By Dr Garry Cussell, Founder and Clinical Director of Rejuvenation Clinics of Australia
Acne scarring can remain visible long after active breakouts have resolved. For some people, these changes in skin texture can become more noticeable over time, particularly as the skin naturally loses collagen and firmness with age.
One of the most important things to understand about acne scarring is that not all scars are the same. Some appear as small, deep indentations, others create a rolling or uneven texture, while some form raised areas of scar tissue.
The type, depth and severity of scarring all influence which treatment approaches may be appropriate.
In short: Acne scarring develops when inflammation associated with acne disrupts the skin’s normal healing process, resulting in changes to its underlying structure. These may appear as indented (atrophic) or raised (hypertrophic or keloid) scars. While established scars generally don’t disappear completely on their own, professional treatments may help improve their appearance. The most appropriate approach depends on the individual scar characteristics and skin type.
Is It an Acne Scar, or Just a Mark?
One of the first distinctions to make is whether you’re looking at an acne scar or a lingering mark left behind after a breakout.
Although they can look similar, they involve different changes in the skin and may require different approaches.
Post-Inflammatory Marks
After a pimple heals, the skin may be left with flat areas of discolouration.
These can include:
- Post-inflammatory erythema (PIE): Pink, red or purplish marks associated with changes in superficial blood vessels following inflammation.
- Post-inflammatory hyperpigmentation (PIH):Â Brown, grey or darker patches caused by increased pigment production after inflammation.
Unlike true acne scars, these marks generally don’t involve a permanent change in skin texture.
Many gradually fade over time, although some can persist for months or longer, particularly where pigmentation is more pronounced or additional inflammation occurs.
True Acne Scarring
Acne scars involve structural changes within the skin.
They may appear as depressions, raised areas or uneven texture caused by changes in collagen and the tissue beneath the skin’s surface.
Unlike temporary post-inflammatory marks, established textural scars are less likely to resolve spontaneously.
How Can You Tell the Difference?
There are a few characteristics that may help you recognise the difference:
- Texture: Post-inflammatory marks generally feel smooth, while scars may create indentations, raised areas or unevenness.
- Appearance: Scars can become more noticeable under angled lighting because of the shadows created by changes in skin texture.
- Duration:Â Colour changes may gradually fade, while established textural changes often persist.
These observations can provide useful clues, but they aren’t a substitute for a professional skin assessment. Some people have both pigmentation changes and acne scarring in the same area.
Understanding which is present is an important first step towards selecting appropriate treatment options.
The Main Types of Acne Scarring
Acne scars are generally classified according to their appearance and the way the underlying tissue has healed.
Icepick Scars
Icepick scars are narrow, deep indentations that extend into the skin.
They often resemble small punctures and can be particularly challenging to address because of their depth.
Boxcar Scars
Boxcar scars are wider depressions with relatively defined edges.
They may be shallow or deep and can give the skin a pitted or uneven appearance, particularly across the cheeks and temples.
Rolling Scars
Rolling scars create broad, wave-like depressions in the skin.
They are often associated with fibrous bands beneath the surface that pull the skin downwards, creating a tethered appearance.
Hypertrophic and Keloid Scars
Unlike indented scars, hypertrophic and keloid scars involve excessive scar tissue formation.
Hypertrophic scars remain within the boundaries of the original affected area, while keloid scars can extend beyond those boundaries.
Raised acne scars are more commonly seen on areas such as the chest, shoulders, back and jawline.
Can You Have More Than One Type?
Yes. Many people experience a combination of scar types, sometimes alongside ongoing acne or post-inflammatory pigmentation.
This is one reason why acne scar treatment often requires an individualised approach rather than relying on a single treatment for every concern.
Clinical research on acne scarring discusses the importance of assessing scar characteristics when considering treatment options.
What Causes Acne Scarring to Form?
Acne scarring develops when inflammation associated with a breakout damages the surrounding skin tissue and interferes with normal healing.
As the skin repairs itself, changes in collagen production and organisation can lead to either a loss of tissue, creating an indentation, or excessive scar tissue formation, resulting in a raised scar.
Several factors can influence the likelihood of scarring.
Severity of Acne
Deep, inflammatory acne lesions, including nodules and cysts, are more likely to cause scarring than superficial breakouts.
More severe inflammation can affect deeper layers of the skin and increase the risk of lasting structural changes.
Delayed Treatment
Persistent inflammatory acne may increase the risk of scarring, particularly when breakouts are severe or recurring.
Seeking appropriate treatment early can help manage inflammation and reduce the likelihood of further damage.
