Acne scars are a common aesthetic issue because acne is one of the most prevalent skin diseases worldwide, affecting around 85% of adolescents and young adults of all ethnicities. When an inflammatory acne lesion heals, it typically leaves a visible mark in almost 100% of cases. The more severe the inflammation, the more disfiguring the resulting scarring can be. Although not life-threatening, acne scarring is not merely a cosmetic concern. It can lead to anxiety and depression, and in general, it can cause psychological and psychosocial impairment, especially in younger individuals, impacting their daily lives.
In this article, I will discuss the available methods to prevent scarring and to make acne scars disappear, from home remedies and natural methods to medical devices available at aesthetic clinics.
Types of acne scars
Not all scars are the same, likewise not all acne scars are the same. They can be classified mainly into the following categories based on their characteristics:
- Atrophic scars. Atrophic scars can be described as an indentation in the skin. Due to the inflammation caused by acne there is loss of dermal components such as collagen, and during the healing process our organism is not always able to compensate for that, leaving a depressed area in the skin. Atrophic acne scars are the most common (80-90%) and can be further classified as:
- Boxcar scars. These types of acne scars are wide (usually more than 4 mm) with well demarcated edges and no tapering.
- Ice pick scars. These types of acne scars are narrow (less than 2 mm) and deep (up to 4 mm), with a cone shape wider at the skin’s surface and tapering down to a point deep in the dermis.
- Rolling scars. These types of acne scars are wide (often more than 4 mm) and shallow, with sloping edges that give them a wavy appearance. The rounded look is caused by rigid fibrous bands that attach the epidermis to the dermis in a similar way the fibrous septae cause the skin dimples in cellulite.
- Perifollicular elastolysis scars. These type of acne scars are rare and look like “wrinkled papules”. They usually appear on the body where the skin is thicker rather than the face.
- Hypertrophic scars and keloidal scars. These types of scars occur in just 10-20% of cases and can be described as raised lesions on the skin caused by hypertrophy (increased growth) of fibrous tissue. The difference between the two is that hypertrophic scars are still contained within the original wound boundaries while keloids expand beyond them.
Moreover, acne scars can also be classified depending on the color difference between the scar and the surrounding healthy skin:
- Hyperpigmented scars are very common with acne and other inflammatory processes, and they look like brown or dark spots on the skin. Inflammation stimulates the melanocytes causing them to deposit extra melanin in the skin and this is especially common in darker skin types.
- Hypopigmented scars are lighter in color and are often called “white scars” for this reason; they commonly develop after trauma or surgery, but acne lesions can also cause them to appear.
- Post-Inflammatory erythema is the generalized redness or the red spots that persist after the active acne lesion has healed, commonly developing in lighter skin types.
Almost all types of scars get better over the course of weeks and months, and evolve improving in appearance for up to a couple of years. In some cases, the scar or pigmentation issue can go away completely, while in others the issue is permanent and requires medical intervention for a proper resolution.
How to make acne scars disappear quickly?
The approach to treating acne scars varies depending on the individual characteristics of the patient and the specific type of scar that requires treatment. The most effective way to achieve a quick disappearance of acne scars is through preventive treatment, which involves addressing and treating the underlying acne condition. Early intervention and a combination of personalized therapies can also aid in the swift and effective treatment of both active acne and the resulting scars.
How long does it take for acne scars to disappear?
The length of time it takes for an acne scar to disappear can vary greatly depending on the severity of the acne and the resulting inflammation. This is in addition to other patient characteristics such as skin type according to the Fitzpatrick scale. Hyperpigmentation typically fades over time, but it can persist for several months to two years in individuals with darker skin types (Fitzpatrick III to VI). Redness, on the other hand, usually fades within a few weeks, while hypopigmented white scars tend to be permanent. Keloids and hypertrophic scars continue to evolve for up to a year, after which they may improve over the following two years. Atrophic scars may improve over time, particularly if they are shallow, but deeper scars tend to be permanent.
Can acne scars disappear completely?
It is true that in some cases, acne scars may disappear completely without medical intervention. However, for more severe scarring, medical treatment can greatly improve their appearance and in many cases, completely eliminate them. Combination treatments may be necessary for more severe scarring, and can often result in at least a 50-75% improvement in the appearance of the scars. It is important to consult with a dermatologist or medical professional to determine the most effective treatment plan for each individual case.
