Acne Scars: The Ultimate Guide to Types, Treatments and Results
Updated: 1 day ago
Acne scars are lasting changes in the skin's structure. They are left behind when deep or inflamed spots damage the skin and it heals with too little collagen, which leaves a dip, or too much, which leaves a raised scar. They are different from the flat red or brown marks that often follow a breakout, which often fade over months, sometimes longer. Established scars rarely disappear on their own. Several treatments can improve how they look, and the right choice depends on the type and depth of each scar, your skin and whether acne is still active. No treatment removes scars completely, and most people with noticeable scarring benefit from a combination of approaches over time.
At a glance
Scars and marks are different. A scar changes the contour of the skin. A flat red or brown mark is a colour change that usually improves with time, sun protection and gentle skincare.
Most acne scars are depressed. The main patterns are ice-pick, rolling and boxcar scars, and most people have a mix. Raised hypertrophic scars and keloids are less common and are managed differently.
Control acne first. Treating active acne early is the most effective way to limit new scarring. Scar treatment usually starts once breakouts are under control.
Different scars need different approaches. Microneedling, laser resurfacing, subcision, focal chemical treatments, surgery and fillers each work at a different depth or on a different scar shape.
Evidence is real but limited. Many treatments help, but studies are often small and short, and no single option is proven best for everyone.
Doing nothing is a valid choice. Scars are not harmful to health. Treatment is a personal decision, and support is available if scarring is affecting your wellbeing.
Jump to a section
Acne scars or acne marks?
What is an acne scar?
When a spot becomes deeply inflamed, the inflammation can damage the dermis, the supportive layer of skin beneath the surface that contains collagen and elastic fibres. As the skin repairs itself, it lays down new collagen. If too little is produced, or the healing tissue pulls the surface downwards, a depression forms. If too much collagen is laid down, the scar sits above the surrounding skin. [1, 2]
The British Association of Dermatologists notes that the more inflamed a spot becomes, the more likely it is to scar, and that whether someone scars is largely down to their genes. [3] This is why two people with similar acne can heal very differently.
Flat red or brown marks
Many marks left after acne are not scars at all. They are colour changes in skin whose surface is still smooth:
Post-inflammatory hyperpigmentation (PIH) means brown, grey-brown or darker patches. Inflammation prompts pigment cells to produce extra melanin. PIH is more common in medium and darker skin. [2, 4]
Post-inflammatory erythema (PIE) means flat pink, red or purplish marks. They are caused by small blood vessels that have widened during inflammation, and they are more common in lighter skin. [2, 5]
Colour changes often improve with time, although this may take months or longer. [5] Daily sun protection and treating the underlying acne help, and procedures designed for deep scars are not usually the first step for marks alone. [4]
A simple test is how the area behaves in different light. A flat mark looks the same from every angle. A depressed scar casts a shadow, especially under overhead or side lighting, and may look more obvious when you are tired or the light is harsh.
Mixed texture and colour
Colour and contour often appear together. A rolling scar may also be red, or a boxcar scar may sit next to brown marks. It helps to separate the two, because treatment for texture and treatment for colour are usually different, and pigment can be worsened by procedures that are too aggressive for the skin.
Concerns that can be mistaken for scarring
Enlarged pores are visible openings of hair follicles. They are influenced by oil production, genetics, age and sun damage. They can look like small ice-pick scars, but they are a normal part of the skin's structure.
General uneven texture after years of acne may reflect several small, shallow scars combined with dryness, roughness or sun damage.
Raised bumps on the chest, back or jawline may be hypertrophic scars, keloids or something else entirely. Any lump that is growing, changing, bleeding or painful should be checked by a GP.
Descriptions and photographs cannot diagnose your skin. An in-person assessment in good, consistent lighting is the most reliable way to work out which concerns are present.
Types of acne scar and why they matter
Dermatologists commonly describe three main types of depressed (atrophic) acne scar, plus raised scars. [6, 1] The British Association of Dermatologists uses the same terms and notes that most people have a mixture. [3, 1]
Ice-pick scars
Ice-pick scars are narrow, deep scars that are wider at the surface and taper as they go deeper, a little like a small puncture. The American Academy of Dermatology describes them as looking small but going deep into the skin. [1] Because they are narrow and deep, treatments that work across the surface often reach only their upper part.
Rolling scars
Rolling scars are wide, shallow depressions with soft, sloping edges that give the skin an undulating, wavy appearance. [1, 6] They are caused by tethering: bands of fibrous scar tissue beneath the skin that pull the surface down, like a button pulling on a cushion.
Boxcar scars
Boxcar scars are round or oval depressions with sharp, defined edges, like a small crater. [1, 6] They can be shallow or deep. Shallow boxcar scars may respond to resurfacing treatments, while deeper ones may need focal or surgical techniques to address the edge or the base.
