4 Types Of Acne Scars And Their Treatment Options

The appearance of acne scars varies based on the type and severity of the acne. The four types of acne scars are: Ice-pick acne scars., depressed fibrotic scars, boxcar scars, and rolling "hill and valley" scars.
acne scars and treatment options
There are four different forms of acne scars, each with different treatment options.

Acne scars can take the form of holes, pits, or craters in the skin. These sunken, cavity-like, inward-directed scars, also known as atrophic scars or crateriform scars, are associated with a lack of tissue that occurs when the inflammation from healed acne causes devastation to the skin (similar to scars that often result from chickenpox). Scar tissue tightens and ties the skin together.

When discussing treatment options with your dermatologist, terms and descriptions linked to this type of scarring will be helpful since certain therapies work better than others for different scars. Here are a few other names that are more descriptive:

Ice-pick acne scars

ice-pick acne scars

The most common acne scars that appear on the cheeks are ice-pick scars. They’re usually small, with a jagged edge and steep edges, similar to ice pick wounds. They can range in depth from shallow to deep.

Ice pick scars can resemble tiny craters on the cheeks visually. They are deep, narrow scars that are less than two millimeters broad and appear as if a sharp object (hence an ice pick) has punctured your skin.

Treatment of ice-pick scars

Medical insurance does not usually cover therapy for ice pick scars in the United States, limiting a person’s ability to treat them. Multiple sessions or a mix of treatment may be required to treat ice pick scars.

We’ll go through some of the treatment methods for minimizing the appearance of ice pick scars in this article. We also go into the causes of ice pick scars and avoid them.

Punch excision

The acne scar is surgically removed using the punch excision procedure, which involves using a surgical tool that fits the size of the spot (ideally 1.5-3.5 mm). A stitch is used to seal the residual wound. Punch excision is a great way to fix deep ice pick scars and narrow, deep boxcar scars (under 3 mm). This can be a far more effective and time-saving method of treating these more complex scar forms.

The depth and prominence of deeper scars cause many cosmetic issues that acne scar sufferers face. An indented scar or hole is effectively turned into a flat linear spot via punch excision.

These flat linear scars can then be enhanced further with laser resurfacing, with the resulting scar minimization being far more cosmetically acceptable. The corrected scar would be dull and readily concealable with a light covering of foundation or make-up.

Punch excision scar removal typically costs $250 to $750 per scar.

Punch grafting

Punch grafting procedure

Punch grafts are known for their high success rate. This procedure can usually eliminate 100 percent of discrete, minor ice pick-type deep acne scars. For even smoother results after punch grafts, the patient may opt for laser skin resurfacing, chemical peels, or Microdermabrasion.

Photos are taken, and scars are marked with a surgical marking pen on the day of the surgery. The scar tissue is treated with a topical anesthetic administered behind one ear. A cleanser is used to prepare the skin. After excising the scars with a punch device, punch grafts from behind one ear are harvested using a.5 mm bigger punch device.

Under microscopic guidance, the grafts are placed in place. The grafts are covered with steristrips and a translucent plastic-like covering. In most cases, patients are allowed to drive to and from the office.

Only at the time of consultation can these procedures’ specific risks and suitability for a particular person be evaluated. Minor issues that have no bearing on the outcome arise from time to time. It’s unusual to have serious complications.

Expect to pay roughly $500 for a smaller and less apparent scar. You could pay up to $4,000 for a skin graft for a larger and more intricate scar. A skin graft is usually included in this hefty price tag.

Laser resurfacing

Laser resurfacing procedure

Laser resurfacing removes damaged skin one layer at a time by directing brief, concentrated pulses of pulsating light into areas of uneven skin. Laser resurfacing is extremely accurate, focusing exclusively on regions with irregularities, such as acne scarring, avoiding some of the issues with laser acne scar treatment. Healing begins once the injured skin is removed, and the new skin that emerges is smoother.

Those with shallow acne scarring are the ideal candidates for the surgery; those with deeper scars will see a more negligible difference. Over the course of around 18 months, most patients see up to an 80% improvement in the look of their acne scars. For those anticipating rapid results, this may seem like a long time, but the idea of living with scars for the rest of their lives puts the wait into perspective.

The cost of laser resurfacing varies depending on where you live, the doctor who performs the procedure, and the type of laser you employ. Because laser resurfacing is considered a cosmetic procedure, health insurance usually does not cover it. Treatment costs could range from just over $1000 to over $2000.


Microneedling procedure tools

Microneedling for acne scars works by entering the top layer of skin with small needles, causing collagen formation to rise where the micro-wounds are produced.

Excess collagen acts as a ‘filler,’ smoothing out the skin around scars and improving the overall appearance.

Microneedling has been proven to be a safe and effective treatment for acne scars and other skin disorders. The following are some of the benefits of the treatment:

  • Recovering quickly
  • There are a few side effects.
  • Visible outcomes

Microneedling has also been hailed in clinical research as a great alternative to larger, more invasive procedures such as chemical peels and laser resurfacing.

