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  • Writer's pictureAli Rislan

Acne Scarring: What, Why, How?

Updated: Nov 28, 2023

Acne scarring is one of the most irritating skin problems you can have. You deal with relentless cycles of breakouts, try countless acne treatment products, and do your best not to touch or squeeze spots. Your efforts help you to manage and reduce your acne's visibility, and eventually, you stop having breakouts.

Time for celebration, you're acne-free! But it has left you with a new challenge - acne scarring.


Continue reading to discover more about acne scarring, its causes, and ways to prevent and treat it. You'll learn some seriously helpful information if:

  • You have acne scarring

  • You currently have active acne.

  • You just find the topic interesting!

What is Acne Scarring?

Acne scarring is the end result of damage to your skin because of breakouts. This is a similar process to scars such as from cuts, but you might notice that acne scars look unique.


Acne scars often appear as deep grooves and dips in the skin, different to a raised scar you might have from a cut or a burn. This is largely because the skin damage that causes acne scarring is a little different. We'll come back to this in the next section!


The types of scars you may get aren't always the same either. The 4 types of acne scarring are:


Ice-Pick Scars

Acne Scarring | A photo of ice-pick acne scars on a woman's cheek

These kinds of scars have fitting names and resemble narrow and sharp indent in the skin. Ice-pick scars genuinely look as if a tiny ice-pick has penetrated the skin and left a scar.


These commonly appear towards the top of your face, the upper cheeks and forehead. They can be quite deep in the skin, and so are difficult to treat.


Boxcar Scars

Acne Scarring | A photo of boxcar acne scars on a man's cheek

These scars more closely resemble craters, with sharp edges. They are quite deep but not as sharp as ice-pick scars.


These more commonly occur on the lower half of the face, on the cheeks and towards the jaw.



Rolling Scars

Acne Scarring | A photo of a woman with rolling acne scars on her cheek

Rolling scars also appear in similar areas to boxcar scars, the cheeks and jaw. Rolling scars get their name from their appearance, as they seem to roll into one another, resembling waves


Rolling scars can sometimes have a larger surface area than the acne that caused them. This all depends on the way your body heals.

Acne Scarring | A photo of a hypertrophic acne scar on the forehead.

Hypertrophic and Keloid Scars

These are the types of scars that leave a raised scar on the surface of your skin, rather than a groove or dip.


This can be a small bump where breakouts have healed or a large raised scar that extends outwards called a keloid scar. You'll most commonly find hypertrophic and keloid scars on the back, chest, and shoulders.


As you now know, not all acne scarring is equal. Different types of scars have different developments, and this is true for acne scarring. So why do we get these scars, and what determines the type of scar? Let's learn about this in the next section.


Why Do We Get Acne Scarring?

So you know about the types of acne scarring, but it might make you even more curious about why they develop. Why are there different types of acne scars, and what's going on in the healing process that causes them?


To understand this, we should first look at the acne development and healing process:

Acne Scarring | An illustration of the acne development process.
  • Your pores trap sebum, dead skin cells, and dirt.

  • This becomes a breeding ground for acne-causing bacteria, p. acnes.

  • Levels of the p. acnes bacteria exceed normal levels and induce an immune response, and the area becomes inflamed. The spot begins to form.

  • The pus development causes erosion of the surrounding skin tissue.

  • Eventually, the spot will pop; either naturally or by actively popping it.

  • The skin now begins to heal by producing lost collagen and repairing damage.

This is what happens in an ideal acne recovery process, but what happens to cause scarring?


Several factors can increase the risk of scarring at various stages in the acne development and healing process. Some factors can be the type of acne, and how you manage it. But, your body's healing process is responsible for some of the scarring risk!


The Type of Acne

The type of acne plays a massive role in the scarring risk. This is relevant to stages 2-4 in the cycle you learned about earlier.

Acne Scarring | A side profile photo of a woman with severe acne on the jaw area.

Severe acne is much more likely to scar. Blackheads and whiteheads won't commonly scar, but there's a high scarring risk with:

  • Pustules

  • Papules

  • Nodules

  • Cysts

Consider active treatments and preventative measures if you have more severe types of acne, which you'll learn more about later on. You'll not only control and minimise its appearance but also prevent future scarring.


Your Body's Immune Response

Some people have a much more aggressive immune response than others. This is a normal variation from person to person, but it can impact the chance of scarring.


A more powerful immune response results in more inflammation and damage in the area. This makes it harder for your body to repair the damage after the acne has subsided. A scar is then more likely to form, as you may imagine.


Your Body's Healing Process

Your body is exceptionally good at repairing damage, such as cuts, burns, and even acne damage. We would all have a very tough time navigating the world if it wasn't. But, in most cases, it can't repair damaged skin to as good as new.


Your body will most commonly either over-repair damage or under-repair damage. This can result in specific types of scars, which you learned about earlier.


Over-Repair

Your body's repair process can cause hypertrophic scars when it produces a little too much collagen during healing. This is not uncommon with acne, though most of these scars will be pits in the skin.

Acne Scarring | A photo of keloid acne scarring on the back of the shoulder

Hypertrophic scars will appear as slightly raised bumps and may have a pink to red colour.