Most used treatments to make acne scars disappear
Below, I will list some of the most popular and widely available treatments for acne scars. However, it is important to note that not all treatments are suitable for all patients or all types of acne scars.
Subcision for rolling acne scars
Subcision is a minimally invasive surgical procedure that effectively treats rolling acne scars. It involves inserting a small needle around the borders of the scar and using its sharp edges to cut the fibrous bands that cause the scar to look depressed under the skin. This technique releases the epidermis from being bound to the dermis, lifting the scar and allowing for improved collagen formation during the wound healing process. It is a targeted approach that is effective for specific types of scars.
Punch excision for icepick scars
Excision with a punch biopsy tool followed by absorbable sutures can be a highly effective treatment option for icepick scars or deep boxcar scars with atrophic scar tissue extending deep to the subcutaneous fat layer. While this approach may result in another scar, it is typically much less visible than the original acne scar. Combining this treatment with other options such as lasers can lead to even better outcomes.
Punch elevation for broad boxcar scars
Punch elevation, like the previous treatment, uses a punch instrument which in this case should be equal in size to the atrophic scar. After excising the scar with the punch, the tissue is not excised, but elevated to the same level as the surrounding healthy skin and then sutured in place with dissolvable stitches.
Laser treatments for acne scarring
There are several treatment options when it comes to lasers and acne scars. Both CO2 lasers and Er:YAG lasers can be used effectively both in the full field modality and in the fractional one. While full resurfacing treatment is more effective and requires a lower number of sessions to achieve considerable improvement, it also requires longer recovery with more severe side effects such as redness, pain and transient post-inflammatory hyperpigmentation. For this reason, fractional laser resurfacing is generally chosen over full field resurfacing. CO2 lasers are superior than Er:YAG for acne scarring, but they are also less tolerated by patients due to the side effects. Fitzpatrick’s skin type is going to be one of the major factors when choosing between the two types of lasers. This is because darker skin types have a higher tendency to develop hyperpigmentation after CO2 laser treatments.
Another way lasers can help in making acne scars disappear is by treating the hyperpigmentation or hypopigmentation that develops due to inflammation. For this, different lasers from the above ones can be used namely Pico lasers and Q-Switch lasers: while ablative and non-ablative, fractional and full-field lasers work by producing a controlled injury to the skin using thermal energy, picosecond and nanosecond lasers don’t cause a thermal injury, but deliver an intense amount of energy that targets melanin, the skin pigment, in a very short time causing something like a shockwave that mechanically breaks it down without causing damage to the surrounding tissues. These lasers also improve the texture of the scar by increasing the formation of collagen and elastic fibers.
Pulsed-dye lasers are another type of laser that can be employed to treat erythematous acne scars, which are the “red spots” left after the acne lesion disappears. They usually happen on lighter skin types, while darker skin types tend to experience post-inflammatory hyperpigmentation with dark spots. The pulsed-dye laser targets the capillaries and blood vessels that cause the redness decreasing the erythema and scarring; moreover, the heat that diffuses from the blood vessels to the surrounding dermal tissue stimulates the fibroblasts increasing collagen production.
For all types of lasers, usually 3 to 6 treatment sessions spaced 4 to 8 weeks apart are needed for significant improvement.
Using isotretinoin (Accutane), a popular acne medication, has been a contraindication for laser treatment as it was believed there would be an increased risk of hyperpigmentation and scarring following treatment due to the increased skin’s sensitivity caused by the oral retinoid administration. It was believed that you had to wait for at least 6 months after stopping Accutane to be eligible for laser treatment. In recent years, this assumption has been challenged and multiple studies have shown that laser treatment can be safe even while taking systemic retinoids.
Laser treatment combined with PRP for acne scars
Fractional CO2 laser has been studied in combination with intradermal PRP treatment for improvement of acne scars. Not only the combination treatment leads to a superior cosmetic outcome, but it also reduces the severity of the side effects caused by the laser and reduces the recovery time after the procedure.
Intense Pulsed Light (IPL) for pigmented acne scars
IPL, unlike lasers, emits a broad range of wavelengths and depending on the settings of the device may treat redness and hyperpigmentation simultaneously. Not all patients are good candidates, and it requires multiple treatment sessions to achieve a satisfying result.
