Acne Scars: Causes and Treatments

One of the main reasons to treat acne is to prevent scarring. When scarring does occur, though, there are treatments available. Scars can be raised, depressed, and/or discolored, and the type of scar determines the treatment or combination of treatments we use.

Treating Depressed Acne Scars

Depressed, or atrophic, scars are the most common type of acne scars and mostly appear on the temples, cheeks, upper neck, and back. A variety of treatments can help improve their appearance. The choice of which treatment to use depends partly on the type of atrophic scar. Atrophic scars can be ice pick, rolling, or boxcar shaped.

Fractional CO2 Laser

Laser acne scar treatment before Before

Laser acne scar treatment after After one treatment

Ice pick scars are the ones that are deep and pitted. These are best treated using the the fractional CO2 laser, the CROSS technique, or by cutting them out. The CROSS technique is a method of chemical peeling using very high concentrations of acid directly into the scars.

Rolling atrophic scars are depressed scars that have a broad base and gentle rolling edges. They are best treated by filling or by using subscision. Subscision is a technique using a special needle to cut and release the fibrous connections that pull the scar down.

Boxcar scars are depressed scars that are usually a few millimeters wide and look like little punches in the skin. These are best treated using the fractional CO2 laser or by cutting individual ones out. Chicken pox scars are also boxcar scars.


Most people with depressed acne scars have more than one scar type.

Red Indented Scars

Recent acne scars on the face are often both red and indented.  It is often the red color that makes them stand out.  The redness is residual inflammation that lasts long after the active acne lesion subsides.  It will eventually go away, but it can take many months.  Treating with the  V-Beam laser clears it up much faster.  Often, 1 or 2 treatments clears the red scar marks.

Treating Raised Acne Scars

Acne scars that are raised generally appear as firm, pink bumps often on the jaline, neck, or back. These are referred to as hypertrophic scars and are best treated using a combination of cortisone injections and V-Beam laser treatments. Sometimes, the fractional CO2 laser and other injected medications like fluorouracil can help. Additionally, silicone sheets are helpful.

Treating Discoloration

Discolored marks are not actually scars. They come in two varieties: brown or red. Brown marks are best treated using a combination of bleaching creams, strict sun protection, and chemical peels.

Red marks are the result of residual inflammation in the skin after larger acne lesions have resolved. It usually eventually goes away on its own. Rarely, it can heal as an atrophic scar, and treating may help prevent this from occurring. The best way to treat red marks is by using the V-Beam laser.

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