The effects of microneedling can be seen nearly immediately after the procedure. Each person is unique, and the treatment’s long-term results will differ.

Microneedling patients are usually recommended to have a series of treatments every four weeks, each lasting around 30 minutes. During your appointment with your specialist, the number of 30-minute sessions will be determined based on the severity of your skin and other criteria.

Sessions can also differ in length depending on the location of the body that is being treated. Microneedling for back acne scars, for example, may take longer than microneedling for facial acne scars.

Microneedling is typically not covered by insurance since it is considered a cosmetic procedure rather than a medical need.

While treatment costs vary, they are significantly less than the expense of alternative surgery or a more intrusive procedure. Similarly, at-home product treatments are less expensive, but the benefits are less significant.

A microneedling session will cost between $200 and $300 on average.


Microdermabrasion procedure in action

Microdermabrasion is a treatment for acne scars and other skin issues that affect the epidermis or outer layer of the skin. The therapy includes spraying tiny crystals onto the skin with a portable instrument. The tiny crystals exfoliate and remove the skin on the surface, resulting in a more even, clear skin texture and the removal of acne scars on the surface.

Indented or atrophic acne scars respond well to Microdermabrasion, whereas elevated scars do not. Those with elevated scars should avoid Microdermabrasion because its capacity to promote collagen formation may cause raised scars to develop or exacerbate.

Microdermabrasion is only helpful in healing shallow indented scars since it only stimulates collagen formation on the skin’s surface. Scars that are deeper than 0.5 mm will not improve much.

Microdermabrasion is a gentle technique that can be done in salons, spas, or at your dermatologist’s office for people of all skin colors and types. It is pretty inexpensive compared to other acne scar treatment options, such as surgeries.

Unlike other more intrusive acne scar treatments, Microdermabrasion does not require any downtime. After a session, you are free to return to work or go about your day as usual.

Exfoliation eliminates debris, dead skin cells, and excess oils from the skin’s surface, which helps to prevent pore-clogging. This helps to prevent breakouts in the future, resulting in clearer skin.

A single microdermabrasion session can cost anywhere from $75 to $200. Add-ons, such as specifically formulated serums, additional aftercare measures, or combined treatment techniques, are available from some providers.

These add-ons can make surgery better suited to an individual’s needs, but they can also drastically increase costs. Depending on the complexity of the process and the number of add-ons added, the price could exceed $800.


Dermabrasion procedure explained

Dermabrasion, also known as dermaplaning, is a surgery that uses controlled surgical scraping to “refinish” the top layers of skin. The new skin is usually smoother and brighter. The consequences can be both spectacular and long-lasting.

Acne scars, pox marks, and scars from accidents can all improve from dermabrasion. On burn scars, it’s less effective. For fair-skinned people, the treatment is a suitable option. For those with a darker complexion, it can cause discoloration.

To begin, the treatment area is carefully cleaned. The treatment region is anesthetized with numbing medicine or a freezing spray. The scar tissue is then removed with a specific wire brush or a rough-edged diamond wheel.

Depending on how much skin is being treated, dermabrasion can take anywhere from a few minutes to more than an hour. If you have significant scarring or an extensive skin area to treat, dermabrasion may be performed more than once or in stages.

After dermabrasion, the treated skin will be coated with a moist, nonstick covering. Self-care instructions will be given to you to follow at home, and you may be prescribed pain medication.

Your doctor will most likely need to see you immediately after treatment to assess your skin and change your dressing.

Your new skin will be sensitive and red after dermabrasion. Swelling usually goes away within a few days to a week, although it might continue for weeks or months. Your skin tone may take up to three months to restore to normal.

You’ll notice that your skin looks smoother when the treated area heals. To avoid lasting skin color changes, protect your skin from the sun for six to twelve months.

Keep in mind that the effects of dermabrasion aren’t always permanent. Squinting and smiling will leave lines on your face as you become older. New sun exposure can potentially undo the impact of dermabrasion.

According to 2020 figures from the American Society of Plastic Surgeons, the average cost of dermabrasion is $1,786. This is only a portion of the entire cost; it excludes anesthesia, operating room facilities, and other related expenses.

Chemical peels

Chemical peel performed at the dermatologist office

Chemical peels improve the appearance of acne scars by removing the outer layer of old skin with a chemical solution. The new skin that grows in its place is usually smoother and less scarred.

Chemical peels may help minimize the appearance of acne scars depending on the type of scarring and your skin type.

Medium and deep peels are the most effective for resurfacing the skin, smoothing scars, and lightening dark spots. On the other hand, chemical peels are more helpful for clients who have lighter skin tones and deep acne scars.

People with darker skin tones had higher rates of unwanted side effects such as crusting and hyperpigmentation, according to a 2018 research of 473 chemical peels conducted over five years. People with darker skin tones should avoid thorough peels, according to other studies, because they are more prone to scarring and severe discoloration.

However, if you have darker skin prone to hyperpigmentation and still want to undergo a chemical peel, glycolic peels may be the best option.