RadioFrequency treatment for acne scars
Radiofrequency induces tissue remodeling with increased collagen production and the softening of scars. The RF category includes monopolar, bipolar, and fractional devices. Usually you need three or four treatment sessions to see a 25-75% improvement in acne scars after 3 months from the last treatment session, as fibroblasts take time to produce dermal matrix components; this treatment is particularly indicated in icepick and boxcar scars and is most effective as a combination treatment.
Microneedling for acne scars
Microneedling also known as percutaneous collagen induction therapy has been used for over 100 years in skin rejuvenation. For acne scars, microneedling has been proved effective in several clinical studies: by creating small injuries in the epidermal and dermal layers of the skin, it causes a release of growth factors that lead to cell proliferation and regeneration, increased collagen production, and tissue remodeling lasting several months.
To be most effective, a dermaroller with needle length between 1 mm and 2 mm needs to be used every 2 to 4 weeks for at least 6-10 sessions in total depending on the severity of the scarring.
RadioFrequency Microneedling for acne scars
Unlike a traditional RF treatment where the RF energy travels from the skin’s surface to the dermis, RadioFrequency microneedling delivers the RF energy directly to the dermis. This allows for deeper and more effective energy delivery. The combination of percutaneous collagen induction by microneedling and the skin remodeling and collagen stimulation by the RF component of the treatment makes this therapy more effective than either of those alone. Usually, 2 to 6 treatments spaced 4 to 6 weeks apart are recommended. After the last treatment, the skin will continue to improve for a couple of months. Not only RF microneedling is effective at treating the acne scars, but it also reduces the inflammation which will result in less severe outbreaks and less resulting scarring. While RadioFrequency microneedling is less effective when compared to other treatment options such as lasers, it is safer, with less side effects and with lower risk profile especially in darker skin types (Fitzpatrick III-VI) that have a higher risk of hyperpigmentation and other adverse events.
Microneedling with PRP for acne scars
For atrophic acne scars, the combination of microneedling and PRP treatments can significantly improve the cosmetic outcome by reducing scar depth. PRP has shown efficacy both intradermally, delivered through injections, and by applying it topically on the skin after the microneedling treatment. In studies, sessions were spaced 1 month apart with 3-4 sessions total for an appreciable improvement.
Biofillers, alloplastic fillers, Autologous Fillers and fat grafting for atrophic acne scars
Fillers are widely used in the cosmetic dermatology field and can also be employed for the treatment of atrophic scars. By replacing the missing volume in the skin, the improvement is often immediate and substantial. Among the many available options there are:
- Hyaluronic acid fillers, which immediately increase volume and are made of a biomaterial; they last 6-18 months according to the producers, although there are reports of HA Fillers lasting far longer than that. Their effect can be reversed with the use of hyaluronidase, making them the safest option among fillers.
- Calcium Hydroxyapatite (CaHa) fillers like Radiesse consist of an aqueous gel filled with small CaHa particles. After the injection the gel is absorbed and the calcium microspheres stimulate the fibroblasts to produce more collagen providing a gradual volume increase over the course of weeks and with effects lasting for 12-18 months.
- Poly-L-Lactic Acid (PLLA) fillers like Sculptra consist of microspheres of PLLA, the same material used in absorbable sutures. After the injection the PLLA stimulates the fibroblasts for weeks, increasing their production of dermal proteins with effects lasting up to 2 years.
- Polymetylmethacrylate (PMMA) filler (Bellafil) is the only permanent filler to be FDA-approved and to have in its indications the treatment of acne scars. It is made of bovine collagen and PMMA microspheres which do not degrade over time. It has a higher risk profile compared to other fillers but is also the only one providing long term tissue augmentation.
- Fat grafting is another option available for long lasting volume enhancement and although more expensive, it is preferrable and safer since it uses our own fat tissue to provide its filling effect.
- Autologous fibroblast injection is a less widespread and more recent therapy performed by culturing fibroblasts from the patient and then injecting them in tissue so that, over time, there’s a volume increase thanks to the increased synthesis of dermal components.
Other injectables for acne scars: PDRN
I talked already about injecting PRP which is effective both as a standalone treatment and as a combination therapy. There are other recent and interesting therapies that could be employed to treat acne scars although less data is available on them. One that deserves to be mentioned is PDRN aka Salmon DNA treatment: it can be used and acts from many angles including to prevent scarring, to reduce inflammation, to stimulate the fibroblasts and increase dermal component production, to promote wound healing which can be especially interesting when used in combination with other treatments that induce controlled damage to the skin.