Hypertrophic scars and keloids
Raised scars form when the skin produces too much collagen as it heals. [1] A hypertrophic scar stays the same size as the spot that caused it. A keloid grows larger than the original area and may itch or feel tender. [5, 7] Keloids are more common on the jawline, chest and upper back, [5] and in people with darker skin. [1] The NHS notes that keloids cannot be removed completely, that treatment aims to improve their appearance and reduce irritation, and that surgery to remove a keloid is not usually recommended because it is likely to grow back bigger. [7]
Mixed patterns
Most people have more than one scar type, often alongside marks or enlarged pores. [1, 3] A treatment plan therefore usually involves more than one approach, sometimes staged over months.
Scar types compared
Scar type | What it looks like | What sits beneath | Why it matters for treatment |
Ice-pick | Small, narrow, deep openings | A narrow tract extending deep into the dermis | Surface treatments reach only part of the scar; focal techniques are often discussed |
Rolling | Broad, shallow, wavy dips with soft edges | Fibrous bands tethering the surface down | Releasing the tethering is often part of the plan; surface treatments alone may be limited |
Shallow boxcar | Round or oval dips with sharp edges, not deep | Loss of collagen in the upper dermis | Resurfacing treatments may soften the edges |
Deep boxcar | Larger, deeper craters with steep sides | Deeper loss of tissue | Focal, surgical or combined approaches may be needed |
Hypertrophic | Raised, firm, within the original area | Excess collagen | Managed differently from depressed scars, often with flattening treatments |
Keloid | Raised and spreading beyond the original area | Excess collagen that keeps growing | Specialist management; recurrence is common |
Why a scar label does not decide your treatment
Scar names are useful shorthand, but they describe shape, not everything that matters. Depth, how firmly a scar is tethered, how many scars there are, where they are, your skin tone, your healing history and what bothers you most all affect the plan. Two people with "rolling scars" may need quite different approaches.
What causes acne scars, and can they be prevented?
Risk factors
Scarring is common. In one US study of 1,972 people seeing dermatologists for acne, 43% had acne scars. [8] The main risk factors are:
Severity and duration of acne. NICE advises that the risk of scarring increases with the severity and duration of acne. [9]
Deep, inflamed spots. Nodules and cysts, which are large, painful lumps deep in the skin, are more likely to scar. [1]
Delay in effective treatment. The same US study identified the time between acne starting and effective treatment as a key risk factor that can be changed. [8]
Picking, squeezing and scratching. [9, 10]
Genetics and skin type. Family history, skin colour and individual healing all play a part. [3]
Scarring is not a sign that you did something wrong. Many people scar despite good skincare, and some people with only mild acne still develop scars. [8]
Treating acne early
The most effective way to prevent new scars is to bring active acne under control promptly. The NHS advises seeing a GP if you have lots of spots, or if spots are deep, painful or causing scars. [10] NICE recommends that people whose acne is leading to scarring are considered for referral to a dermatology team. [9] Acne treatment may include prescription medicines, which a GP or dermatologist can discuss with you.
Picking and aggressive home treatment
Persistent picking, squeezing or scratching of spots can increase the risk of scarring. [9, 10] Harsh scrubs, strong acids applied too often, at-home needling devices and repeated irritation can also inflame the skin and, in some skin types, leave dark marks that last longer than the original spot.
Do acne scars fade over time?
Flat marks usually improve gradually. Scars behave differently.
NICE explains that, in its committee's experience, skin continues to remodel and heal for up to about a year after acne has cleared, which is why it suggests waiting this long before referring someone for specialist scar treatment. [11] During this time, redness often settles and some scars look softer.
After that, established depressed scars do not usually disappear on their own, and keloids persist. [7]
Older scars can still be treated. Age of the scar matters less than its type, depth and the condition of the surrounding skin.
What skincare can and cannot do
Skincare cannot rebuild the structure of a deep scar. It can:
help control active acne, which prevents new scars;
help flat marks fade, especially with daily broad-spectrum sun protection;
improve overall texture and skin quality, which can make shallow scars slightly less noticeable.
Be cautious of creams or serums sold as scar removers. Products marketed for acne scars may help marks or general texture, but they do not fill depressions or release tethered scars.
Before treatment: assessment and suitability
A proper assessment looks at your skin in person and considers your history, not just the scars themselves.
Active acne
Scar treatment usually begins once acne is under control. [12] Active spots can be irritated or spread by some procedures, new scars may still be forming, and controlling inflammation helps protect the results of treatment. Ongoing acne is managed first, often with a GP or dermatologist.
Skin tone and pigment history
Every skin tone can scar, and every skin tone can be treated, but the risks differ. Medium and darker skin is more prone to darkening after inflammation, and some procedures carry a higher risk of pigment change or, rarely, lightening. Tell the person assessing you if your skin has darkened or lightened after spots, injuries, waxing or previous treatments. This history matters more than any label on a chart.
Healing history, infection and skin conditions
Mention any tendency to raised or spreading scars, slow healing, cold sores, recent infections, eczema, psoriasis, vitiligo or other skin conditions in the area. Some may mean a treatment needs to be adapted, postponed or avoided.
