5 Types of Acne Scars And How To Treat Them

Aesthetics Hub | 2 Nov 2016
Breakouts can come and go, but the scars they leave behind can linger for years (or more). You've probably been told, "Don't pop your pimples, or you'll end up with a mark." But recently, I learned that the most common acne scars have nothing to do with your tendency to squeeze zits. "Popping pimples doesn't cause scarring," Mark Karolak, D.O., a board-certified facial plastic surgeon at Reflections Center for Skin and Body, tells SELF. "If it's just a whitehead and blackhead on the surface, it can be popped without creating any scarring."
 
alt

So if popping pimples doesn't cause scarring, what does? Long-lasting scars typically turn up after a recurring bout with cystic acne. Cystic acne is a breakout that burrows deep into the skin. These red, painful nodules occur when clogged pores are filled with pus and bacteria, which causes inflammation. Cystic breakouts are often tied to an internal fluctuation of hormones like testosterone (that's why they're common during puberty, monthly menstruation, and perimenopause). "If there is a cyst in the skin, it's going to cause a scar the longer it sits there because pus or bacteria deeper inside the pores cause surrounding inflammation," says Dr. Karolak. And as a result, the inflammation affects the collagen production as well as the fat stores under the skin, creating a visible scar on the surface.

Acne scars take many different forms. You might see tiny pockmarks, a swollen keloid, or a discolored area on the skin. And just like the types of scars vary, there isn't a one-size-fits-all fix. Your dermatologist can use a combination of treatments including lasers, chemical peels, or fillers to minimize the spots. "Once there is scarring you can't get the skin back to the way it was before," says Dr. Karolak. "But we can get it to look significantly better, so that [clients] feel more comfortable in social environments."Here are the five primary types of acne scars and the popular treatments available to treat each one.

 

alt

 

An ice pick scar is a small depression in the skin (almost as if tiny needles punctured the area).

The inflammation caused by your breakout can cause more than just the pimple you see on the surface, it can also cause damage below the skin. "The inflammatory response produces a loss in collagen and the overlying skin will collapse and leave a depression," Howard Sobel, M.D., a NYC dermatologist and founder of DDF Skincare, tells SELF. To get rid of these tiny pockmarks, Dr. Karolak relies on a TCA Cross chemical peel. TCA stands for trichloroacetic acid. "We use a little applicator and go into the hole with chemicals to cause a burn. That causes the wall of that ice pick to heal itself and close in on itself," explains Dr. Karolak.

 
alt

A boxcar scar is also a depression in the skin, but the indentation has very sharp edges.

"If you occupy the area [under the skin] with a cyst, it destroys fat around it. Once the cyst goes away, the loss causes indentation," Dr. Karolak explains. A boxcar scar is a depression that has hidden scar tissue, which acts like an accordion pulling the scar downward. Subsicion is one solution for these deeper scars. Subsicion uses a sharp needle to go under the surface and break up that scar tissue. Then, you can fill it in with fillers made specifically for acne scars like Bellafill. Or you can do a fat transfer. "One of my favorite treatments for volume loss is fat transfer, which allows me to take inject a patient's own body fat instead of synthetic filler," says Dr. Karolak. Another treatment for boxcar scars is punch excision where the indented area of the scar is removed and the edges are pulled together with a suture. These treatments are often followed up with a collagen-boosting laser treatment.
 
 
alt

Rolling acne scars have smooth edges and look like tiny hills and valleys in the skin.

Rolling scars can look like little saucers, giving the skin a wavy texture. Lasers that resurface the skin are Dr. Karolak's top treatment pick for this type of scar, and Dr. Sobel agrees. "Many scars can be improved with lasers such as the matrix CO2, which remove the outer layers of skin, burning away the scar tissue and stimulate new collagen production," he says. "Non-ablative lasers such as the Fraxel can help activate the production of collagen without damaging the surface of the skin." Keep in mind, that these laser treatments can take a bit of recovery time and require multiple treatments to see results. For a quicker solution, your dermatologist can plump the bowl-like scar with fillers like Juvederm, Restylane, or Bellafill.
 
 
alt

A keloid acne scar is a raised bump over the skin.

