Acne scars

Acne scars are what remains after inflammatory acne has resolved. They form when inflammation damages the dermis: either tissue is lost, leaving a depression, or too much collagen is laid down, leaving a raised scar.

The single most useful thing to know is that "acne scarring" is not one problem. Different scar types respond to different treatments, most people have more than one type, and that is why a single treatment applied across a whole face gives uneven results.

The types

Ice-pick scars

Narrow, deep, sharply defined pits - like a puncture. They extend well into the dermis. The hardest type to treat with resurfacing alone, because the scar is deeper than the resurfacing reaches. Usually addressed individually before any surface treatment.

Boxcar scars

Round or oval depressions with sharp, vertical edges - wider than ice-pick scars and with a flat base. Shallow boxcar scars respond well to resurfacing; deeper ones respond partially.

Rolling scars

Broad, shallow undulations giving the skin a wave-like surface. Caused by fibrous bands tethering the skin to deeper tissue. Because the cause is tethering rather than surface damage, releasing the tether does more than resurfacing does.

Atrophic scars with volume loss

Deep divots where subcutaneous volume has been lost.

Hypertrophic and keloid scars

Raised scars. Hypertrophic scars stay within the original lesion; keloids extend beyond it. More common on the chest, back, shoulders and jawline, and in darker skin. These need the opposite approach from depressed scars - reduction rather than resurfacing.

Macular scarring and post-inflammatory pigmentation

Flat areas of increased or decreased pigment with no change in skin contour. Strictly this is pigmentation rather than scarring - and, unlike true scarring, much of it fades on its own over months, faster with sun protection. It is worth knowing the difference before paying for scar treatment.

Matching treatment to scar type

Scar type	What tends to work
Ice-pick	Individual treatment of each scar, then resurfacing; excision of the worst
Boxcar, shallow	Fractional or ablative laser resurfacing; skin needling
Boxcar, deep	Resurfacing plus individual treatment; partial improvement realistic
Rolling	Release of tethering (subcision), then needling or laser; filler for residual depressions
Volume-loss divots	Dermal filler, repeated as it absorbs
Hypertrophic and keloid	Cortisone injections, silicone; avoid aggressive resurfacing
Pigmentation only	Sun protection, topicals, peels, light-based treatment - and time

Treatments we use

Laser resurfacing - CO2 and erbium for deeper resurfacing; Fraxel fractionally, with less downtime and more sessions
Skin needling - collagen stimulation for depressed and textural scarring, in a course
Cortisone injections - for raised scars
Surgical excision - for individual deep scars, replacing a pit with a fine line
Dermal fillers - to lift individual depressions; temporary and repeated
Chemical peels, microdermabrasion and epidermal levelling - for surface texture and pigment
LED and cosmeceutical skincare - supporting treatments
Mineral make-up - cover, and physical sun protection

Treat the acne first

Scar treatment on actively inflamed skin is a poor investment: new scars form while old ones are being treated, and some resurfacing treatments are unsuitable on active acne. Get the acne under control first.

If you have recently taken oral acne medication, say so - resurfacing is usually deferred for a period afterwards because of healing risk.

What results are realistic

Acne scarring improves. It does not disappear. A realistic outcome from a well-chosen course is meaningful, visible improvement - commonly described as a substantial reduction in how noticeable the scarring is, not a return to unmarked skin.

Expect a course of treatments over months, and expect to combine approaches. Deep ice-pick scarring improves least. Individual results vary with scar type and depth, skin type, age and how the skin heals.

Anyone offering to remove acne scars completely is overstating what these treatments do.

Risks

Redness, swelling, crusting and peeling after resurfacing or needling - days to weeks depending on depth
Post-inflammatory hyper-pigmentation, notably more likely in darker skin types
Hypo-pigmentation, which can be permanent
Infection, including reactivation of cold sores after facial resurfacing
New or worsened scarring, particularly with aggressive treatment or in keloid-prone skin
Skin thinning or dimpling after cortisone injection
Lumps, asymmetry or vascular complications after filler
Incomplete improvement
Prolonged sun sensitivity after treatment

See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. Dermal skin treatments start from $130. Because acne scar treatment runs as a course, ask for the cost of the whole plan rather than a single session. Not covered by Medicare.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.