Medicines, including isotretinoin
Tell your clinician about all current and recent medicines, including prescriptions, supplements and skincare. The American Academy of Dermatology suggests telling your dermatologist about all acne treatments used within the last two years. [12]
Isotretinoin is a prescription acne medicine. For many years, people were told to wait 6 to 12 months after finishing it before any procedure. That advice rested on a few small reports from the 1980s. [13] A 2017 systematic review with expert consensus found insufficient evidence to delay superficial chemical peels, minor skin surgery, laser hair removal, or fractional ablative and non-ablative laser treatment. It advised that mechanical dermabrasion and fully ablative laser resurfacing should not be performed during isotretinoin treatment. [13] A separate 2017 consensus from the American Society for Dermatologic Surgery reached similar conclusions. [14] The evidence is limited, so timing is a decision for your treating clinician and prescriber based on the specific procedure. Never stop or change a prescribed medicine to have a cosmetic treatment without advice from your prescriber.
Pregnancy and breastfeeding
Many scar procedures are postponed during pregnancy, partly because skin and pigment behave differently and some products or medicines used alongside them are unsuitable. Ask about each treatment specifically.
When to see a GP or dermatologist
See your GP if:
you still have frequent, deep or painful spots, or acne that is causing scars; [10]
you have raised scars that are growing, itchy or painful;
any mark or lump is new, changing, bleeding or unusual;
scarring or acne is affecting your mood, confidence or daily life.
NICE recommends considering referral to a dermatology team when acne is leading to scarring, or when acne of any severity is causing persistent psychological distress. It also recommends considering referral to mental health services if someone experiences significant psychological distress. [9] You do not need to manage distress about your skin on your own, and support is worth asking for whether or not you choose treatment.
Choosing no treatment
Acne scars do not harm your physical health. Some people decide that their scars do not bother them enough to justify the cost, recovery time and uncertainty of treatment, and that is a perfectly reasonable decision. Skin camouflage make-up is another option. The NHS notes that you can get a GP referral or refer yourself to a skin camouflage service. [15]
Acne scar treatments explained
There is no single best treatment for acne scars. A Cochrane review of 24 trials found a lack of high-quality evidence and concluded that its results did not support the first-line use of any one intervention. [16] Studies since then have added useful information, but many remain small, use different scar-scoring systems and follow people for only a few months. The descriptions below explain what each option does, what it may help, and its main limits and risks.
What Juvenology offers. Of the treatments in this guide, Juvenology offers microneedling, gentle superficial chemical peels and skin consultations. The other procedures are explained for general understanding, so that you can compare options and know when a referral to a dermatologist or other specialist may be appropriate. Juvenology does not offer them.
Microneedling
How it works. Microneedling, also called collagen induction therapy, uses a pen-like device with fine needles to make many tiny, controlled punctures in the skin. The skin responds with a repair process that can lay down new collagen over the following weeks and months. Unlike lasers, microneedling does not use heat and keeps much of the skin's surface intact. [17]
What it may help. Microneedling is most often used for rolling and shallow boxcar scars and for general uneven texture. It is less effective for deep ice-pick scars, which extend below the depth that surface treatments typically reach. [6, 2]
Evidence. In a randomised trial published in JAMA Dermatology, 15 participants completed treatment. Scar scores improved significantly at six months compared with baseline, while the change at three months was not statistically significant. [18] A 2022 meta-analysis of 12 randomised trials (414 participants) found that microneedling improved acne scars, and the authors concluded that microneedling did not cause post-inflammatory hyperpigmentation in the included trials. [19] A broader systematic review found that all patients treated with microneedling achieved some improvement, ranging from 31% to 62% across studies, and its authors called for larger trials. [20] These figures describe study groups, not what any individual can expect.
Recovery. Redness, warmth, tightness and mild swelling are common for a day or two, sometimes longer after deeper treatment. Pinpoint bleeding during treatment and mild flaking afterwards are also common.
Risks. The US Food and Drug Administration (FDA) lists dryness, redness, bruising and bleeding as common effects, and pigment changes and infection as less common. It notes that some side effects can last a long time or be permanent. [21] Microneedling is generally regarded as a favourable option for darker skin because it does not rely on heat or pigment, but darkening of the skin can still occur. One review reported hyperpigmentation in 0% to 17% of patients across studies. [17]
Course. Microneedling is usually given as a series of sessions several weeks apart. The number depends on the scars and how the skin responds.
Radiofrequency (RF) microneedling
How it works. RF microneedling combines fine needles with radiofrequency energy, which heats the deeper layers of skin through the needle tips. It is a separate procedure from conventional microneedling, with different devices, settings and risks. Evidence or recovery advice for one should not be assumed to apply to the other.
What it may help. It is used for rolling and boxcar scars and for overall texture.
