Thursday, 12 September 2019 23:56

Acne Scarring: 4 Therapies for Improvement

Written by   Tom Qiao

Did you know that acne scars are a huge problem for many clients? The scars that acne leaves behind can have lasting social and psychological effects, stretching beyond the teenage years into adulthood.


In a recent study of 1,972 acne patients, over 40% suffered some degree of scarring, with the highest risk factors being acne severity and delayed treatment.1


Moreover, most patients are unaware of existing scar treatment options, many of which are affordable and can be offered at spas.


Today, we’ll discuss four effective scar therapies: chemical peels, microdermabrasion, microneedling, and laser resurfacing.



Acne scars are quite common following moderate to severe cases of acne. This is because chronic inflammation has severely damaged the hair follicle and surrounding skin tissue, including critical components such as collagen.2


Unfortunately, the most severe and painful types of acne – cysts, nodules, and papules – tend to result in the worst scars due to widespread inflammation and skin damage.


That’s why it is critical to help clients get their active acne under control as soon as possible to prevent future acne scars.



Atrophic Scars: Also called pitted or indented scars, atrophic scars are characterized by a noticeable loss of collagen in the skin:

  • Ice Pick Scars: narrow and deep puncture marks
  • Boxcar Scars: indentations with defined borders
  • Rolling Scars: depressions with no defined borders


Effective treatments for atrophic scars include chemical peels, microdermabrasion, microneedling, and laser resurfacing.


Raised Scars: These types of scars are elevated, bumpy, discolored (red to purple), and may feel itchy:

  • Hypertrophic Scars: thick, fibrous bands of scar tissue that do not grow larger
  • Keloids: lumpy, shiny knots of fibrous scar tissue that grow larger over time


According to the International Advisory Panel on Scar Management, the best treatments for raised scars include silicone gels or sheets and corticosteroid injections.3



Acne scars are often accompanied by skin discoloration, including:

  • Hyperpigmentation: brown marks caused by excess melanin production
  • Erythema: red or pink marks caused by damaged capillaries near the skin surface


Chemical peels, laser resurfacing, vitamin C serums, and brightening creams are just some of the many options for hyperpigmentation.


For post-inflammatory erythema, the pulsed dye laser is one of the best procedures, as it specifically targets damaged blood vessels.4



Most clients have heard of chemical peels but may not know that it can help improve acne scars and hyperpigmentation.


Superficial peels like glycolic acid remove layers of damaged skin in the epidermis. This smoothes out skin texture and makes boxcar and rolling scars look less pronounced.


Chemical peels also trigger inflammation and encourage collagen growth to create long-term improvements in scar appearance.


Side effects include redness, itchiness, flakiness, and hyperpigmentation. These are usually temporary and resolve within a week, particularly with superficial peels.


Glycolic acid at a concentration of 30% to 50% has been shown in numerous studies to improve scars, wrinkles, fine lines, and hyperpigmentation.5


For clients with more sensitive skin, lactic and mandelic acid are milder alternatives with minimal side effects.


For those with active acne, 30% salicylic acid is an excellent acne-fighting peel.5


Chemical peels are a simple and affordable option for mild atrophic scars. And, of course, sun protection is a must following treatment.



Microdermabrasion is suitable for mild to moderate atrophic scars.


In this procedure, fine particles of aluminum oxide or salt crystals are blown onto the skin to buff away dead skin cells.


Unlike dermabrasion, microdermabrasion only removes the outer layer of the epidermis – it’s painless, does not require anesthesia, and can be repeated with greater frequency.6


On the other hand, results are less pronounced than dermabrasion and require more sessions. Microdermabrasion is not suitable for deeper scars like ice pick scars.7


In a study of 38 patients (divided into four groups, including one with acne scars), researchers found that microdermabrasion produced mild to moderate improvements in scarring after eight sessions repeated weekly.8 Furthermore, clients with acne scars demonstrated greater collagen density and more regular collagen fiber arrangements in punch biopsy samples.


Microdermabrasion is an effective and painless technique for mild atrophic scars. With frequent use, it can encourage collagen growth and reduce scar severity.



Microneedling is one of the best treatments for indented and pitted scars.


A dermaroller or motorized dermapen is used to create microwounds in the skin. This helps trigger inflammation and restore healthy skin through new collagen growth.


It may take up to 12 months to see the full results of microneedling, as collagen deposition is painstakingly slow. Side effects include mild bruising, bleeding, and soreness.


Microneedling is an excellent alternative for clients with darker skin tones due to the lower risk of hyperpigmentation compared to laser resurfacing.


In a study of 30 patients, five sessions of microneedling resulted in an average improvement of 50% to 75% on a quartile scale in the majority of clients. Twenty-two achieved a good response, while four achieved an excellent response on a visual analog scale.9


Microneedling with platelet-rich plasma (PRP) has also become widely available. This procedure boosts the wound healing process with PRP-rich in natural growth factors – to achieve better aesthetic results.


However, the procedure can cost over $750 per session compared to a few hundred dollars for standard microneedling.


Microneedling is one of the best options for atrophic scars. It’s particularly well-suited for clients with darker skin tones due to the lower risk of hyperpigmentation.



An ever-popular option, laser resurfacing can help with many types of acne scars. Laser resurfacing works by delivering targeted thermal damage to the dermis, removing scarred collagen, and encouraging the growth of healthy skin tissue. Lasers are broadly categorized into ablative lasers and non-ablative lasers.


