With a whopping 40 to 55 percent of today's adult population suffering from persistent breakouts, acne is a more common daily annoyance for grown-ups than you'd think...which seems so cosmically unfair. There should be a rule that we only have to deal with pimples or fine lines, dammit.
The good news is that there are much, much better face wash options, medications, and topicals available today than back in your high-school days. The only downside is that even if you are able to clear up breakouts, you might be left with acne scars that permanently reside on your face. (Double ugh.)
"Acne scars are very challenging to treat and are even more challenging to treat once they've been given time to age," says Joel Schlessinger, M.D., a board-certified dermatologist in Omaha, Nebraska. Although he says the best option is prevention (but if you just can't resist popping your pimples, do it the doctor-approved way!), there are ways to treat acne scars to drastically reduce their appearance.
Here's why you're noticing scars on your pretty face in the first place—and what dermatologists recommend to get rid of them.
Why do acne scars form in the first place?
Even if you have amazing willpower—like the willpower of a Girl Scout with a full inventory of Thin Mints under her bed—and never, ever mess with your acne, you can still scar. "Acne scars result from damage to the skin following repeated inflammation from acne cysts," says Judith Hellman, M.D., a board-certified dermatologist in New York City. "Pimple popping can make the process worse, but acne can cause scarring even without pimple popping."
How big of a scar you'll be left with after a blemish (if any at all) depends on the depth of the breakout, Schlessinger says. "As our pores become engorged with oil and form a blemish, the pore may swell and collapse the follicle wall," he says. "The depth of the resulting lesion determines the severity of the scar. Shallow lesions usually heal quickly and leave little-to-no scarring, while deeper lesions spread to nearby tissue, causing a more pronounced scar."
If you see scars form, Hellman says they are likely one of these four types:
- Ice-pick scars: deep, narrow, pitted scars
- Rolling scars: broad depressions with a sloping edge
- Boxcar scars: broad depressions with sharply defined edges
- Atrophic scars: flat, thin scars or depressed scars
There's an over-the-counter option... right?
You can apply all the topicals you want, but unfortunately, most treatments you'll find at the drugstore won't help with acne scars, Hellman says. However, she notes that derma rollers (at-home microneedling devices) may help with acne scarring. If you're on a tight budget, that should be your first stop. You can get one on Amazon for less than $20. (Use yours once a week followed by a Vitamin C serum for best results—here's how to pick the best ones.)
"Derma rollers can help produce new collagen in the skin and may help soften the scars," Hellman says. "Beyond that, professional treatments are needed to deliver an improvement."
Get your derm's help.
If a derma roller isn't effective at getting rid of your scarring, your next trip is to your dermatologist's office.
Your doctor might recommend an injectable treatment called a filler. "Mainly, I treat acne scars with hyaluronic acid fillers, such as Restylane, but not all acne scars respond to this sort of treatment," Schlessinger says. "Additionally, I personally find that Accutane has a remarkable effect on acne scars if it is prescribed early on in the course of a scarring acne."
But keep in mind, Accutane can cause some potentially nasty side effects and isn't for everyone. Hellman says that's why she prefers treatments like fillers and lasers. What treatment you'll need depends on the type of scar you have.
"Depressed scars can sometimes be filled with hyaluronic acid fillers, which last about a year," she says. "But the more definitive treatment for scarring is with a laser. For red acne scars (and active acne), I use the Pulse Dye Laser, which takes away the redness and inflammation. It also works for the raised scars."
For depressed scars, she also uses a device called Fractora, which she describes as radiofrequency (RF) microneedling. She says it can help with collagen production and gives her patients the best results she's seen.
"The improvement is so impressive, it's sufficient to change the self-image and confidence of the patient," she says. "These treatments are life-changing. Fractora is also unique in that it works for even the darkest skin types, since RF doesn't affect the pigment in the skin."
Nazanin Saedi, M.D., also uses the Fraxel—which sounds like a Dr. Seuss character but is, in fact, a non-ablative fractional resurfacing laser—at Jefferson Laser Surgery and Cosmetic Center in Philadelphia. "So many dermatologists use this as their first line of defense to encourage collagen rebuilding on shallow acne scars," she says.
Saedi also says that ice pick scars can be treated by deep peels and a special technique called the CROSS technique, which uses trichloroacetic acid (or TCA) to encourage collagen production. It's a fairly inexpensive procedure and can take as little as a few seconds, depending on the number of scars needing treatment.
Speaking of money—what's this gonna cost?
Treatments like radiofrequency microneedling, lasers, and fillers can be effective to treat acne scars, but they can run you hundreds of dollars per treatment. And Hellman says you'll need six to eight treatments and a good amount of time before seeing results. "The process takes a good part of a year," she says. (Her office does offer some package options to help offset some of the cost.)
Schlessinger recommends seeing your dermatologist as soon as your skin starts breaking out. He says medication and topical acne treatments are less pricey than expensive treatments for scars. So, tempting as it may be, your driving desire to pop a pimple is never going to be worth the cost of treating a scar later on.