Evidence. A 2025 systematic review of 16 studies (481 patients, 6 of them randomised trials) concluded that RF microneedling is likely to be effective on its own for acne scars. Scoring systems varied too much to combine results, follow-up was mostly six months or less, and none of the studies included people with the darkest skin type (Fitzpatrick type VI). [22]
Recovery and risks. Redness lasted up to about a week in some studies, and temporary darkening of the skin was reported. [22] In October 2025, the FDA issued a safety communication about RF microneedling after reports of burns, scarring, fat loss, disfigurement and nerve damage, some needing surgery or other medical treatment. It advised choosing a licensed provider trained in these devices and not using them at home, describing RF microneedling as a medical procedure, not a cosmetic treatment. [23] This is a US communication about US-cleared devices. It does not set UK law, but the risks it describes are relevant to anyone considering the procedure.
Fractional laser resurfacing
How it works. Fractional lasers treat the skin in a grid of tiny columns, leaving untreated skin in between to speed healing.
Ablative fractional lasers, such as carbon dioxide (CO2) and erbium lasers, vaporise columns of tissue. This stimulates significant remodelling and tightening.
Non-ablative fractional lasers heat columns of tissue without removing the surface, so recovery is quicker.
What it may help. Lasers are used for shallow boxcar and rolling scars and for overall texture. NICE lists CO2 laser, alone or after punch elevation, as one option a specialist scarring team may consider for severe, persistent acne scarring. [9]
Evidence. A systematic review of 59 studies of energy-based devices found that ablative lasers achieved the greatest improvement but with significant pain and downtime, while non-ablative fractional lasers were safer but less effective. The authors noted an overall lack of high-quality evidence. [24]
Recovery. Ablative resurfacing usually involves redness, swelling, oozing and crusting, with healing typically taking one to four weeks. [25] Non-ablative treatment usually causes redness and swelling for a few days.
Risks in darker skin. In a small split-face study of 30 people with darker skin, fractional CO2 laser improved scars more than microneedling but caused hyperpigmentation in 30% of patients compared with 6.67% for microneedling. Ice-pick scars responded least to both, and follow-up lasted only two months. [26] Non-ablative fractional lasers can be used in darker skin with careful settings, and a review found that treatment density, meaning how closely the laser columns are packed, affects pigment risk more than energy level. [27] Other risks include infection, prolonged redness, cold sore reactivation, lightening of the skin and, rarely, scarring.
Subcision
How it works. Subcision uses a needle or blunt cannula inserted under the skin to cut or break the fibrous bands that tether a scar down. Releasing the tethering allows the surface to rise, and the small amount of bleeding and healing that follows may add some support beneath the scar.
What it may help. Subcision is best suited to rolling scars that are tethered. It is less effective for ice-pick and boxcar scars. [6, 2]
Evidence. Studies report improvement ranging from 10% to 100%, a range that reflects small studies, different techniques and inconsistent measurement. [20] A 2023 review described subcision as particularly effective for atrophic acne scars and noted that many people benefit more when it is combined with other treatments, although controlled studies of combinations are lacking. [28]
Recovery and risks. Bruising and swelling are common, and bruising is frequent when sharp needles are used. [28] Make-up can be used to cover bruising. [29] Other risks include infection, lumps and, rarely, raised scars. It is performed by doctors and other trained practitioners under local anaesthetic.
TCA CROSS and other focal techniques
How it works. TCA CROSS (chemical reconstruction of skin scars using trichloroacetic acid) involves a trained clinician applying a high-strength acid precisely to the base of individual scars with a fine applicator. This creates a controlled injury that prompts new collagen within the scar, without treating the surrounding skin.
What it may help. A 2026 review concluded that TCA CROSS works best for ice-pick scars, then boxcar scars, and is less useful for rolling scars. [30]
Evidence and risks. The evidence is mainly small studies with inconsistent follow-up. Post-inflammatory hyperpigmentation is the most common complication, with rates in individual studies ranging from about 7% to more than 60%. People with the darkest skin types were barely represented in the studies. [30] In one comparative study, redness and downtime lasted longer than after microneedling. [30] This technique uses a concentrated acid that can burn or scar skin if misused. It is a clinical procedure, not something to attempt at home.
Punch excision, punch elevation and other scar surgery
How it works.
Punch excision removes a scar with a small circular blade, and the skin is stitched closed, leaving a fine line instead of a pit.
Punch elevation cuts around a scar with a flat base and lifts it level with the surrounding skin.
Punch grafting replaces the removed scar with a small plug of skin from elsewhere. [31]
What it may help. These techniques are used for deep ice-pick scars and deep boxcar scars, which surface treatments often cannot reach. [6, 31] Resurfacing is sometimes used afterwards to blend the treated area.
Evidence and risks. The evidence is low level, with no randomised trials identified in one review. [31] Risks include visible fine scars, a slight raise or dip at the site, infection and colour mismatch with grafts. These procedures are carried out by dermatologists or surgeons experienced in scar surgery.
Chemical peels
How they work. Chemical peels apply an acid to remove the outer layers of skin and encourage renewal. Depth varies:
Superficial peels affect the outermost layer and mainly improve tone, brightness, oiliness and fine texture.