Traditional Ablative Lasers: Traditional carbon dioxide and Er:YAG lasers can produce significant results after just one session. However, these come with greater discomfort, risk of hyperpigmentation, and potential skin infections (pre-treatment antibiotics are required). In an 18-month study of 60 patients, researchers found that atrophic scars were greatly improved after one session of the 10,600 nanometers carbon dioxide laser. Clinical improvement scores were 69% at one month and 75% at 18 months, along with persistent collagen formation.10


Fractional Ablative Lasers: Fractional lasers split the laser beam into microthermal zones, which allows the epidermis to remain intact and accelerate the recovery process. These lasers have milder side effects than traditional ablative lasers, but with reduced overall effectiveness. In a study of 13 patients, two to three sessions of fractional carbon dioxide laser every one to two months yielded an average improvement of 66% based on 3D imaging analysis. Side effects were mild to moderate and included temporary erythema.11


Non-Ablative Fractional Lasers: Non-ablative lasers are milder versions of their ablative cousins with fewer side effects but require more sessions to achieve similar results. These types of lasers are suitable for clients with darker skin tones due to the lower risk of dyspigmentation. In a study of 53 clients (skin types I to V) with atrophic scars, monthly treatment with the erbium-doped laser produced scar improvements in the 51st to75th quartile in almost 90% of clients after three months. Side effects were mild, including erythema and skin dryness, and no discoloration or scarring was reported.12


Pulsed Dye Laser: For clients with post-inflammatory erythema, the pulse dyed laser is an excellent option. Pulsed dye laser selectively targets oxyhemoglobin in blood vessels, removing damaged capillaries near the skin surface that are responsible for post-acne red marks. In a study of 22 patients, one or two treatments with pulsed dye laser helped reduce erythema and scarring by 68% after six weeks compared to untreated skin. Side effects include blistering and purpura (purple-colored blood spots).13


Unlike diamonds, scars don’t need to be forever. With so many effective scar treatments, there are plenty of options for clients to choose from. Finally, remember to manage client expectations, as scar improvements don’t happen overnight. It can take months or even years to achieve the desired results.



1 Tan, J., S. Kang, and J. Leyden. “Prevalence and Risk Factors of Acne Scarring Among Patients Consulting Dermatologists in the USA.” Journal of Drugs in Dermatology 16, no. 2 (2017): 97-102.

2 Gauglitz, Gerd G., Hans C. Korting, Tatiana Pavicic, Thomas Ruzicka, and Marc G. Jeschke. “Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies.” Molecular Medicine 17, no. 1-2 (2011): 113-125.

3 Gold, M.H., M. McGuire, T.A. Mustoe, A. Pusic, M. Sachdev, J. Waibel, C. Murcia. “Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatment.” Dermatologic Surgery 40, no. 8 (2014): 825-31.

4 Connolly, Deirdre, Ha Linh Vu, Kavita Mariwalla, and Nazanin Saedi. “Acne Scarring—Pathogenesis, Evaluation, and Treatment Options.” Journal of Clinical and Aesthetic Dermatology 10, no. 9 (2017): 12-23.

5 Soleymani, Teo, Julien Lanoue, and Zakia Rahman. “A Practical Approac to Chemical Peels.” Journal of Clinical and Aesthetic Dermatology 11, no. 8 (2018): 21-28.

6 “Fabbrocini, Gabriella, M.C. Annunziata, V. D’Arco, V. De Vita, G. Lodi, M.C. Mauriello, F. Pastore, and G. Monfrecola. “Acne Scars: Pathogenesis, Classification and Treatment.” Dermatology Research and Practice (2010).

7 Valeska Gozali, Maya and Bingrong Zhou. “Effective Treatments of Atrophic Acne Scars.” Journal of Clinical and Aesthetic Dermatology 8, no. 5 (2015): 33-40.

8 El-Domyati, M., W. Hosam, E. Abdel-Azim, H. Abdel-Wahab, E. Mohamed. “Microdermabrasion: a clinical, histometric, and histopathologic study.” Journal of Cosmetic Dermatology 15, no. 4 (2016): 503-513.

9 Dogra, S., S. Yadav, and R. Sarangal. “Microneedling for acne scars in Asian skin type: an effective low cost treatment modality.” Journal of Cosmetic Dermatology 13, no. 3 (2014): 180-7.

10 Rivera, A.E. “Acne scarring: a review and current treatment modalities.” Journal of the American Academy of Dermatology 59, no. 4 (2008): 659-76.

11 Chapas, A.M., L. Brightman, S. Sukal, E. Hale, D. Daniel, L.J. Bernstein, and R.G. Geronemus. “Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing.” Lasers in Surgery and Medicine 40, no. 6 (2008): 381-6.

12 Alster, T.S., E.L. Tanzi, and M. Lazarus. “The use of fractional laser photothermolysis for the treatment of atrophic scars.” Dermatologic Surgery 33, no. 3 (2007): 295-9.

13 Alster, T.S. and T.O. McMeekin. “Improvement of facial acne scars by the 585 nm flashlamp-pumped pulsed dye laser.” Journal of the American Academy of Dermatology 35, no. 1 (1996): 79-81.


Tom QiaoTom Qiao is the author of, an evidence-based skin care website that solves skin mysteries like acne scars and hyperpigmentation. Previously a financial analyst for a major pension fund, Tom enjoys investigating the latest medical literature to help his readers find clinically proven skin care treatments.

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