Picking or Squeezing Breakouts
Picking, squeezing or repeatedly touching inflamed acne lesions can worsen inflammation and damage surrounding tissue.
This may increase the risk of both scarring and post-inflammatory pigmentation.
Genetics and Individual Healing Responses
Some people are naturally more prone to developing scars than others.
Genetic factors, skin characteristics and individual healing responses can influence how the skin repairs itself following inflammation.
How Can You Reduce the Risk of Acne Scarring?
Although not all acne scarring can be prevented, managing active acne and supporting the skin’s healing process may help reduce the risk.
Consider the following steps:
- Address persistent acne early. Seek professional advice if breakouts are deep, painful, recurring or difficult to control.
- Avoid picking or squeezing. Allow inflamed lesions to heal without unnecessary trauma.
- Protect your skin from the sun. Daily sun protection can help reduce the worsening of post-inflammatory pigmentation.
- Use suitable skincare. Gentle cleansing, appropriate moisturising and avoiding unnecessarily irritating products can support the skin barrier.
- Seek advice for ongoing inflammation. Persistent or severe acne may require assessment and treatment by an appropriately qualified healthcare professional.
Treating active acne is generally an important priority before undertaking procedures intended to improve established acne scars.
Learn more about active acne and treatment considerations.
Can Skincare Alone Improve Acne Scarring?
Skincare plays an important role in maintaining skin health, supporting the skin barrier and managing uneven tone.
However, there is a distinction between improving the appearance of post-acne marks and addressing established structural scarring.
Certain skincare ingredients may be useful as part of an ongoing routine.
Retinoids
Retinoids can support skin cell turnover and influence collagen-related processes, depending on the formulation.
They may help improve aspects of skin texture and pigmentation over time, although topical products generally have a limited effect on established, deeper acne scars.
Some retinoids require medical guidance and may not be suitable for everyone.
Vitamin C
Vitamin C contributes to normal collagen synthesis and is commonly included in skincare formulations designed to support skin appearance and address uneven tone.
Its effects depend on the formulation, concentration and individual skin characteristics.
Niacinamide
Niacinamide is commonly used to support the skin barrier and improve the appearance of uneven skin tone.
It may be useful for skin affected by post-inflammatory marks, although it cannot be expected to correct deeper structural scarring.
What Skincare Cannot Usually Do
Established icepick, boxcar and tethered rolling scars involve changes beneath the skin’s surface.
While a consistent skincare routine may improve overall skin condition, topical products alone are unlikely to substantially correct deeper indentations or raised scar tissue.
Professional assessment can help determine whether additional treatment approaches may be appropriate.
Where Rejuvaus Fits In
The Rejuvaus skincare range, developed by Dr Garry Cussell, includes products designed to support everyday skin maintenance and concerns such as uneven skin tone and skin barrier health.
An appropriate skincare routine can complement a broader skin management plan, but it should not be considered a replacement for professional assessment of established textural acne scarring.
Can Different Acne Scar Types Need Different Treatments?
Yes. Different acne scars involve different structural changes, and this can influence which treatments are likely to be appropriate.
For example, shallow textural irregularities may respond differently to resurfacing treatments than deep icepick scars or rolling scars associated with tethered tissue.
Similarly, raised hypertrophic or keloid scars require a different assessment and treatment approach from indented scars.
Scar depth, distribution, skin tone, previous treatments and the presence of active acne are all relevant considerations.
Some individuals may benefit from a combination of approaches rather than a single procedure.
The purpose of a consultation is to identify the characteristics of the scarring and discuss suitable options, realistic expectations and potential risks.
What Professional Treatments May Help With Acne Scarring?
Professional acne scar treatments aim to improve the appearance of skin texture through different mechanisms, including controlled skin renewal and collagen remodelling.
The most appropriate option depends on the type and severity of scarring, individual skin characteristics and clinical suitability.
At Rejuvenation Clinics of Australia, treatment options that may be considered following assessment include the following.
Pico Scar Repair
Pico Scar Repair uses laser technology to address selected skin texture concerns.
Depending on the technology and treatment parameters used, laser energy may stimulate processes associated with skin remodelling.
Its suitability for acne scarring depends on the scar type, depth, skin tone and other individual factors.
Not all acne scars respond equally to laser treatment, particularly deep or tethered scars.
RF Needling (Radiofrequency Needling)
RF Needling combines fine needles with radiofrequency energy delivered into the skin.
The controlled treatment is intended to stimulate tissue remodelling and collagen-related processes.
RF Needling may be considered for selected atrophic acne scars and uneven skin texture.
However, the response depends on factors such as scar depth, severity and whether underlying tissue tethering is present.
Microneedling
Microneedling creates controlled micro-injuries in the skin using fine needles.