Medium-depth peels reach deeper and can soften shallow scarring, but with more recovery and higher risk.
It helps to separate general resurfacing peels, applied across the whole face, from focal techniques such as TCA CROSS, which treat individual scars with a far stronger acid.
What they may help. Superficial peels can help flat marks, general texture and the appearance of very shallow scars. They do not lift deep or tethered scars. A glycolic acid peel is one of the options NICE lists for specialist teams treating severe, persistent scarring. [9]
Evidence. The Cochrane review found low-quality evidence that chemical peeling was associated with a higher risk of hyperpigmentation than skin needling, although scar improvement was comparable at one early time point. [16] Combining peels with microneedling has been reported to work better than either alone in a 2025 meta-analysis, but follow-up in most studies was short. [32]
Recovery and risks. Superficial peels usually cause mild redness, dryness or light flaking for a few days. Risks include irritation, pigment changes, cold sore reactivation and, with deeper peels, scarring. Irritation from a peel can worsen hyperpigmentation in darker skin, so peel choice matters. [4]
Dermal fillers for selected depressed scars
How they work. A filler is injected beneath a depressed scar to raise it level with the surrounding skin. It is generally used for soft, "distensible" scars, meaning scars that flatten when the skin is stretched. [33]
Evidence. In a randomised trial of 147 people, 64% of those treated with a permanent filler made of polymethylmethacrylate (PMMA) microspheres in collagen achieved treatment success at six months, compared with 33% of those injected with saline. The trial was funded by the manufacturer. [34] In the US, this filler was approved for moderate to severe, atrophic, distensible acne scars on the cheeks. [33] Evidence for temporary hyaluronic acid fillers in acne scars is limited to small, short studies. [35]
Limitations and risks. Temporary fillers are gradually broken down, so treatment needs repeating. Permanent fillers cannot be easily removed if a problem occurs. Risks of any filler include bruising, swelling, lumps, infection and, rarely, blocked blood vessels.
Treatments for raised scars
Raised hypertrophic scars and keloids are managed very differently from depressed scars, and they are a common reason for referral to a GP or dermatologist.
Silicone gels and sheets. A Cochrane review found that silicone gel sheeting reduced scar thickness, but the trials were of poor quality and at high risk of bias. [36] They are a low-risk first step that can be used at home with advice.
Steroid injections and creams. The NHS lists steroid injections or cream among treatments for keloid and hypertrophic scars. [7] Injections are given by a doctor or other prescriber and can cause thinning or lightening of the skin. [37]
Other clinician-directed treatments. Cryotherapy (freezing), laser therapy and other injected medicines may be used, sometimes in combination. [7, 38] Surgery to remove a keloid is not usually recommended, because it is likely to grow back bigger. [7]
Keloids are more common on the jawline, chest and upper back. [5] Avoid any procedure on or near a keloid-prone area without specialist advice, because treatments that injure the skin can trigger new keloids.
Treatments for red and brown marks
Brown marks (PIH). Management starts with controlling acne and inflammation, and daily broad-spectrum sunscreen of SPF 30 or higher. [4] Some cosmetic skincare ingredients can help even out tone, and a GP or dermatologist can discuss prescription creams where appropriate. Marks in the upper layer of skin may take months to years to fade without treatment. [4]
Red marks (PIE). Post-acne redness can settle by itself, but in some people it lasts for years. [39] Vascular lasers and intense pulsed light, which target blood vessels, are sometimes used, although trials are small. [39]
Gentle superficial peels and microneedling are sometimes used for marks, but they need care in skin that darkens easily. Juvenology's hyperpigmentation consultation explains its approach to dark marks.
Add-ons: PRP, polynucleotides and exosomes
Some clinics combine microneedling with additional products applied to the skin. The evidence for each varies:
Platelet-rich plasma (PRP), made from a sample of your own blood, has the most evidence. A 2022 meta-analysis of 14 studies (472 patients) found that microneedling with PRP was more effective than microneedling alone. Only four of those studies were randomised, and PRP preparation was not standardised. [40]
Polynucleotides are DNA-derived molecules marketed for skin repair. A 2024 review found limited high-quality evidence for their use in aesthetic medicine and only one small randomised trial in acne scars. [41]
Exosomes are tiny particles released by cells. A 2026 scoping review of exosome treatments in dermatology found mostly non-randomised, single-group studies with potential conflicts of interest. [42] The FDA states that there are currently no FDA-approved exosome products. [43]
Adding a product to microneedling does not automatically improve results. If one is suggested, ask what evidence supports it for your type of scar and what difference it is expected to make.
Combining and staging treatments
Because most people have more than one scar type, treatments are often combined or staged. A plan might, for example, release tethered scars first, treat individual deep scars with a focal technique, and then use resurfacing to soften the overall texture. Some combinations have performed better than single treatments in studies, but controlled comparisons are limited. [28, 32] Combining treatments can also add to recovery time and risk, so each step should have a clear reason.