Keloid bumps are generally discolored and raised. These scars form when the body tries to recover from the inflammation caused by cystic acne. According to Dr. Sobel, you can get a keloid if too many fibroblasts or dermal cells are produced during the healing process. The first step in treatment is to flatten the bump with a shot of cortisone. Then, you can follow up with other treatments like laser or retinol to even out the skin tone.
 
 
alt

And hyperpigmentation is a dark spot or discoloration caused by inflammation.

"Hyperpigmentation is an increase of melanin, which is the substance that colors the skin," says Dr. Sobel. Hyperpigmentation often clears up on its own. However if you want to speed up the process, you can use topical treatments with ingredients like retinol, vitamin C, and kojic acid, which can help brighten skin overall. We like Sunday Riley Sleeping Night Oil ($105, sephora.com) and InstaNatural Vitamin C Serum ($17, amazon.com). The most important thing is to stay out of the sun to keep the dark spots from getting even deeper in color.

All illustrations by Jocelyn Reunice

 

This article first appeared in Self.

Our Panel of Doctor's Services
DR Celine Leong, Astique Clinic
Acne Treatment Programme, $349
PPx Pore-Cleansing ACNE Treatment™ (PPX) is an advanced technology that combines a gentle vacuum with therapeutic broadband light, to help rid skin of acne-causing impurities, leaving your skin cleaner and clearer. It is combined with laser treatments, chemical peels and blue LED light treatment to bring about more effective results and healthier, clearer, more youthful-looking skin.
CO2 Fractional Laser Skin Resurfacing, $399
Fractional Laser Skin Resurfacing is effective in reducing acne scars.
350 Orchard Road, #08-00 Shaw House, Singapore 238868
Dr. Dylan Chau, Celevenus Aesthetic & Wellness Clinic
Intracell, from $300 onwards
INTRAcel combines microneedling with radiofrequency and fractional resurfacing, this cutting-edge procedure with little downtime is effective for sagging skin, jowls, lines and wrinkles, large and open pores, acne and acne scarring and stretch marks/scarring.
391B Orchard Road #16-03/04 Ngee Ann City Tower B, Singapore 238874
Dr Ivan Tan, Nu.Reflections Medical Aesthetics
E-Plus Sublative Skin Renewal, from $1,000 onwards
The E-Plus Sublative Skin Renewal treatment utilises a fractional bipolar radiofrequency technology to treat mild to moderate wrinkles, acne scars, discolouration and tectural irregularities.
EnerJet Acne Scarring Removal, from $1,500 onwards
An effective treatment targetted at stubborn acne scars with the revolutionary pneumatic needle-less sytem.
123 Penang Road, Office tower #05-12 Regency House (next to old Cockpit Hotel), Singapore 238465
Dr. Terence Tan, Halley Medical Aesthetics
Acne Buster Programme 1
Get to the root of the acne problem with a treatment programme that includes laser therapy for smoother, acne-free skin and smaller pores. This programme includes a laser carbon peel, Acne Buster Facial, Deep Pore Cleansing Facial, and glycolic acid peel treatments.
Acne Buster Programme 2
Get to the root of the acne problem with a treatment programme that includes pampering yet healing facials and no downtime facial peels for smooth, acne-free skin. This programme includes a two Acne Buster Facials, two Deep Pore Cleansing Facials, and two glycolic acid peel treatments.
Acne Scars Programme
Get rid of the ugly acne scars and pigments left behind with a treatment focused on skin renewal and skin smoothening. This programme includes two fractional CO2 laser treatments and two glycolic acid peels.
277 Orchard Road, #03-15 Orchard Gateway, Singapore 238858