Acne Scars Don't Have to Be Permanent
Acne scars are one of the most stubborn cosmetic concerns to address. Long after the active breakouts have cleared, the pitted, discoloured, or raised marks remain, serving as a constant reminder of past inflammation.
If you're living with acne scarring, you've likely tried numerous products promising to fade scars, only to see minimal improvement. That's because acne scars aren't just surface-level discolouration. They're structural changes in the skin's deeper layers, and effective treatment requires rebuilding collagen and remodelling damaged tissue.
This guide explains the different types of acne scars, why they form, and which treatments genuinely improve their appearance.
Why Acne Leaves Scars
Not everyone who experiences acne develops scars. Whether scarring occurs depends on the severity of inflammation, how deep it penetrates, your genetics, and how your skin heals.
Acne develops when hair follicles become clogged with sebum (oil) and dead skin cells. Bacteria (Cutibacterium acnes) colonise the blockage, triggering an immune response. White blood cells rush to the site, releasing enzymes that destroy bacteria but also damage surrounding collagen and tissue. When inflammation is severe and extends deep into the dermis, the skin's repair mechanisms struggle to restore the original architecture.
Atrophic scars (the most common type) form when insufficient collagen is produced during healing. The skin heals below the surrounding surface, creating depressions. These include ice pick scars (narrow, deep pits), boxcar scars (wider depressions with defined edges), and rolling scars (undulating, wave-like indentations).
Hypertrophic and keloid scars occur when too much collagen is produced during healing. These raised, firm scars are more common in people with darker skin tones and typically develop on the chest, shoulders, and back rather than the face.
Post-inflammatory hyperpigmentation (PIH) isn't technically a scar but rather temporary darkening of the skin after inflammation resolves. PIH fades gradually over months but can persist longer in darker skin tones or with continued sun exposure.
The key distinction is that PIH is a pigmentation issue, whilst true scars involve structural changes to the skin. Treatments that fade pigmentation won't improve atrophic or hypertrophic scars, and vice versa.
Why Over-the-Counter Products Don't Fix Scars
Most acne scar products you'll find at pharmacies or online target post-inflammatory hyperpigmentation rather than structural scarring. Ingredients like vitamin C, niacinamide, alpha arbutin, and liquorice root extract can lighten dark spots by inhibiting melanin production, but they don't rebuild lost collagen or fill in depressions.
Even retinoids, which do stimulate collagen production, can only do so much when applied topically. Retinol increases cell turnover and encourages fibroblast activity, which can produce modest improvements in shallow scars over many months. However, deep atrophic scars require interventions that penetrate into the dermis, where the structural damage resides.
Silicone gels and sheets are more effective for raised hypertrophic and keloid scars. They hydrate the scar tissue and apply gentle pressure, which can flatten and soften raised scars over several months. However, they're ineffective for atrophic scars.
Treatments That Genuinely Improve Acne Scars
Effective acne scar treatment requires triggering controlled injury to the skin, which forces it to produce new collagen and remodel damaged tissue. Several evidence-based approaches achieve this.
Microneedling uses fine needles to create thousands of micro-channels in the skin. This controlled injury activates the wound-healing cascade, stimulating fibroblast proliferation and collagen synthesis. Over several sessions, the newly formed collagen gradually fills in atrophic scars, improving texture and reducing depth.
Clinical studies show that microneedling improves acne scars by 50-70% after four to six sessions spaced four weeks apart. Results are most pronounced for rolling scars and shallow boxcar scars, whilst deeper ice pick scars often require additional interventions.
Platelet-rich plasma (PRP) combined with microneedling enhances results significantly. After microneedling creates the micro-channels, PRP (concentrated growth factors from your blood) is applied topically or injected into the scarred areas. The growth factors penetrate deeply through the micro-channels, amplifying collagen production and accelerating tissue regeneration.
Research published in the Journal of Cosmetic Dermatology compared microneedling alone versus microneedling with PRP for acne scars. The combination group showed significantly greater improvement in scar depth, skin texture, and overall appearance. Patients also reported faster healing and less post-treatment inflammation.
Fractional laser resurfacing uses targeted laser beams to create columns of thermal injury in the skin. These microscopic wounds stimulate collagen remodelling whilst leaving surrounding tissue intact, which speeds healing. Fractional CO2 lasers and erbium lasers are most commonly used for acne scars.
Lasers produce dramatic results but come with significant downtime (typically 5-10 days of redness, swelling, and peeling) and carry risks of hyperpigmentation, especially in darker skin tones. Multiple sessions are usually needed, spaced several months apart.
Chemical peels exfoliate the outermost layers of skin, promoting cell turnover and gradual collagen stimulation. Superficial peels (glycolic acid, salicylic acid) improve skin texture and fade post-inflammatory hyperpigmentation but have minimal impact on deeper scars. Medium-depth peels (TCA) penetrate further and can improve shallow atrophic scars, though multiple sessions are required.
