Hey guys, Sandra Lee, M.D. (aka Dr. Pimple Popper), here!

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xo, Sandra

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The 5 Kinds of Acne Scars & How To Treat Each Type

The only thing worse than breaking out? Those deep, dark marks your pimples leave on your skin long after they’re gone. Whether the fallout your skin experiences post-pimple is a deep indent in your skin or a dark spot that’s more obvious than your original breakout, acne scarring and pigmentation is the worst. Trust us, we get it.

Here’s a guide to 5 of the most common kinds of acne scars and how to treat each!

Keloids

When your skin becomes discolored, bumpy and raised, it’s likely scarring into what is commonly called a keloid. These mounds form as a result of the body trying to heal itself post-inflammation, but your body accidentally produces too many cells. To learn more about keloids and why they form, watch me talk to Dr. Sandra Lee (aka Dr. Pimple Popper) all about these stubborn scars.

How do you treat keloids?

The first way to attack a keloid is typically with a shot of cortisone, but this isn’t a guaranteed way to shrink them, unfortunately. Retinol topicals and laser treatments can be used on keloids once they’ve been flattened a bit. Keloids can be surgically removed, but they often just grow right back (frustrating, we know) so treating them topically is typically a better bet.

Icepick Scars

The best way to describe icepick scars are as itty bitty depressions in your skin — they almost look like someone took a tiny needle and punctured your skin. Icepick scars happen because your skin loses collagen, so the overlaying skin collapses and leaves a “hole”. They’re typically narrow yet also deep, and are usually the result of cystic acne — those really deep, incredibly painful pimples you get on your jawline, chin and cheeks thanks to, yep, you guessed it: hormones.

How do you treat icepick acne scars?

A popular way to treat these suckers is with chemical peels, which will cause a “burn” that actually causes the skin to heal itself and therefore closing in on that opening. Chem peels must be done carefully, however, as they can cause some scarring to become worse. Unfortunately, icepick scars can be tricky to treat, but you can target them with the same laser and resurfacing methods as rolling and boxcar scars. Punch incisions can also be used — this is when a dermatologist cuts out the deep scar and resurfaces the area.

Rolling Scars

If your skin looks like it has its own miniature hills and valleys, it’s likely you’ve got rolling acne scars. They can look almost like tiny saucers, and usually give the skin a wavy texture. They tend to be shallower, so if you were to stretch the skin it might be hard to tell that they’re there. Their “shoulders” (the term a dermatologist uses to refer to the edges of something) are typically soft and smooth. Rolling scars are almost always a result of long-term inflammatory acne. Unfortunately, this type of scar can become more obvious and/or severe as you get older, when your skin loses its natural tightness and elasticity.

How do you treat rolling acne scars?

Laser treatments are a common way to target rolling scars, as they resurface the top layers of your skin. Unfortunately it’s not a “one and done” option — laser treatments do take multiple sessions and can require some downtime, but they are a great way to target scar tissue and encourage collagen production. Facial fillersJuvederm, Restylane, and Bellafill, specifically — are FDA approved to correct moderate to severe facial scars from acne, and can be a viable option for some patients.

Boxcar Scars

Courtesy of thehomeopathiccollege.org.

When you have inflammatory acne (red, inflamed, irritated papules and pustules), boxcar scars are an unfortunate common aftermath. They tend to be shallow, but they have sharper edges, unlike the rounder, softer edges of rolling scars. Boxcar scars look almost like someone pushed their fingernail directly into your skin. This depression in your skin holds scar tissue that becomes pulled downward into the rest of the skin.

How do you treat boxcar acne scars?

This type of scar can be treated with subsicion, which involves a dermatologist or PA using a sharp needle underneath the surface of your skin to break up that tough scar tissue. Punch excisions are another option, which means a dermatologist will remove the indented area of the scar and then use a suture to pull the edges of the scar together, closing the gap. Collagen-boosting laser treatments are also used in conjunction with these treatments to encourage the skin to produce collagen and naturally “re-plump” itself. Skincare professionals can also use fillers, such as Bellafill, or fat transfers to fill in boxcar scars.

Hyperpigmentation

Technically, pigmentation isn’t a type of scar, but so many people confuse hyperpigmentation with scarring that we decided to set the record straight. Hyperpigmentation is a fancy words for the dark mark that’s left on your skin when your body has produced too much melanin — that chemical that gives your skin pigment. (Melanin is the same chemical that’s produced when you tan!) As an aftermath of inflammation, many people will see an extra deposit of melanin that’s left behind on the surface layers of their skin.

How do you treat hyperpigmentation?

For some people, their dark marks will disappear, but for other people the fail to fade, and this can be frustrating to be continually covering with makeup and concealer. Luckily, there are dozens of ingredients that target dark spots — from vitamin C and kojic acid to retinol and hydroquinone. Here’s a breakdown of 13 great ways to treat dark spots, and here’s a list of 22 editor-approved lightening and brightening solutions!

3 Comments
  1. Hi. My name is Helena Bandera. I live in Colombia (South America). I am 63 years old. I have acne scars equal to those in the photo. What do you recommend me?

  2. I got fraxel for the first time and I feel like it’s not done by what it should to my scaring . Plus it didn’t really hurt so I’m thinking maybe the machine is. Not a very good one ??

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