Matching approaches to different scars
The table shows options a qualified clinician may consider for different concerns. It is not a prescription, and many people need more than one approach. Options marked † are offered at Juvenology. The rest are described for general understanding and are available through dermatologists and other specialists.
Scar pattern or concern | Options a clinician may consider | Limitations | Key risks to discuss |
Rolling scars (tethered) | Subcision; microneedling†; RF microneedling; fractional laser; filler | Surface treatments alone may not release tethering; results often need several sessions | Bruising, pigment change, lumps with filler |
Shallow boxcar scars | Microneedling†; fractional laser; RF microneedling; peels combined with other treatment | Gradual, partial improvement | Pigment change, prolonged redness |
Deep boxcar scars | Punch elevation or excision; TCA CROSS; then resurfacing | More invasive; may leave fine scars | Pigment change, visible small scars |
Ice-pick scars | TCA CROSS; punch excision | Respond least to surface treatments | Pigment change, especially in darker skin |
Raised (hypertrophic) scars or keloids | Silicone; clinician-directed steroid injections; cryotherapy; laser; combinations | Keloids often recur | Skin thinning or lightening; recurrence |
Brown marks (PIH) | Sun protection; skincare; GP or dermatologist for prescription creams; gentle peels† with care | Slow to fade | Irritation can worsen pigment |
Red marks (PIE) | Time; vascular laser or intense pulsed light | Small evidence base | Bruising, pigment change |
General uneven texture | Microneedling†; superficial peels†; non-ablative laser | Modest improvement | Irritation, pigment change |
Sources: Jacob et al., Connolly et al., Kravvas and Al-Niaimi, Stratman and He, Gupta et al., NHS, and Davis and Callender. [6, 2, 20, 24, 30, 31, 7, 4]
Why depth and structure matter
Treatments work at different depths and on different structures. Microneedling and resurfacing mainly encourage remodelling in the upper and middle dermis, which can soften shallow edges and texture. A tethered rolling scar is held down from below, so it may change little until the tethering is released. A narrow ice-pick scar extends deeper than most surface treatments reach, so focal or surgical techniques are usually discussed. [6] This is why a treatment that helps one person's scars may do little for another's, and why there is no universal ranking of the "best" treatment.
Skin tone and body area
Scarring across skin tones
All skin tones can develop acne scars, and all can be treated with suitable choices. The main difference is in how skin responds to inflammation and injury:
Lighter skin is more likely to show persistent redness after acne. [2]
Medium and darker skin is more likely to develop post-inflammatory hyperpigmentation, both after acne and after procedures. [2, 4] Keloids are also more common in darker skin. [1]
Treatments that rely on heat, such as lasers, or that cause more inflammation, such as stronger peels and TCA CROSS, can carry a higher risk of pigment change in darker skin. [26, 30, 4] Microneedling and carefully adjusted non-ablative lasers are often considered in darker skin, but no procedure is free of pigment risk in any skin tone. [17, 27]
Skin tone categories, such as the Fitzpatrick scale, describe how skin reacts to sun. They are not the same as ethnicity, and two people with similar-looking skin can respond very differently. Your own history of darkening or lightening after spots, injuries or treatments is often more useful than a category label. Many treatment studies included few or no people with the darkest skin types, so results may not transfer directly. [22, 30, 27]
Face, back, chest and shoulders
Acne often affects the trunk as well as the face. Survey data suggest that around 30% to 60% of people with facial acne also have acne on the trunk, depending on the population studied. [44]
Scarring on the back, chest and shoulders differs from facial scarring in several ways:
Keloids are more common on the chest, shoulders and upper back. [5, 38]
Most acne scar studies treated facial scars, so evidence and recovery advice for the face cannot simply be applied to the body.
Any treatment on the trunk needs careful assessment, particularly in areas prone to keloids.
Results, courses and reviewing progress
What realistic improvement looks like
The aim of acne scar treatment is improvement, not removal. A large study of people with acne noted that treatments that can completely resolve acne scars are not yet available. [8] Realistic goals are softer edges, shallower dips, smoother texture and scars that are less noticeable in everyday light.
Improvement is usually gradual, because collagen remodelling continues for weeks to months after each session. In one microneedling trial, scar scores had not improved significantly at three months but had improved at six months. [18] Swelling straight after treatment can make skin look smoother for a few days. That temporary effect should not be confused with lasting change.
Courses and spacing
There is no universal schedule. Microneedling and many resurfacing treatments are given as a series of sessions spaced several weeks apart. Subcision is often repeated at intervals of a month or more. [29] Combination plans may be staged over many months. The number of sessions depends on the scar types, their depth, the treatments chosen and how your skin responds.
A good plan includes review points. These help you decide whether to continue, change approach or stop, and they help you notice if a treatment is not helping enough to justify further sessions.
Photographs and lighting
Scars look very different under different lighting. Overhead or side light deepens shadows, while flat, front-on light hides them. Progress is best judged with consistent clinical photographs taken in the same lighting, position and camera settings before and during treatment. Comparing a selfie in a bathroom mirror with one taken in daylight can be misleading in either direction.