Subcision is a minor surgical procedure specifically for rolling scars and deep tethered scars. A small needle is inserted beneath the scar to break the fibrous bands anchoring it to deeper tissue. This releases the tethering, allowing the depressed area to lift. Subcision is often combined with filler injections to further elevate the scar and stimulate collagen production.
TCA CROSS (chemical reconstruction of skin scars) involves applying high-concentration trichloroacetic acid directly into individual ice pick scars. The acid triggers intense collagen production within the scar, gradually filling it from the bottom up. Multiple treatments are typically needed, and results develop slowly over several months.
Creating a Treatment Plan for Your Specific Scars
Acne scars are heterogeneous. Most people have a combination of scar types, and effective treatment requires a tailored approach rather than a one-size-fits-all solution.
For mixed scarring (rolling, boxcar, and ice pick scars), a combination strategy often works best. Start with subcision to release tethered scars, followed by microneedling with PRP to stimulate overall collagen production and improve texture. Individual ice pick scars can be treated with TCA CROSS or excision. Post-inflammatory hyperpigmentation is addressed concurrently with topical brightening agents and sunscreen.
For primarily superficial rolling scars and textural irregularities, microneedling with PRP alone may suffice. For deeper, more severe scarring, fractional laser resurfacing delivers more aggressive collagen remodelling but requires longer recovery.
What to Expect from Treatment
Acne scar improvement is gradual. Unlike filler injections that provide instant volume, scar treatments rely on your body's natural collagen production, which takes time.
With microneedling and PRP, initial improvements (smoother texture, slightly reduced scar depth) become noticeable after the second or third session. Continued improvement occurs over the following three to six months as collagen remodelling progresses. Most patients require four to six sessions spaced four weeks apart for optimal results, with maintenance treatments every 6 to 12 months.
Fractional laser resurfacing produces more dramatic results after fewer sessions (typically two to three treatments), but each session involves significant downtime. Improvement continues for up to six months post-treatment as collagen regeneration proceeds.
Subcision provides immediate lifting of tethered scars, with additional gradual improvement over the following months as collagen fills in the released areas.
Preventing Future Scarring
If you're still experiencing active acne alongside existing scars, preventing new scars should be a priority. The best approach is early, aggressive treatment of inflammatory acne before it penetrates deeply into the dermis.
Prescription treatments like topical retinoids, oral antibiotics, or isotretinoin (Accutane) effectively control moderate to severe acne. For hormonal acne, oral contraceptives or spironolactone can reduce breakouts by regulating androgen levels.
Never pick, squeeze, or manipulate active acne lesions. This drives inflammation deeper, increases the risk of scarring, and introduces bacteria that worsen infection. If you struggle with skin picking, consider speaking with a therapist who specialises in body-focused repetitive behaviours.
Lifestyle Factors That Support Healing
Clinical treatments work best when supported by habits that optimise skin health and collagen production.
Sun protection is critical. UV radiation degrades newly formed collagen and worsens post-inflammatory hyperpigmentation. Wear broad-spectrum SPF 30 or higher daily, and reapply every two hours when outdoors. After microneedling or laser treatments, sun protection becomes even more essential, as treated skin is highly vulnerable to hyperpigmentation.
Nutrition supports collagen synthesis. Vitamin C is a cofactor for collagen production, so ensure adequate intake through citrus fruits, berries, peppers, and leafy greens. Protein provides the amino acids (particularly proline and glycine) needed to build collagen. Zinc and copper also play roles in collagen formation and wound healing.
Hydration improves skin elasticity. Well-hydrated skin heals more efficiently and tolerates treatments better. Drink at least two litres of water daily, and use a hydrating serum (hyaluronic acid or glycerin-based) alongside a moisturiser to lock in moisture.
Avoid smoking. Smoking constricts blood vessels, reducing oxygen and nutrient delivery to the skin. It also depletes vitamin C and directly inhibits collagen production. Smokers heal more slowly from scar treatments and see less impressive results overall.
Taking the First Step
Acne scars don't have to be permanent fixtures on your face. Whilst complete elimination may not be realistic, significant improvement is achievable with the right combination of treatments.
If you're ready to address acne scarring with an evidence-based approach that stimulates genuine collagen remodelling, microneedling combined with PRP therapy offers a safe, effective, and minimally invasive option. The treatment is well-tolerated, requires minimal downtime, and delivers progressive, natural-looking results.
For personalised advice and to discuss a treatment plan tailored to your specific scar types, reach out for a consultation. Addressing acne scars early, before they become deeply entrenched, gives you the best chance of achieving smooth, even skin.
