Treating acne scarring

Flat red, purple or brown marks left behind after a spot are post-inflammatory pigmentation or erythema, not scars. The skin surface is intact; the colour simply has not settled. These fade on their own over months, and they respond well to sun protection, gentle treatment and time.

A true scar is textural — the skin surface itself has changed, either lost or raised. Run a finger over it: if you can feel it, it is a scar. If you can only see it, it is a mark.

This distinction changes the plan entirely, and it is the first thing I assess. People are frequently relieved to find that what has been bothering them for a year is going to fade largely on its own.

Rolling scars — shallow, wide, with soft sloping edges, giving the skin an undulating look. These respond best to microneedling and to collagen-stimulating treatment, because the aim is to build volume underneath and smooth the transition.

Boxcar scars — wider with sharply defined vertical edges, like small craters. These respond moderately; the edges are the difficult part.

Ice-pick scars — narrow and deep, as though the skin was punctured. These respond least to microneedling, because the scar extends deeper than the treatment reaches. They often need a different approach entirely.

Most people have a mixture, and a plan usually needs to address more than one type.

Treating scars while acne is still active is a poor use of money and carries a real risk of spreading bacteria across the face during treatment. Get the acne controlled first — with your GP or a dermatologist if it needs prescription treatment, which it often does.

If you have taken isotretinoin, most practitioners wait six to twelve months after finishing before resurfacing treatment, as the skin's healing response is altered during and shortly after. I follow that.

This is a conversation where I regularly tell people to come back in a year. It is not what anyone wants to hear and it is the right advice.

Richer skin tones carry a higher risk of post-inflammatory hyperpigmentation after any resurfacing treatment. That does not mean no treatment — it means gentler settings, proper preparation of the skin for several weeks beforehand, and more patience between sessions.

Any practitioner who proposes the same aggressive protocol regardless of skin type has not understood the risk, and treating acne scarring in a way that leaves pigmentation behind is trading one problem for another.

Meaningful improvement, not erasure. Somewhere between 30% and 70% improvement across a full course is a fair expectation for most scar types — enough that the skin reads as textured rather than scarred, and enough that most people stop noticing it in the mirror.

It takes several sessions spaced four weeks apart, and the result continues improving for months after the final one as collagen remodels.

Anyone showing you a single-session transformation for established scarring is showing you lighting.