As difficult as it can be to get rid of acne (and that is a prerequisite here), treating the scars acne leaves behind can be an even greater challenge. The hugely profitable skin care industry pushes a vast array of quick and easy solutions, confusing consumers into wasting money. The unfortunate truth is that the most effective, research-based treatments for acne scarring are performed by a doctor. Usually, these procedures involve the administration of controlled violence to destroy the outer layer of skin so that newer, more evenly contoured and colored skin can take its place. No single treatment is “most effective” for everyone; rather, acne scar treatment is tailored to one’s individual scars and skin health.
Below I outline how to get rid of acne scars using both professional and at-home treatments. While the former treatments are far more expensive, they are also potentially more effective. But you’ll find no directives here. I’m not telling you what to do but simply presenting a starting point: a list of research-based options for you to pursue further.
What’s the deal with scars?
Scars are made up of skin tissue just like any other skin on your body, the only difference being the alignment of the fibers of the collagen are more synchronous and less random. Typical skin cells are woven, almost like a basket. Scars are woven more like rope, making them harder to tear again.
Types of Acne Scars
- Depressed Scars. These scars fall below the level of the surrounding skin and can be classified according to their size and shape.
- Raised Scars. As the name implies, these scars (also known as hypertrophic scars) are raised above the surrounding skin.
- Icepick acne scars are small, narrow pits that can sometimes be quite deep, as if a Smurf took a tiny icepick to your complexion. They are the most common type of depressed acne scar.
- Boxcar acne scars often look like large pores or small, walled boxes.
Rolling acne scars create a wavy, rippling (and quite aging) texture.
- Keloids, a type of raised scar, form when the scar overgrows its natural boundary. Keloid scars can be quite painful and irritating.
Professional Acne Scar Treatments
Laser treatments. Laser resurfacing — which can cost anywhere between $1,000 to $6,000 — involves destroying the top, outer layer of skin (epidermis) and heating up the inner layer (dermis). This will foster new skin growth and diminish the appearance of acne scars. The type of laser treatment you pursue will depend on your scarring, skin health, expectations, and your bank account. Numerous studies have shown this acne scar treatment to be effective for shallow boxcar scars and ice pick scars, and certain lasers (pulsed dye lasers) are also being used to treat raised (hypertrophic) acne scars. Healing can take up to two weeks, but many people continue to see improvement months after the procedure.
Chemical peels. To get rid of depressed acne scars, an acid is used to destroy the outer layer of skin (and sometimes deeper with stronger acids), which will foster new skin growth. Light, superficial chemical peels ($100 – $200) will need to be repeated every four to six weeks for many sessions. On the other end of the spectrum, a deep chemical peel ($4,000 – $6,000 for full face) is considered a serious cosmetic operation, involving months of recovery time. The stronger, deeper acid peels can — when all goes according to plan — produce amazing results, but they also come with the risk of more severe side effects and a hefty price tag.
Microdermabrasion and dermabrasion. These acne scar treatments are used to get rid of depressed scars. Dermabrasion ($1,500 per session) is by far the more intense treatment. During a session, a diamond blade or wire brush is used to blast away the top layer of skin along with the acne scars, leaving room for smoother, more evenly contoured and colored skin to grow. It can be painful and you’ll need to set aside a week for healing. Microdermabrasion ($50 – $300) — best used for smaller, shallow, depressed acne scars — involves several shorter sessions using gentler instruments, and there is no downtime for healing.
Fillers. Used to treat depressed acne scars, fillers (from $500 to $2,500) have become more popular as methods have improved and become longer-lasting. With this acne scar treatment, a doctor will inject collagen, PMMA (polymethylmethacrylate — the only permanent filler), your own fat, or another agent underneath and into the acne scars to give them a flat, even appearance. Fillers are fast and easy; they allow you to go back to everyday activities immediately. However, most fillers are temporary and require maintenance treatment every few months (collagen) or years (your own fat).