If results are limited
Some scars respond less than hoped, even with appropriate treatment. Possible reasons include deep or tethered scars that need a different technique, new acne, or individual variation in healing. A limited response is a reason to review the plan, not necessarily to repeat the same treatment.
Safety, preparation and aftercare
Expected reactions and complications
Most procedures cause temporary redness, swelling, tenderness or flaking. Bruising is common after subcision and fillers. These usually settle within days to a couple of weeks, depending on the procedure.
Complications are less common but important:
Infection, particularly after procedures that break the skin.
Pigment changes, either darkening or lightening, more likely in darker skin and after heat-based or inflammatory treatments.
Burns, particularly with lasers and RF devices. [23]
Prolonged redness or delayed healing.
Cold sore reactivation after facial procedures in people prone to cold sores.
New scarring, including raised scars in people prone to them.
General preparation principles
Your treating clinician should give you written instructions for the specific procedure. Common principles include:
avoiding sunburn and tanning before treatment;
telling your clinician about any new medicines, cold sores, skin infections or changes to your health;
pausing strong active skincare, such as exfoliating acids or retinoids, on the area if advised;
not treating over active spots, broken skin or infection.
General aftercare principles
Keep the skin clean and avoid touching or picking it.
Use gentle, fragrance-free products until the skin settles.
Protect treated skin from the sun with a broad-spectrum sunscreen and shade.
Avoid heat, swimming pools and heavy exercise for the period your clinician advises.
Restart active skincare only when advised.
Procedure-specific instructions always take priority over general advice.
When to seek help
Contact your treating clinic promptly if you have:
pain, swelling or redness that is getting worse rather than better;
blisters, crusting or open areas that you were not told to expect;
dark or light patches developing.
Seek medical advice from your GP, a pharmacist or NHS 111 if you have signs of infection, such as increasing pain, warmth, swelling, pus or a high temperature, or if you feel unwell. Call 999 or go to A&E if you have a severe allergic reaction, or if you notice sudden severe pain, skin colour change or vision changes after a facial filler injection.
Home skincare and home devices
Good skincare supports scar treatment but does not replace it. A gentle cleanser, a moisturiser, daily sunscreen and effective acne control are the foundation.
Be cautious with home microneedling rollers and pens, strong home peels and home RF devices. They can cause infection, irritation, pigment changes and scarring, and they do not reach the depth or precision of clinical treatment. The FDA advises against using RF microneedling devices at home. [23] This guide does not give needle depths, acid strengths or instructions for clinical procedures, because these depend on individual assessment and trained technique.
Costs, NHS access and choosing a provider
What affects the cost
Total cost varies widely and depends on:
assessment, including any separate consultation fee;
the techniques used, which range from relatively simple procedures to specialist surgery or laser resurfacing;
the area treated, such as the cheeks only, the whole face or the back;
the number of sessions and whether treatments are combined or staged;
follow-up reviews and any maintenance;
recovery, including time off work for procedures with longer downtime.
When comparing quotes, look at the whole plan rather than the price per session. The lowest session price does not tell you the total cost, or whether the treatment suits your scars.
NHS access
Acne treatment, including treatment to prevent scarring, is available through the NHS. Cosmetic treatment of established acne scars generally is not. The British Association of Dermatologists notes that treatment for acne scarring is not readily available on the NHS. [3]
NICE recommends that people whose acne-related scarring is severe and persists a year after their acne has cleared are referred to a consultant dermatologist-led team with expertise in scarring. [9] Whether treatment is funded depends on local NHS policy. Some local NHS commissioning policies state that laser or peel treatment for scarring is not routinely funded, except where acne scarring is severe and has lasted at least a year after the acne has cleared. [45] Your GP can advise on the policy in your area. There is no guarantee of eligibility.
How to choose a provider
In England, there is currently no national licensing scheme specifically for non-surgical cosmetic procedures. The government has confirmed plans for one, based on tiers according to risk, but which procedures fall into each tier and when the scheme will start have not been confirmed. [46] This makes your own checks important.
Questions to ask:
What qualifications and professional registration do you hold, and what training have you had in this procedure and device?
Which scar types do you think I have, and which treatments are most likely to help each one?
What are the realistic benefits for my scars, and what are the limits?
What are the risks for my skin tone and history, and how will you reduce them?
What alternatives are there, including treatments you do not offer?
How many sessions do you expect, and how will we review progress?
What is included in the price, and what are the cancellation and refund terms?
What aftercare will I receive, and who do I contact if I have a problem?
Do you have insurance for this treatment?
Can I see your consistent clinical photographs, with permission, and understand how typical they are?
A provider who discusses limits, alternatives and when to refer you elsewhere is usually more trustworthy than one who promises dramatic results.
Acne scar treatment at Juvenology in Kent
Juvenology Clinic is a nurse-led clinic at 82 King Street, Maidstone, and sees clients from across Kent.
