Much of what people call acne scarring is not scarring at all.
Post-inflammatory hyperpigmentation
Flat brown or dark marks left after a spot heals. The skin texture is normal. This is pigment, not scar tissue, and it fades over months — faster with sun protection, slower without.
Post-inflammatory erythema
Flat red or pink marks, again with normal texture. Also temporary, though it can take many months.
True scarring
A change in the texture of the skin — a pit, a depression or a raised area. This is permanent tissue change and will not resolve on its own.
The test is texture, best judged in angled light rather than straight-on. If the surface is smooth, time and sunscreen are the treatment.
Types of True Scar
- Ice pick — narrow, deep, sharply defined pits; the hardest to treat
- Boxcar — wider depressions with defined edges
- Rolling — broad, shallow undulations caused by tethering beneath the skin
- Hypertrophic and keloid — raised scars, more common on the chest, shoulders and back
Different types respond to different procedures, which is why an assessment matters before choosing a treatment.
What Is Available
Scar treatment is generally considered cosmetic and is rarely funded by the NHS, though severe scarring with significant psychological impact is sometimes an exception worth asking about.
- Microneedling — stimulates collagen; usually a course of sessions; better for rolling and shallow boxcar scars
- Chemical peels — varying depths; the deeper ones have real downtime and real risks
- Laser resurfacing — ablative and non-ablative options; effective but requires an experienced practitioner, and carries higher pigmentation risk in darker skin tones
- Subcision — releases the tethering under rolling scars
- TCA CROSS — a targeted technique for ice pick scars
- Dermal fillers — temporary volume for depressed scars
- Punch excision — surgical removal of individual deep scars
Most people need a combination rather than a single modality, and realistic expectations matter: significant improvement is achievable, complete erasure generally is not.
Choosing a Practitioner
This is an unevenly regulated market. Look for a doctor, dermatologist or appropriately qualified practitioner with specific experience in acne scarring, ask what they would do for your particular scar types and why, and ask about risks — especially pigmentation risk if you have a deeper skin tone. Be sceptical of a package sold before an assessment.
Treat the Acne First
Scar treatment on skin that is still actively breaking out is treating a moving target. Active acne should be controlled first, which sometimes means isotretinoin. Most practitioners will also want a gap after isotretinoin before resurfacing procedures — ask about the interval they use.
The Uncomfortable Truth
No scar treatment matches prevention. Scarring is a direct argument for treating acne properly and early rather than waiting to see whether it settles — and it is one of the reasons guidance treats scarring, or the risk of it, as a trigger to escalate treatment rather than continue as before.
If you have active acne and are already seeing textural change, that is the moment to push for a review, not the moment to wait.