Types of acne scars on face

Depressed types of acne scars on face

A depressed (atrophic) scar forms when the skin makes too little collagen to fill the spot where the acne was. The American Academy of Dermatology says most people who get acne scars have this kind, and often more than one type of it.

• Ice pick: small at the surface but deep. The AAD calls it the most common acne scar, and DermNet describes it as narrow, deeper than it is wide and V-shaped.
• Boxcar: a round or oval dip with distinct edges, wider than an ice pick scar but not as wide as a rolling scar.
• Rolling: wide and shallow with a sloping edge. Many rolling scars together give the skin a wavy look, and DermNet notes that the edge can be smoothed out if you stretch the skin.

Raised types of acne scars on face and jawline

A raised scar forms when the skin makes too much collagen while it heals. The AAD notes that raised acne scars are more common in people with darker skin tones.

• Hypertrophic scar: firm, about the same size as the spot that caused it, and usually on the jawline, chest or back. It tends to appear 1 to 2 months after the breakout clears.
• Keloid: grows larger than the original breakout. The first sign is thickening skin, usually 3 to 12 months after the acne clears. If you notice it, the AAD says a pressure garment can prevent a keloid or reduce its size.
• Papular scar: skin-colored or lighter bumps, usually on the nose, chin, jawline or back, that are easy to mistake for acne.

Flat marks that are not scars

A flat spot of color where a pimple used to be is usually post-inflammatory hyperpigmentation (PIH), not a scar. On lighter skin it is often red or pink; on medium and darker skin it is often brown and can be bluish gray. Some people get flat white spots instead (hypopigmentation). The AAD says these marks usually fade with time and leave no trace, though fading can be slow. If the dip or bump is still there once the color has gone, that part is a scar.

How to tell which type you have

Look in side light, such as a window to one side of a mirror, because shadows make dips easier to see. Many faces have a mix, so a dermatologist will usually name each type before planning treatment.

Which treatment fits which scar

The AAD says ice pick scars need different treatment than rolling scars, and DermNet explains why. Resurfacing, such as a laser, a peel or microneedling, works best on shallower scars, which makes it a fit for many boxcar scars. Deep, narrow scars like ice picks may need a small excision such as a punch technique. Rolling scars are pulled down by a fibrous band under the skin, so subcision, which cuts that band, lets the skin lift back up. Fillers add volume under depressed scars, and most give temporary results that last from 3 months to 2 years. Raised scars need the opposite approach: corticosteroid injections, laser, silicone gel sheets or freezing.

If you would rather pick by what matters most to you, such as downtime or the number of visits, see the best acne scar treatment sorted by priority.

Why most plans combine two treatments

Because most people have more than one of the types of acne scars on face, a dermatologist often combines methods. The AAD gives the example of acne surgery to lift sunken scars followed by a filler, and a mild peel may take 3 to 5 sessions given every 2 to 4 weeks. Results build slowly as new collagen forms. For the order dermatologists usually follow, read about the best treatment for acne scars.

Clear the active acne first

Scar treatment typically begins once acne is under control and you are using acne medicine to prevent new breakouts, the AAD says. Deep breakouts such as cysts and nodules scar most often, and picking or scratching raises the risk. Tell your dermatologist about every acne treatment you have used in the last two years, because some scar treatments can cause side effects when started during or soon after certain acne medicines.

What at-home products can and can't do

For mild scarring, the AAD names a retinoid or salicylic acid as products that can make scars less noticeable. They cannot rebuild the collagen under a deep pit, so ice pick, boxcar and rolling scars need an in-office procedure to change their shape. The AAD also notes that acne scars can fade but rarely go away completely on their own.

Darker skin needs a careful plan

In brown and Black skin, some peels, lasers and freezing treatments can leave lasting dark or light spots. The AAD advises seeing a dermatologist before any chemical peel, microdermabrasion or laser and asking how many people with skin of color the doctor has treated. Radiofrequency and radiofrequency microneedling are safe for all skin tones, according to the AAD.

Questions to ask at the consultation

• Which of the types of acne scars on face do I have, and which treatment fits each one?
• How many sessions will I likely need, and how far apart?
• How much downtime should I plan for after each session?
• What are the risks for my skin tone, including dark or light patches?
• Is my active acne under control enough to start?

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