Acne Scarring

Acne scars are not simply “marks”. They are structural changes in the skin caused by an inflammatory wound-healing response.

When an inflamed spot ruptures beneath the surface, it damages collagen and elastin—the fibres responsible for strength and smoothness. The skin then attempts rapid repair:

• Too little collagen → indented (atrophic) scars
• Too much collagen → raised (hypertrophic or keloid) scars

True scars differ from post-acne pigmentation (brown marks) or erythema (red marks), which fade with time or basic treatments.

There are three main types of acne scars.

1. Atrophic (Indented) Scars

The most common category:

• Ice-pick scars: narrow, deep pits extending into the dermis
• Boxcar scars: wider depressions with defined edges
• Rolling scars: soft-edged dips creating an uneven, wavy skin texture

2. Hypertrophic & Keloid Scars

Raised, firm scars caused by excess collagen. More common on the chest, shoulders, and jawline.

3. Post-Inflammatory Pigmentation (PIH) & Post-Inflammatory Erythema (PIE)

Not true scars, but discolouration:

• PIH: brown marks (common in darker skin tones)
• PIE: red or pink marks (common in lighter skin tones)

Acne scarring doesn’t happen at random. Several specific factors increase risk:

1. Inflammation Level

Deep, painful cysts or nodules greatly increase the risk of scarring. The more swollen, red and tender a spot is, the more collagen damage occurs.

2. Genetics

Some people genetically produce less collagen during healing, making indentations more likely.

3. Timing of Acne Treatment

Leaving acne untreated for years increases the likelihood of permanent scars dramatically.

4. Picking or Squeezing

This is one of the leading causes of scarring. Pressure drives inflammation deeper into the skin, rupturing tissue.

5. Skin Tone

Darker skin types (Fitzpatrick IV–VI) are more prone to PIH; lighter skin types (I–III) are more prone to PIE.

6. Skin Healing Quality

Factors like sleep, hydration, nutrition, and stress strongly influence how well your skin repairs itself.

Here is an expanded, detailed, clinically realistic prevention roadmap.

1. Treat Acne Early & Properly

Don’t wait for acne to get “bad enough.”
Early intervention dramatically reduces scar risk.

Evidence-backed topical ingredients:

• Retinoids (tretinoin, adapalene) — regulate cell turnover, fade marks, reduce inflammation
• Benzoyl peroxide — kills acne-causing bacteria
• Salicylic acid — deeply unclogs pores
• Azelaic acid — reduces redness and pigmentation
• Niacinamide — calms inflammation and supports the skin barrier

Consistent use is more important than high strengths.

2. Absolutely Avoid Picking and Squeezing

Even one session of picking can cause an ice-pick scar.
A good rule:
If you wouldn’t poke at a wound on your body, don’t poke at a spot on your face.

If you must extract:

• Steam your face
• Use sterile tools
• Disinfect before and after
• Only extract fully matured whiteheads

A professional extraction is always safer.

3. Protect Your Skin from Sunlight

UV radiation:

• worsens pigmentation
• slows collagen repair
• makes scars appear deeper

Daily SPF is essential—rain or shine.

4. Support Skin Repair from Within

Nutrients that specifically support wound healing:

• Zinc (repair, reduces acne inflammation)
• Vitamin A (skin regeneration)
• Vitamin C (collagen synthesis)
• Protein and collagen peptides (amino acids needed for healing)
• Omega-3s (reduce inflammation)

5. Strengthen Your Skin Barrier

A damaged barrier increases inflammation and slows healing.
Support it with:

• ceramides
• cholesterol
• fatty acids
• hyaluronic acid

A strong barrier = better scar prevention.

6. Manage Hormonal Triggers Early

Hormonal acne scars deeply because the inflammation is severe.
If you notice monthly flares, seek hormonal support early.

These are supportive—not replacements for clinical treatments—but they genuinely help inflammation, PIH, redness, and early healing.

1. Green Tea & Aloe Overnight Gel

• Brew strong green tea, cool it, and mix with pure aloe vera.
• Apply as an overnight mask.

Benefits: anti-inflammatory, reduces redness, encourages repair.

2. Raw Honey Spot Mask

Apply raw (not processed) honey directly to healing blemishes or fresh scars.

Benefits: antibacterial, speeds healing, softens early scars.

3. Turmeric & Greek Yoghurt Brightening Paste

Mix:

• ½ tsp turmeric
• 1 tbsp plain yoghurt
• few drops honey

Apply for 10–15 minutes.

Benefits: reduces PIH and PIE, brightens tone, calms inflammation.

4. Sugar-Free Baking Soda Exfoliant (VERY Gentle Use Only)

Not for sensitive skin or deep scars.
Mix baking soda and water into a paste, use once per week maximum.

Benefits: exfoliates superficial marks.

5. Rosehip Oil Massage

Rosehip oil contains natural vitamin A precursors.

Massage nightly for 2–3 minutes.

Benefits: improves texture, softness, early shallow scars.

6. Vitamin C “Slugging”

Apply vitamin C serum, then layer a thin occlusive (like a balm) overnight.

Benefits: enhanced penetration, significant brightening for PIH.

1. Chemical Skin Peels

Chemical skin peels exfoliate damaged skin layers and stimulate collagen renewal.