Acne scar consultations and microneedling at Juvenology are carried out by Marina Kostadinova-Yankova, the clinic's founder, an NMC-registered nurse with more than 25 years of nursing experience. [47]
Skin consultation. A 30-minute in-person skin consultation costs £50. It covers your scars and marks, skin history, medicines and goals, whether microneedling or another option at the clinic is suitable, and when a GP, dermatologist or other specialist would be more appropriate. [48]
Microneedling. Juvenology offers microneedling with a choice of serum: vitamin mesotherapy, polynucleotides, PRP or exosomes. Sessions are listed from £200. [49] The clinic's three-session vitamin mesotherapy microneedling course, listed at £540, is a published skin-rejuvenation package. It is not an automatic quote for treating acne scars, and a scar-specific plan may involve a different number of sessions or approach. [50]
Chemical peels. The clinic offers gentle glycolic and salicylic chemical peels for dull, uneven or congested skin, at £150 each. [51] These are superficial peels. They are not designed to treat deeper acne scarring, but they may form part of a plan for marks or texture.
Treatments not offered. Juvenology does not offer RF microneedling, laser resurfacing, subcision, TCA CROSS, scar surgery or injections for raised scars. If your scars are likely to respond better to one of these, you will be told so and advised to see your GP or a dermatologist.
Treatment goes ahead only if it is suitable for you. Booking a consultation does not commit you to treatment.
Discussing your acne scars at Juvenology
A consultation gives you time to understand which scars you have, whether the clinic's treatments are likely to help, what improvement would be realistic, and what other options exist. If you would like to ask a question first, you can arrange a free discovery call by WhatsApp.
Frequently asked questions
Are acne marks the same as acne scars?
No. Marks are flat colour changes, either brown (post-inflammatory hyperpigmentation) or red (post-inflammatory erythema), and often fade over months, sometimes longer. Scars change the texture of the skin, as a dip or a raised area, and rarely disappear on their own. [2]
Can old acne scars be improved?
Often, yes. The age of a scar matters less than its type and depth. Skin continues to remodel for up to about a year after acne clears, so specialists often wait until then before assessing scars for treatment. [11]
Can creams get rid of acne scars?
Creams cannot rebuild the structure of a depressed scar. They can help flat marks fade, improve general texture and control acne to prevent new scars. Be wary of products sold as scar removers.
Can I have scar treatment if I still get spots?
Usually acne needs to be controlled first. Some procedures can irritate active spots, and new scars may still be forming. [12] A GP or dermatologist can help with ongoing acne.
I have taken isotretinoin. How long do I need to wait?
It depends on the procedure. A 2017 expert consensus found insufficient evidence to delay several procedures, such as superficial peels and fractional lasers, but advised against mechanical dermabrasion and fully ablative laser during treatment. [13] Your treating clinician and prescriber should decide timing for you.
Is treatment suitable for darker skin?
Yes, many treatments can be suitable, but the risk of pigment changes is higher with some procedures. Choosing the right technique and settings, and telling your clinician about any past darkening or lightening, matters more than a skin type label. [4, 17]
Does treatment hurt?
Discomfort varies by procedure and by person. Some treatments, such as ablative laser and scar surgery, can be painful, and numbing cream or local anaesthetic is often used. Your clinician should explain what to expect.
How much downtime should I expect?
It varies by procedure, from a day or two of redness after microneedling, or a few days of mild flaking after a superficial peel, to one to four weeks of healing after ablative laser resurfacing. [25] Your clinician should explain what to expect for your specific treatment.
What if treatment does not work?
Some scars respond less than expected. A review should help work out why, and whether a different technique, a referral or stopping treatment is the best next step.
Are results permanent?
Improvement from collagen remodelling is intended to last, but most studies follow people for months rather than years, so long-term evidence is limited. [16] Skin also continues to age, new acne can cause new scars, and temporary fillers wear off and need repeating.
Can I get acne scar treatment on the NHS?
Not usually. NICE recommends referral to a specialist dermatology team for severe scarring that persists a year after acne has cleared, but funding depends on local NHS policy. [9, 3, 45]
About Juvenology Clinic
Juvenology Clinic is a nurse-led aesthetics, skin health and longevity clinic at 82 King Street, Maidstone, Kent ME14 1BH. It was founded by Marina Kostadinova-Yankova, an NMC-registered nurse with more than 25 years of nursing experience. Read more about Marina and the clinic.
This guide is general educational information and is not a substitute for an individual assessment or medical advice. If you have active acne, raised or changing scars, or scarring that is affecting your wellbeing, speak to your GP. Information was checked in October 2026.
References
British Association of Dermatologists, Acne Support. Scarring. Accessed 20 October 2026.
US Food and Drug Administration. Microneedling devices. Content current as of 15 October 2025.
Juvenology Clinic. Microneedling in Maidstone: course costs, results and recovery.
Juvenology Clinic. Chemical peels. Accessed 20 October 2026.