest of the body. Third question, how deep they are?
The deeper they are, the less chance of improvement? That is not true. No matter how deep they are, you shouldn’t be discouraged to seek improvement. With the aid of present acne scar treatment modalities your overall skin appearance can be improved significantly. They will get better and your skin can change. However, you should keep your expectation in a realistic jurisdiction. Complete eradication of body or facial scars may not be feasible using available modalities.
Now if you made your mind to improve appearance of your acne scarring and its treatment, which one suits you most? There are many factors you should consider. Among the most important ones are recovery period, cost, complexion type, an at home program as oppose to an office procedure. Can you stay home for three four weeks after a procedure at a plastic surgeon office?
For how long you have been dealing with scarring and damaged skin? Ongoing regimens versus one-time procedures? Which one works better? Does the result of office resurfacing procedures last longer? Is the result permanent? These are the type of questions you may have for at a dermatologist or a plastic surgeon. See also our frequently asked questions page to find answer for some of your questions.
Some may get healed on their own. Spontaneous attenuation of hypertrophic lesions is sometimes seen. Wait at least six to twelve months to see how your skin own healing mechanisms progress to correct unfavorable results. Discolorations are more amenable to treatment while degenerated tissue in case of atrophic scars is more toilsome to treat and ultimately not fully recoverable.
The truth is most available treatment modalities work through skin resurfacing, renewing your skin by removing top layer of the skin. The outcome and efficacy of these acne scars products could be different though. One factor that especially affect the result is individual’s skin type. Interestingly, individual’s skin type can make you a better candidate for certain procedures. Most of these treatments even retinoid creams act on epidermis, removing the top layer of the skin, their influence on dermis, the second top layer, if there is any, is minimal.
Arrangement of extracellular fibers has been impaired as a result of work of skin’s healing mechanisms in response to an injury. Disorderly reorganization of extracellular fibers is clearly noted. Rearranging these haphazardly-arranged collagen fibers in dermis is not something most procedures/treatments can achieve. Targeting deeper layers of the skin, dermis, is more challenging yet more promising as is the case with Dermal Repair serum, which prominently affects dermis for connective tissue activation and recovery.
Having said all that, should I start an acne scar treatment? Our answer is yes, we understand the amount of distress scars can bring to your life and we are here to help while believing early intervention is the key. We believe, deep facial acne scarring may not be relieved entirely, however, their appearance could be improved. Your face can experience smoothness, vitality and a healthy glow. Simultaneously, appearance of deep facial scarring could be overwhelmed by epidermis uniformity and integrity.
Acne scarring remains one of the most challenging dermatological sequelae, both for patients and clinicians. Despite an extensive repertoire of therapeutic strategies, including topical agents, procedural interventions, and emerging biologics, complete resolution of acne scars is seldom achievable. This review highlights the multifaceted nature of acne scar formation, progression, and management, emphasizing the need for individualized, evidence-based approaches.
The pathophysiology of acne scarring is underpinned by chronic inflammation, follicular rupture, and dysregulated dermal remodeling. While not all individuals with acne develop permanent scars, those with prolonged or severe inflammatory acne—particularly involving nodules and cysts—are at higher risk. The reparative process often leads to the formation of fibrotic tissue with disorganized collagen architecture, primarily type I and III, which imparts the characteristic atrophic or hypertrophic morphologies observed clinically.
A noteworthy point in acne scar management is the temporal aspect of healing. Many post-acne lesions, especially erythema and post-inflammatory hyperpigmentation, demonstrate partial or full resolution over time without the need for invasive intervention. Thus, premature procedural treatment—particularly within the first 2–3 months—may be unnecessary or even counterproductive. Clinicians should advise patients to allow a period of observation, provided no active inflammation persists, before initiating interventions such as laser resurfacing or microneedling.
In terms of prevention, the literature consistently supports early and effective acne management as the most critical strategy in reducing scar risk. Additional preventive measures include optimal wound care—ensuring a moist, protected environment, minimizing infection risk, and avoiding mechanical trauma. The deleterious effects of certain common antiseptics, such as hydrogen peroxide, on keratinocyte viability, further stress the importance of evidence-based wound management practices.
Topical therapies remain the cornerstone of non-invasive scar treatment. Retinoids, alpha hydroxy acids (AHAs), and beta hydroxy acids (BHAs) promote epidermal turnover and have shown modest efficacy in superficial atrophic scars. Their role in enhancing percutaneous absorption of adjunctive agents, such as antioxidants and peptides, further supports their inclusion in multimodal regimens. However, it is critical to acknowledge the limitations of these agents. While they contribute to epidermal remodeling and textural improvement, their influence on dermal collagen reorganization remains minimal, particularly in established, deep atrophic lesions.
More advanced non-invasive therapies, such as high-potency serums incorporating retinol, glycolic acid, and salicylic acid, may offer additional benefits. Some formulations claim to exert effects beyond the epidermis by stimulating collagen remodeling within the dermis, yet robust, independent clinical evidence supporting such outcomes is limited. Moreover, the efficacy of commercially marketed ingredients, such as onion extract and alpha-lipoic acid, remains unsubstantiated in well-controlled trials, warranting caution against overreliance on anecdotal or marketing-driven claims.
Invasive procedures, including fractional laser therapy, subcision, punch grafting, and chemical peels, demonstrate greater efficacy for deeper scars, albeit with variability in outcomes. Each modality offers specific advantages depending on scar morphology. For instance, lasers are more effective for rolling or hypertrophic scars than for ice-pick variants, which often require mechanical excision or reconstruction. It is also important to consider the patient’s skin phototype, as post-inflammatory dyspigmentation is a recognized complication of many ablative therapies in individuals with darker skin tones.
The decision between invasive and non-invasive treatments must be guided by several factors: scar type, depth, anatomical location, patient tolerance for downtime, cost considerations, and treatment goals. While invasive interventions may yield more dramatic results, they are not universally suitable, and non-invasive regimens may offer comparable improvement in select cases when applied consistently and in combination.
A key takeaway is that while no single treatment guarantees full scar eradication, a layered approach—incorporating preventive care, topical agents, and procedural interventions—can significantly improve skin texture and appearance. Furthermore, patient education and expectation management are crucial. The promise of “complete” scar removal is, at present, unrealistic. However, measurable improvements in dermal architecture and patient-reported outcomes are attainable with a structured, individualized plan.
In conclusion, acne scar treatment is an evolving field with ongoing advances in both technology and understanding of skin biology. Future directions may include regenerative therapies, such as stem cell-derived products and targeted molecular agents capable of modifying collagen synthesis and degradation at the genetic level. Until then, clinicians must rely on current, evidence-based modalities, tailored protocols, and a nuanced understanding of scar pathogenesis to provide optimal care.
