Acne scars are a common problem for all those who have suffered from breakouts. In cases of severe, inflamed blemishes, even when acne has finally cleared out, the skin might stay damaged leaving scarring with different degrees of severity. Most people want to have the scarring removed for purely aesthetic reasons, but also because it simply makes them very self aware and affects their confidence and self-esteem.

Depending on the nature and severity of the scars, covering them up isn't always an option. Luckily there are numerous available acne scars treatments designed to help remove different types of scarring you may be suffering from. (Learn more about these treatments with 14 Safe Acne Scar Treatments to Improve Your Skin.)

Why Does Acne Leave Scars?

Scarring is the result of the bursting of inflammatory acne, which causes damage to the deeper layers of skin.The bursting is caused by the swelling of pores due to excess oil and bacteria. The swelling of the pores causes a break in the follicle wall, causing lesions. If the lesions are deep, the wall of the pore is broken, and the infected material spills out into the surrounding tissue. In order to heal itself, the skin starts forming new collagen fibers, but the mechanisms aren’t smooth, creating damaged new skin that is unable to seamlessly blend in, which is then perceived as scarring.

What Are the Recommended Ace Scarring Treatments?

Currently, the most popular acne removal treatments are dermabrasion and chemical peels. Dermabrasion is a skin resurfacing treatment which entails the use of a high-speed ablative instrument that “sands” the skin, removing the top layer of skin (scarring included), and giving way to the growth of new, smoother skin.

Chemical peels are ways to remove the damaged top layer of skin through chemical exfoliatoin. Here's Your Ultimate Guide to Chemical Peels.)

However, these are not the only options for acne scar removal and treatment. The options are numerous, and they affect different types of scars in their own unique ways. This is why it’s important to be aware of the type of scarring you have so you can make an educated choice about your preferred healing treatments.

Acne scars have many subcategories, and it’s important to identify what type of scarring you have because this will influence your decision when it comes to choosing the right treatment.

What Are the Different Types of Acne Scars?

Generally, scarring is divided into two groups: keloid scars (hypertrophic), or depressed scars (atrophic). Keloid scars are caused by excess collagen production as a failed attempt to repair the skin, and they look like bumps: they create a mass of raised tissue on the surface of the skin, and they’re usually highly pigmented.

Depressed scars develop due to the loss of tissue and the lack of collagen produced during the skin’s attempts to heal itself. The scars are depressed areas in the skin, usually round in shape and very similar to chickenpox scars.

Ice-pick scars

Ice-pick scars are types of depressed scars, and they get their name because they look like tiny punctures in the skin.

Depending on how intense the scarring is, you have two viable options: skin grafts for isolated scars and smaller areas, or laser resurfacing for bigger areas affected by ice pick scars. Skin grafting is a technique that takes healthy skin from a different part of the body and uses it to fill up and cover up the punctures in the skin, making the surface of the skin look smoother and more even. Skin for the skin graft, in regards to acne scar removal, is usually taken from behind the ear.

Lasers used for laser resurfacing can be either ablative or non-ablative. The ablative lasers remove the damaged tissue by vaporization and stimulate collagen production. Non-ablative lasers use intense monochromatic lights to target the scarred areas of the skin and stimulate the cells that form connective tissues. Those cells create collagen and elastin, which is exactly what the skin needs to repair itself.

A 2016 study has showed that approximately four radiofrequency treatments are needed to create visible improvement, and that the results hold for up to two years. Read Your Comprehensive Guide to Fractional Therapy (Plus, 22 Popular Fractional Lasers).)

Boxcar scars

Boxcar scars are a variation of depressed scars. While the causes are the same, namely lack of collagen production during wound healing, boxcar scars differ from ice-pick scars in shape. They appear wider and generally tend to be bigger in size than ice-pick scars.

Chemical peels are the least invasive method of reducing scarring in the case of boxcar scars. Unfortunately, alongside being the least invasive, it's also the least efficient form of acne scar removal, and has significant results only when in very mild cases of scarring.

Skin resurfacing, carried out with either a laser or ultrasound device, is the recommended way of treating the scarring, as all the energy-based devices stimulate collagen production which is exactly what the skin needs.

Injectable dermal fillers are another way to go, if the scarring isn’t extensive, as the fillers target each scar separately, stimulating collagen formation beneath the surface. Laser skin resurfacing is considered the most effective for cases of extensive scarring which covers a wider surface.

A subcision is a non-invasive surgical option for the treatment of depressed scars in general, but considered most effective for boxcar scars. A subcision entails the use of a needle for the breaking up of scar tissue, which in turn relieves depression and allows the acne scars to fade away. The needle stimulates the growth of collagen within the scar tissue, helping to even out the surface.

Rolling scars

Another type of depressed scars, rolling scars differ from ice-pick and boxcar scars by their smooth edges. The smooth edges of the tissue results in bumpy skin texture, making the skin look like it has hills and valleys.

The recommended treatment for rolling scars is microneedling, often in conjunction with platelet-rich plasma (PRP) treatment. Read PRP: Everything You Need to Know About Platelet-Rich Plasma Injections.)

Microneedling entails the use of a specialized devices with microneedles to prick the skin, creating small wounds that stimulate collagen and elastin growth. The injury done to the skin with needling, no matter how mild, is enough to jump-start the process, as the body detects the injuries and wounds and proceeds to create excess collagen and elastin, which in turn improves the skin and removes the depressed scars which were caused by the lack of collagen in the first place.

The treatment is most often paired with PRP, which is a treatment that entails the injecting of platelet-rich plasma into the targeted area to promote healing. The plasma comes from the patient themselves, as a small blood sample is taken, centrifuged, with the newly separated platelets being injected back into the client, but in the target area (the acne scars). \

Studies have shown that PRP treatment is very efficient, with an overwhelming number of respondents seeing a vast improvement after the microneedling and PRP combo-treatments.

Keloid scars

Keloid scars are results of excess collagen production in the healing process, and are particularly difficult to cover up with make up. The scars are excess tissue formations which look like shapeless bumps on the skin. What’s more, the raised tissue is quite bright in its shades of red and pink, and often very irritable and sensitive to the touch.

Keloid scars are treated with steroid injections. A corticosteroid solution is injected directly into the scar tissue, and due to their anti-inflammatory properties, the injection reduces swelling, redness, itching and tenderness.

The hyperdiscoloration, as well as the irritability of keloid scars, stem from inflammation, which is why steroid injections are recommended as the solution, although they don’t entirely remove the scars, but rather flatten them. This, however, makes the skin even and smoother, and allows for makeup cover up, which was previously impossible due to the severity of the bump.

Another method of combating the discoloration of the tissue is the use of the pulsed dye laser. The laser targets blood vessels, reducing inflammation. Applied directly to the scars themselves, retinoic acid is known to improve the appearance of keloid acne scarring.