Triamcinolone Acetonide injection
Triamcinolone belongs to the class of drugs known as corticosteroids which like naturally occurring cortisol decrease inflammation and reduce immune response. An intralesional injection of 0.05 to 0.25 ml of triamcinolone acetonide, in particular in nodular acne lesions, can be extremely useful to avoid scarring as well as avoiding other therapeutic options like making an incision and draining the lesion.
Triamcinolone acetonide is also effective in treating keloids and hypertrophic acne scars: among the many effects, triamcinolone also reduces fibroblast proliferation and protein production ability, causes fibroblast degeneration and reduces the concentration of several growth factors effectively preventing and treating keloids and hypertrophic scars, with an overall flattening of the scar and decrease in scar volume. For this purpose, injections can be repeated every 4 weeks for as long as there is improvement.
5-Fluorouracil (5-FU) injection for keloids and hypertrophic scars
Another injectable medication available and effective for the treatment of hypertrophic scars and keloids is 5-Fluorouracil often called just 5-FU. It acts by stopping the proliferation of fibroblasts and inhibiting the effect of some growth factors and of collagen gene expression. It can be injected once a week until satisfactory results are achieved. 5FU can be paired with triamcinolone, silicone gel sheets, lasers and other therapeutic options for an optimal outcome.
Chemical peel (medium and deep) for acne scars
While superficial chemical peels can be employed to prevent and treat acne outbreaks, medium and deep chemical peels act deeper and stimulate collagen remodeling, although results are less predictable, the effectiveness is not on par with modern technologies like lasers and can only result in moderate scar improvement, while the risk of complications is higher, and downtime post-procedure is longer. This treatment is more dependent on the skills of the medical professional than others.
Dermabrasion for acne scars
Dermabrasion is a treatment option decreasing in popularity since the development of new technologies like lasers. It has longer recovery and higher risk of complication than other treatment options. Dermabrasion consists in the removal of the epidermis, the upper layer of the skin, with a mechanical tool like a diamond fraise spinning very fast to force the skin components to reorganize during the healing process, improving the look of scars.
Skincare and cosmeceuticals
Several different skin care ingredients and cosmeceuticals can be effective at preventing and treating acne. From cleansers, the first step of any skin care routine, to retinoids like retinol, tretinoin, adapalene and tazarotene that are comedolytic and help normalize hyperkeratinization, abnormal growth and differentiation of keratinocytes, to niacinamide that helps control the production of sebum and oils and treats pigmentation issues, to salicylic acid and glycolic acid, to vitamin C and alpha-arbutin to treat and prevent hyperpigmentation.
Using a broad-spectrum sunscreen on a daily basis will also help to prevent pigmentation issues and permanent scarring.
LLLT for acne
Blue low level light therapy seems to be effective at preventing and treating acne, thus decreasing the chances of new scars forming. Red and infrared light, by stimulating the fibroblasts and boosting dermal protein synthesis, could help in case of atrophic scars. Moreover, red and infrared light penetrate deep in the skin and exert anti-inflammatory properties.
Medications for acne
There are many treatment options available when it comes to medications for acne. Although these will not do much for acne scars once they have formed, they are effective at preventing them by helping reduce active acne lesions. Among the many products there are benzoyl peroxide, commonly used as a cleanser to dry and exfoliate the skin and kill the bacteria, oral isotretinoin (Accutane), oral and topical antibiotics, intralesional corticosteroids, hormonal therapy, prescription-only topical retinoids and in selected cases also metformin or other medication to improve blood sugar levels.
Silicone gel sheets for acne scars
Silicone gel sheets can help treat hypertrophic scars and keloids and are effective at preventing them before their formation.
Natural methods and home remedies for acne scars
There are also multiple possible interventions to prevent acne scars that are based on natural methods and use of ingredients found at home. Unfortunately, most of the natural ingredients will do little to nothing when it comes to treating old acne scars that have already formed.
Lemon juice and baking soda for acne
Mixing baking soda with some lemon juice and forming a paste is a popular spot treatment for active acne lesions. It seems to work thanks to the antibacterial and anti-inflammatory properties of baking soda, plus its scrubbing effect when you apply and remove the paste from the skin, plus the antioxidant and anti-pigmentation properties of vitamin C in lemon juice. This remedy should not be overused since baking soda, due to its alkalinity and rough texture, can cause skin irritation.