Keloid scars occur when the body produces a large excess of collagen. These scars often grow outside the original skin damage and may extend far out of your skin. They'll often have a red to purple colour but may be dark brown depending on your skin tone.

Keloid scars also often have a significant delay before they develop, and may not appear until years after healing. Fortunately, these types of scars rarely occur from acne for most people, and develop from deeper skin damage. Keloid scars are most likely to develop from severe inflamed cystic acne.


Under-Repair

Most types of acne scarring are because of under-repair. The body cannot produce enough collagen to fully restore the skin, leaving you with pitted scars.

This includes the scars you learned about earlier; ice-pick scars, boxcar scars, and rolling scars.


Touching and Squeezing Acne

You'll have heard this a thousand times before, but just for good measure:


Touching and/or squeezing your acne can significantly increase your risk of developing scarring.


This is for a few different reasons, some direct and some indirect. Touching or squeezing your breakouts can increase scarring risk because:

  • You risk spreading the bacteria to other areas of your face when touching or popping acne. This can cause severe breakouts in those areas. Logically, a more severe breakout give more chances to develop scarring.

  • Picking or squeezing spots yourself can cause more damage to the skin than letting it pop naturally. The skin is more likely to scar visibly if the extent of the damage is greater. Having them extracted by a professional can greatly reduce scarring risk, however. This is because a professional will extract breakouts at the right time and in a clean and sterile environment.

  • Touching your skin can introduce more bacteria where you touch it. This increases the chance of acne developing!

Knowing what acne scarring is, the types of scarring, and why you develop them is great. But, how can we make this information useful to us?

Here's the part you may have been waiting for, how to prevent and treat acne scarring.


How to Prevent Acne Scarring

Preventing scarring is always the first port of call, so we'll start with that. Oftentimes it's easier to prevent something going wrong instead of dealing with the fallout afterwards. Prevention is the most effective treatment as they say after all, so how can you stop acne scarring?

Acne Scarring | A before and after of the results of an acne management treatment programme.

Aside from not touching and squeezing your spots, there are other ways to prevent acne scarring. Most of them actually revolve around treatment for acne, to prevent it or reduce inflammation.

This can be:

  • Using products tailored to your skin, rather than over-the-counter products.

  • Being careful to wash your face with a suitable cleanser, and not over-wash. Overwashing can actually cause further breakouts by stripping your skin of oil. This causes your oil glands to overproduce even more sebum, further clogging your pores.

  • Having treatments to control your acne and reduce breakouts.

  • Watching out for day-to-day triggers of acne, such as certain foods or friction from clothing.

You can learn more about preventing breakouts and calming active acne here in our Acne: What, Why, How blog post.


How to Treat Acne Scarring

Don't worry if you do have acne scarring, you aren't necessarily stuck with it forever. Your scarring may fade slightly over the long term, but there are also some active steps you can take.


Plenty of treatment options effectively treat acne scarring. You can choose suitable acne scarring treatments depending on the type of acne and your skin type. Just keep in mind that this is a journey, and your scars won't disappear after just one treatment. You'll need a course of treatment to fully get rid of this scarring.


Peels

Peels are excellent for treating acne scarring as they speed up skin renewal. This essentially encourages removing the top layers of your skin. Think of it as levelling out an uneven surface by shedding enough layers to pass the bottom of the acne scars. Peels are some of the most popular options for people with acne or scarring.

Acne Scarring | A before and after of an acne scarring treatment programme.

You have a choice between chemical and herbal peels here, depending on your skin. The Green Peel is an excellent herbal peel here, and PRX T-33 is a great chemical peel option.


Microneedling

You've probably already heard of microneedling, with how popular it is. Commonly recognised for tightening and lifting skin, it's also great at treating acne scars.


The idea is to speed up skin renewal while heavily increasing collagen production. Your scars will better heal with increased collagen production, and they will become more shallow with increased skin renewal.


Laser Resurfacing

Laser resurfacing works in a similar way to microneedling, but it's a more powerful treatment. That doesn't mean one session will be enough, though you may only need a few sessions in total.


As the saying goes though, with greater power comes greater responsibility. This treatment isn't suitable for all skin types, so have a professional analyze your skin first.


Scar Revision & PRFM

Reserved for deeper and more severe scarring, scar revision is a powerful treatment. Peels or lasers cannot remove all scars, especially if they are incredibly deep. In this case, you can opt to raise the scar closer to the surface, which is the idea behind scar revision.


You can then follow up with PRFM injected under the scars in the revised area. This fills the space created with scar revision to even out the skin's surface and reduces the scars' appearance.


PlexR Technology

Specifically for dealing with hypertrophic scars, PlexR is an incredibly powerful technology. Your raised scar is burned away under anaesthetic, and your skin will heal even and clear.


What is acne scarring, why do you have it, and how can you treat it? Can you answer these questions after reading this article?

You should have all the information you need about acne scarring now, but it's certainly a complex topic. You may still have a question specific to yourself that we haven't covered, or feel we missed something important! Click the button below and fill out the form, or leave us a comment below, if you have any questions or suggestions.


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