This stimulates the skin’s natural repair response and may help improve the appearance of certain superficial or moderate textural irregularities over time.
Multiple treatments may be required, and deeper scars may not respond sufficiently to microneedling alone.
Surface Rejuvenation Laser
Surface Rejuvenation Laser is designed to address selected concerns affecting the skin’s surface, including uneven texture.
Depending on the treatment technology and individual skin characteristics, resurfacing approaches may help improve the appearance of some superficial acne scars.
However, deeper icepick scars and tethered rolling scars may require different or additional approaches.
What About Deep or Tethered Acne Scars?
Some acne scars involve significant tissue loss or fibrous attachments beneath the skin.
These may not respond adequately to general resurfacing or collagen-stimulating treatments alone.
In some cases, other medical procedures or combinations of treatments may be considered by appropriately qualified practitioners.
A clinical assessment can help establish whether the available treatments are suitable or whether another approach or specialist referral may be more appropriate.
Why Skin Tone Matters
Skin tone is an important consideration when selecting acne scar treatments.
Certain laser and energy-based procedures carry a risk of post-inflammatory pigmentation changes, particularly in individuals with darker skin tones or a history of pigmentation concerns.
Your clinician should consider your skin type, medical history and individual risk factors before recommending treatment.
How Long Does It Take to See Results?
Improving the appearance of established acne scarring is usually a gradual process.
Some treatments work by encouraging collagen remodelling, which takes time to develop.
Depending on the treatment and individual response, changes in skin texture may become more noticeable over several weeks or months.
Some people require multiple sessions, while others may need a combination of different approaches.
The number of treatments, recommended intervals and expected recovery will depend on the type and severity of scarring and the treatment selected.
Can Acne Scars Be Completely Removed?
Complete removal of established acne scars cannot be guaranteed.
The aim of treatment is generally to improve the appearance of scarring and create a more even-looking skin texture where clinically achievable.
The degree of improvement varies, and some scars may remain visible despite treatment.
During a consultation, your clinician can discuss what may be realistically achievable for your individual circumstances, including potential risks, recovery considerations and treatment limitations.
Frequently Asked Questions About Acne Scarring
Can Acne Scars Fade Away on Their Own?
Post-inflammatory marks often fade gradually, although some can persist for extended periods.
True textural acne scars involve structural changes in the skin and are generally less likely to resolve completely without treatment.
Can I Treat Acne Scarring While I Still Have Active Breakouts?
Active inflammatory acne is generally addressed before undertaking acne scar procedures.
This helps reduce the risk of additional scarring and allows the clinician to assess the existing scars more accurately.
The appropriate treatment sequence depends on the individual.
Does Acne Scar Treatment Hurt?
Discomfort varies depending on the procedure, treatment area and individual sensitivity.
Some treatments involve sensations such as warmth, pressure or temporary discomfort.
Your clinician can explain what to expect and discuss appropriate comfort measures before treatment.
How Many Sessions Will I Need?
There is no universal number of sessions for acne scar treatment.
The recommended course depends on scar type, severity, treatment selection and individual response.
Some people may require several sessions or a combination of treatments.
Can Acne Scar Treatments Be Used on Darker Skin Tones?
Some acne scar treatments may be suitable for people with darker skin tones, but careful assessment is important.
Certain procedures carry an increased risk of pigmentation changes, and treatment selection and settings should be tailored to individual skin characteristics.
Will My Acne Scars Be Completely Gone After Treatment?
Complete scar removal is not generally a realistic expectation.
Professional treatments may improve the appearance of certain scars, but the degree of improvement varies, and some textural changes may remain.
Is There One Best Treatment for Acne Scarring?
No single treatment is best for every type of acne scar.
The most appropriate approach depends on scar depth, shape, distribution, skin tone, medical history and individual treatment goals.
A professional assessment can help identify suitable options.
Understanding Your Acne Scarring Is the First Step
Acne scarring can affect people long after their active acne has settled, but understanding the type of scarring is an important first step towards identifying appropriate treatment options.
Whether you’re concerned about shallow textural changes, deeper indentations or a combination of scars and pigmentation, an individual assessment can help clarify what may be achievable.
At Rejuvenation Clinics of Australia, our clinicians take a personalised approach to skin health, considering your skin characteristics, medical history, concerns and treatment goals before recommending suitable options.
Established in 2000, Rejuvenation Clinics of Australia provides skin and cosmetic consultations at its Sydney CBD and Chatswood clinics.
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*Individual treatment suitability, risks, recovery and outcomes vary. A consultation is required to determine whether a particular treatment is appropriate for your circumstances.*