Needling (collagen induction therapy). You mean you don’t have to destroy the epidermis to get rid of acne scars? Perhaps not. CIT works by creating hundreds of minute injuries to the acne-scarred skin with the use of a needle-studded roller. The skin responds by creating collagen and elastin, firming up and smoothing over depressed acne scars. Whether you do it at home (see “Home Remedies for Acne Scars”) or pursue professional treatment ($200 – $500 per session), know that collagen production doesn’t happen overnight; it can take up to a year before results are fully apparent, but continual improvement may be seen over that time.
Cryotherapy and injection therapy. Cryotherapy ($80 – $150 per scar) involves freezing raised acne scars with liquid nitrogen. The scar tissue dies and slowly sloughs away, creating a smoother appearance. Sometimes it takes one session to get the desired results, and sometimes a dozen visits are required. Cryotherapy is often paired with injection therapy, a treatment in which steroids or other agents are injected into raised scars to create a smoother, flatter appearance. But injection therapy can be a stand-alone treatment, or it can be paired with acne scar removal surgery. Do you see why you’d need the aid of an actual physician in treating acne scars? Acne scar treatment is highly complex and individualized.
Prescription, topical acne scar treatments. There really aren’t that many topical treatments for acne scars, since scar tissue is simply too tough to expect profound results from this strategy. However, your doctor or dermatologist may prescribe a topical cream or ointment. For example, strong topical steroids and tretinoin (Retin-A, Renova, Avita) are sometimes used to reduce the appearance of mild acne scars.
Acne scar surgery. The surgical techniques used to get rid of acne scars are effective and receive high marks from patients. Indeed, if your expectations are high and your scarring moderate to severe, then you’ll want to at least discuss surgical scar removal with your doctor or dermatologist. Doctors can remove, raise, fill in, and fade acne scars using various methods depending on your skin health and the type and severity of your scarring. Surgery is often paired with the techniques listed above to further reduce scarring. But while surgery often gets the best results, it is also expensive and requires more downtime for healing. And as with all of the above treatments, if you don’t follow the after-care directions to the letter, you’ll have wasted your time and money.
Home Remedies for Acne Scars
Acne scar gels and creams (depressed acne scars). There are very few OTC topical treatments for scars, and even fewer for depressed acne scars. However, cream or gel products containing glycolic acid, vitamin C, or retinol may slightly reduce mild acne scars by boosting the body’s production of collagen, aiding in cell turnover and the growth of new skin, and by correcting mild discoloration.
At-home acid peels and microdermabrasion (depressed acne scars). In the hands of a novice, these products can lead to adverse reactions and tears. That’s not to say they don’t work. While not as strong or effective as their professional counterparts, they can help fade acne scars, especially the small variety. But before you start using one of these products, consult a dermatologist.
Dermal Rollers. Yes, you can practice collagen induction therapy at home to treat depressed acne scars. It’s going to be nearly the same treatment you’d receive from a professional (see “Professional Acne Scar Treatments”), minus the guidance and attention to variables that they bring to the table. The Dr. Roller 1.5mm is an FDA-approved, high quality product ($75). If you visit large vendors such as Amazon, you’ll notice that people buy creams and ointments along with dermal rollers. Why? CIT therapy is supposed to make the skin more responsive to topical treatments.
Silicone sheets and gels. Silicone treatments have been shown to reduce the itching and pain associated with scars, and in some cases even reduce their size. Silicone sheets are a popular treatment for raised acne scars. It is thought that the pressure and moisture (and possibly static electricity) help to reduce the size and appearance of scars. But silicone treatments come in gel form as well. The most popular of these is ScarGuard MD, which consists of silicone, hydrocortisone, and vitamin E. There is some anecdotal and small-scale research showing it can reduce both raised and depressed acne scars — especially newer scars.
Mederma. Mederma — a water-based onion extract gel — is a popular topical treatment for acne scars. It is often cited as “only working as well as petroleum jelly” because of a study comparing the two. Some experts argue that, rather than the ingredients, it’s the moisture and stimulation (when applying) that creates the healing response, but more testing is needed.