According to the American Society of Plastic Surgeons’ 2020 data, the average cost of a chemical peel is $519.

Ice-pick scars treatment at home

Topical acne scar treatments available at home are ineffective in treating these scars. Bleaching agents can help with redness and brown areas, but they can’t help with an ice pick scar’s deep, narrow pit.

Instead, as part of a proper skincare regimen, you could find that using ice pick scar cream is beneficial. Healthy skin can assist in hiding scars while also lowering the risk of future acne breakouts and scarring.

Make a conscious effort to use sunscreen daily. This will help prevent age spots and cancer and the darkening of ice pick scars.

Certain products, such as honey, rosehip oil, and witch hazel, can help with discoloration and skin texture, but they won’t eliminate the deep pits that make up these scars.

Depressed fibrotic scars

Example of depressed fibrotic scar

Fibrotic scars are often larger, steep-sided scars with sharp edges; firm to the touch and can develop from ice-pick scars.

The appearance of depressed scars can be improved by surgically eliminating the scar – generally in the office. Most depressed scars can be improved with skin fillers simple, rapid, and quick. Advanced lasers or dermabrasion can also be used to heal depressed scars on the skin, such as those caused by acne scarring.

Dermal skin fillers like Restylane® can commonly be used to improve depressed scars (such as acne scars or an old cut). These injectable procedures can enhance volume beneath the skin in the scar area, allowing the skin to seem more even and smooth. Dermal fillers have proven to be quite successful at repairing acne scars, and the benefits are often longer-lasting. When the dermal filler’s benefits start to diminish, follow-up treatment can help to keep the results.

Restylane typically costs between $400 and $800 per syringe, indicating relatively inexpensive. Needles may also be less expensive, primarily if available in two sizes. Of course, the final price will vary depending on various factors.

Boxcar scars

Boxcar scars

Long-term, inflammatory acne causes boxcar scars, although their appearance depends on how the skin heals during and after therapy. When the body does not make enough collagen throughout the healing process, the inflammatory lesion sinks deeper into the skin, resulting in scarring.

A boxcar scar is a circular or oval depression in the skin that appears after certain types of acne have healed. Some boxcar scars are red or dark brown in hue, while others are the same color as the surrounding skin.

Atrophic scars are those in which the skin does not return to its previous state after healing.

Boxcar scars rarely fade without medical intervention. Atrophic scars can be reduced in appearance in several methods, including Microdermabrasion. This entails gently abrading or removing the top layer of your skin, which contains dead cells.

The shallower the scar, the better it will respond to treatment in general. The appearance of deeper scars is sometimes more difficult to alter; however, combining treatment methods can help. However, in every case, a dermatologist should conduct the consultation and therapy.

Only a medical practitioner can recommend a treatment or solution to address the depth and color of your scars, and more elaborate procedures necessitate a skilled touch. Chemical peels and microneedling rollers are standard over-the-counter solutions for treating boxcar acne, although they can occasionally cause more harm than good.

Rolling “hill and valley” scars

Rolling (hill and valley) scars

As a result of the acne healing process, rolling scars are a common type of scarring. They show as small indentations in the skin a few millimeters wide. They’re characterized by their sloping edges, which give the skin a wavy, uneven appearance. They’re not necessarily the same size as the acne lesion that created them, as the size varies depending on how the skin heals.

Rolling scars are more common in parts of the face where the skin is thicker, such as the lower cheekbones and jaw.

Rolling scars, like all acne scars, are determined mainly by how your skin heals. Acne scars are more frequent if you tend to scar readily.

Inflammation is also a factor in the formation of acne scars. The deeper an acne lesion’s inflammation penetrates the skin, the more likely it will scar as it heals. One of the reasons it’s critical to treat acne as soon as possible is to avoid deep inflammation.

Picking or squeezing acne lesions can cause harm to the skin and increase the likelihood of scarring. Picking or squeezing your acne is not recommended. In actuality, many people do this in order to get rid of pus. If you persist in plucking or squeezing your acne to get rid of the pus, please read our tips on avoiding hurting your skin here.

If you smoke, you’re also more prone to acquire acne scars because smoking increases the risk of scarring in general.

Rolling scar treatment is divided into two stages: other acne scars. The goal of the first stage of treatment for rolling scars is to lower the scar’s depth so that the skin’s surface can return to being flat. The second stage of treatment for rolling scars is to reduce skin discoloration in the newly flat scar.

Please be aware that rolling scar procedures may cause burns, skin peeling, irritation, skin bleaching, or changes in skin texture. Scar removal has a larger risk of causing adverse effects in people with darker skin. Please speak with your healthcare practitioner to learn more about the risks associated with any treatment you contemplate.

In Conclusion

Do not begin scar therapy until you have used the best over-the-counter acne treatment and your acne is entirely gone and unlikely to return. You’ll have to go through all the trouble and expense of undergoing treatment (or numerous operations) only to develop more acne and consequently additional scars. Imagine how much money that would cost!

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