Why They Work
Peels create controlled injury that triggers regeneration. Stronger peels, such as TCA, can reach the deeper layers where early atrophic scars develop.

Best Peels for Mild Scarring

• Salicylic acid 20–30%
• Glycolic acid 35–70%
• Jessner’s solution
• Light–medium TCA
• TCA CROSS (for isolated small ice-pick scars)

Results

• Smoother texture
• Lightened pigmentation
• Softening of early superficial scars
• Best results after a course

2. Microneedling

One of the most effective treatments for mild acne scarring and superficial texture concerns.

How It Works
Microneedling creates microchannels that:

• break down early scar tissue
• stimulate fresh collagen
• thicken the dermis
• improve texture from within

Best For

• Rolling scars (mild)
• Superficial boxcar scars
• General uneven texture
• Enlarged pores
• PIH
• PIE

Schedule
A course of 3–6 sessions, spaced 4–6 weeks apart.

3. Microneedling + Polynucleotides (PN)

Combining PN with microneedling amplifies collagen induction and healing.

Why This Combo Works
Microneedling opens channels while polynucleotides deliver:

• cellular repair molecules
• hydration
• anti-inflammatory benefits
• collagen signalling

This accelerates healing and improves scars more effectively than microneedling alone.

4. Medical-Grade Skincare

This is essential — clinical treatments only reach 60–70% of their potential without medical-grade support.

Core Ingredients

• Retinoids (tretinoin, retinaldehyde)
• Azelaic acid
• Arbutin or tranexamic acid (PIH)
• Vitamin C
• Peptides
• Niacinamide

Recommended Brands

• Obagi Medical – gold standard for retinoids and pigment correction
• SkinCeuticals – particularly P-Tiox for anti-inflammatory and antioxidant support

Why It Matters
Daily medical-grade skincare continues collagen rebuilding in the weeks and months between treatments.

1. Subcision

One of the most powerful treatments for depressed, tethered scars.

How It Works
A fine needle releases the fibrous bands pulling scars downward.
This allows the skin to lift naturally and encourages new collagen formation.

Best For

• Deep rolling scars
• Scars that worsen when smiling
• Tethered scars that feel “stuck down”

2. Punch Excision & Punch Elevation

A. Punch Excision

Removes the entire scar using a tiny circular tool; the area is then closed with a micro-suture or surgical adhesive.

Best for:

• Ice-pick scars
• Deep, narrow boxcar scars

B. Punch Elevation

Lifts the base of the scar to the height of surrounding skin.

Best for:

• Boxcar scars with flat bases but defined edges

These techniques replace the scar with a smoother, better-aligned surface.

3. Fractional Laser Resurfacing (CO₂, Er:YAG)

CO₂ and Er:YAG fractional lasers are considered the most effective resurfacing technology for moderate-to-severe acne scarring.

How It Works
Micro-columns of controlled heat vaporise damaged scar tissue while stimulating robust collagen remodelling.

Benefits

• Dramatic texture improvement
• Tightens and smooths scarring
• Long-term collagen renewal

Considerations

• 3–10 days of downtime
• Exceptional results for atrophic scarring
• CO₂ laser must be used cautiously on darker skin tones

4. Dr Hass Clinic Special Acne Scar Protocol

Used for moderate–severe scarring and ideal for patients wanting fast, transformative results in fewer sessions.

This advanced protocol combines four synergistic treatments in 1–2 sessions:

1. Endolift®

Minimally invasive laser fibre that:

• contracts deep tissue
• stimulates collagen production
• improves the “base” of scars

2. Subcision

Releases tethered scars to lift the indentations.

3. Polynucleotides (PN)

Flood the skin with repair molecules that accelerate deep collagen regeneration.

4. Microneedling

Smooths texture and blends the skin surface.

Why It’s Effective
This combined approach treats scars at every level:

• deep (Endolift + subcision)
• mid-dermal (PN)
• surface (microneedling)

Often, patients see dramatic improvement with far fewer sessions than standard isolated treatments.

• Acne scarring is treatable. Most people can achieve significant improvement with the right combination of treatments.
• Different scars need different approaches. Rolling, boxcar, ice pick, and hypertrophic scars respond best to targeted techniques rather than a one size fits all solution.
• Consistency matters. Sun protection, medical grade skincare, and inflammation control will always enhance treatment results.
• Combination therapy gives the best outcome. Chemical peels, microneedling, polynucleotides, skin boosters, and targeted procedures like subcision or punch excision work better together than alone.
• Professional assessment is essential. An experienced clinician can map out your specific scar patterns and guide you toward the most effective plan.

Acne scars can affect both appearance and confidence, but modern dermatology offers more effective solutions than ever before.

With a thoughtful treatment approach, it is possible to smooth texture, improve tone, and rebuild healthy collagen. Non surgical treatments such as chemical peels, microneedling, polynucleotides, skin boosters, and medical grade skincare are ideal for mild to moderate scarring. For deeper or more tethered scars, targeted treatments like subcision, punch excision, and fractional laser resurfacing can achieve transformative improvement.

At Dr Hass Clinic, we create personalised plans that match your scar type, skin condition, and goals. Our approach is centred on safety, precision, and natural looking results. If you are ready to treat acne scarring with expert guidance, our team is here to help you achieve smoother, clearer, and more confident skin.