Aloe vera gel
Aloe vera produces a wide variety of biological effects: it is a natural anti-inflammatory, antioxidant, immunosuppressive and prevents hyperpigmentation by decreasing tyrosinase activity. It also contains zinc which helps fight infections and reduce inflammation. You can apply aloe vera on your whole face or as a spot treatment and leave it overnight to reduce redness, active acne and prevent further scarring.
Honey has been a natural remedy for centuries and is a substance that shows antibacterial, anti-inflammatory and antioxidant properties. Not all honeys are the same, and “medical grade honey” or Manuka honey from New Zealand seem to be the most beneficial choices when it comes to health benefits. It can be applied as a spot treatment to active acne lesions for up to 15 minutes. This will speed up healing, lower inflammation and prevent scarring, although it won’t benefit old scars.
Tea tree oil (melaleuca alternifolia)
While tea tree oil may not be effective for treating existing acne scars, it has been shown to help prevent new scars from forming by fighting acne. This natural remedy has anti-inflammatory, antioxidant, and antibiotic properties, and may also help reduce redness caused by recent breakouts. However, it is important to note that tea tree oil should not be ingested and should not be used in its pure form, as it can cause irritation or other adverse effects. It is recommended to dilute tea tree oil with a carrier oil before applying it to the skin.
Lavender is an essential oil that possesses antibacterial, antioxidant, and anti-inflammatory properties. While it may not be effective in treating existing scars, it can assist in controlling acne, reducing redness, and preventing further scarring.
Green tea is a popular beverage that is rich in antioxidants, but it also has potent anti-inflammatory and antibacterial properties. Once you have brewed your green tea, let the tea bags cool down to avoid any burns, and then apply them on your skin for up to 15 minutes. While this remedy may not be effective for treating old acne scars, it can help reduce redness and the number of acne lesions, which can ultimately prevent the formation of further scars.
Diet and acne
While it may not be the most obvious factor when considering natural remedies, it is important to note that diet can have a significant impact on acne outbreaks. Some foods are thought to trigger acne, so if you notice that a particular food causes breakouts, it would be wise to limit your consumption of it. High-glycemic index foods and those high in simple sugars may be associated with acne breakouts, but further research is needed to fully understand this connection.
So, which one is the most effective treatment to make acne scar disappear?
If you’ve made it this far into the lengthy article, you might be wondering how to choose the best treatment with all the available options. The answer is the same as for other medical concerns: seek out a qualified doctor. A knowledgeable and experienced medical professional will tailor the treatment to your specific case, focusing on preventing and reducing active acne as well as treating the scars already present on your skin with a combination of therapies. However, an inexperienced and less knowledgeable doctor may use a one-size-fits-all approach for all patients, often relying on the tools they are most comfortable using or that are available in their practice. For all the treatments that have been proven effective, the very first thing a doctor should do to ensure that they work is called “patient selection,” which involves evaluating your specific case and determining which treatments are indicated and which are not. This is because the effectiveness of the treatment varies depending on the patient’s characteristics and the concern being treated. It’s also important to consider the patient’s desired outcome, budget and costs, and the risks and adverse event profiles associated with each treatment.
- Update on acne scar treatment.
YS Soliman – Cutis, Jul 2018
- A Review and Update of Treatment Options Using the Acne Scar Classification System.
M Boen – Dermatologic Surgery, Mar 2019
- Fitzpatrick’s Dermatology, 9th Edition
S Kang – McGraw-Hill Education, 2019
- Cosmetic Dermatology – Products and Procedures, 3rd edition
ZD Draelos – Wiley Blackwell, 2022
- Daily Routine in Cosmetic Dermatology
MC Almeida Issa – Springer, 2017
- Acne Scar Treatment: A Multimodality Approach Tailored to Scar Type.
LA Zeleski-Larsen – Dermatologic Surgery, May 2016
- Microneedling Options for Skin Rejuvenation, Including Non-temperature-controlled Fractional Microneedle Radiofrequency Treatments.
D Alessa – Facial Plastic Surgery Clinics of North America, Feb 2020
- 5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Comprehensive Review of the Literature.
VV Shah – Dermatology and Therapy, Jun 2016
- Acne Scarring—Pathogenesis, Evaluation, and Treatment Options.
D Connolly – Journal of Clinical and Aesthetic Dermatology, Sep 2017