Deep Acne Scars
Acne scarring is something more people than you would think experience in their lives. The Cleveland Health Clinic notes that up to 80% of everyone 11-30 experiences acne, and 20% of these people experience acne scarring.
Not everyone experiences deep acne scarring, but there are ways to treat and improve cases of both mild and deep scarring.
Why do Deep Acne Scars Form?
The American Society for Dermatologic Surgery explains that Acne scars form during the healing process of inflamed acne blemishes. When the skin pores are full of excess oil, dead skin cells and bacteria, this causes the pore to swell and break the follicle wall.
Small, shallow lesions are able to heal quickly and smoothly, but deep breaks in the pore walls cause infected material to spill out into surrounding areas which creates a deeper wound. When the skin tries to heal a deep, inflamed wound, the new collagen is rushed and the repair is not as smooth as normal skin and classified as an acne scar.
Deep acne scars are the result of deep, inflamed blemishes healing. The deeper the inflamed acne blemish, the collagen production during the healing process will produce a deep acne scar as a result. There are ways to improve and heal acne scars, but it is always easier and better to try preventing the acne and scarring from happening in the first place.
Types of Deep Acne Scarring
The three acne scar categories are Atrophic meaning indented scarring, Hypertrophic/Keloid meaning raised scarring, and hyper/hypopigmentation meaning skin discoloration that is not technically classified as a scar.
Deep acne scarring only covers the Atrophic, meaning indented, acne scar type, since the other scarring types don’t go deeply into the skin since they are either raised or discolored.
Atrophic, meaning indented acne scarring, is the most common acne scar type, and there are several types of indented scarring, all of which can range from mild to deep.
Types of Indented Acne Scarring
Pitted Scars Pitted acne scars are simply another name for indented scars, also synonymous with atrophic scars. All indented scar types are also pitted and classified as atrophic scars.
Ice Pick
Ice-pick scars are the deepest acne scar type. They are characterized by being thin, deep and narrow. They are also the hardest scar type to treat because they are the deepest and affect so many layers of the skin. The more severe the acne scarring is, the harder it is to treat because it takes longer to treat and heal many layers that go deep into the skin versus treating a smaller, less severe scar that affects only the top layer of skin. The majority of atrophic scars are actually ice-pick scars, so if you have deep ice-pick scars realize you are not alone and there are ways to treat and help improve them.
Pockmarks
Medical News Today defines Pockmarks as, “deep scars on the skin that do not usually go away on their own. They are often caused by severe acne but can also be the result of skin infections or chickenpox.”
Pockmarks can be caused by acne but also by the healing of different types of skin infections such as chickenpox or smallpox. Anytime the skin heals from an infection, there is the possibility of scarring left behind as the result of healing.
Pockmarks are simply a type of marked, pitted, indented scarring that mark the skin when acne heals. When you think of the classic “pockmarked acne face” you likely think of someone with small indented pits marking the entirety of their face, which is what pockmarks look like.
Boxcar
Boxcar acne scars are the result of long-term inflammatory acne when it finally heals and the body produces new collagen that forms into a boxcar scar instead of smooth skin.
Boxcar scars have sharp edging, and they can be mild or very deep. The deeper they are the harder they are to treat due to affecting more layers of skin.
Rolling
Rolling acne scars are scars that look like a little valley running across the skin with many shallow, irregular dips. They look like valleys rolling across the skin and can be shallow or very deep. The shallower they are the easier they are to treat, and rolling scars tend to be shallower, making them an easier acne scar type to treat.
Can you Treat Deep Acne Scarring?
Yes, all type of acne scarring are treatable, even deep scarring. The deeper the acne scar, the more difficult it is to treat and the more time the treatment and healing process will be, but you will be able to get rid of old scarring and see improvement over time.
The Mayo Clinic article by Lawrence E Gibson M.D. notes that acne scars can be stubborn, and that no one treatment is best for everyone, so you can experiment with different treatments over time to see what works the best for you.
How to Treat Deep Acne Scars
Deep acne scars are the hardest acne scar type to treat because they affect so many layers of the skin, and the skin heals layer by layer which takes time to get to the root of a deep scar to fully heal it at its deepest layer.
There are many options to treat deep acne scarring, and you will see best results when you are consistent and do multiple treatments over time as you allow your skin to heal. You can also try different treatment types to see what works the best for you and your skin.
The American Association of Dermatology website outlines a handful of effective treatments for treating deep acne scarring.
Keep in mind that deep acne scarring won’t completely go away with one treatment, although one treatment may help it see some improvement. You will need to do multiple treatments over a long time period, and the deeper the scarring the more treatments that will be needed:
- Micro-needling
One of the best treatments for deep acne scarring is micro-needling because it goes deeper into the skin, allowing for healing at deeper levels.
Micro-needling is a form of acne scar treatment also known as collagen-induction therapy. Micro-needling can be done at a dermatologist office, and it can be done using at-home micro-needling rollers.
When micro-needling, small needles roll across your skin which creates micro-tears in the skin. This has two benefits: 1) It stimulates collagen production in the skin which allows the scarred skin areas to re-heal smoothly. 2) It opens the skin up to receive healing ingredient product more deeply such as Copper peptide serum for acne scars at night and Vitamin C for acne scars in the morning, both of which help deliver healing ingredients to the skin and promote collagen production and healing.
You can only micro-needle at a dermatologist every 4-6 weeks as they go deeper into the skin, and you can only micro-needle lightly at home every 1-4 weeks, depending how deep a needle you use and how lightly you roll. After each micro-needling session you will see small improvements and the stimulated collagen production continues for months after so you will continue to see improvement after that and over time as you continue to do the treatments.
Right after micro-needling skin will be sensitive and red, and makeup shouldn’t be applied for a minimum of 8 hours or as long as possible for best results. It also needs to be kept out of the sun while healing.
Micro-needling is safe for all skin color types. It is not a treatment for raised acne scarring.
- Surgery: There are different surgeries a dermatologist can perform on deeper acne scarring. You would need to go in to get diagnosed with what treatment makes the most sense for your particular scarring type. Subcision, excision and punch replacement grafts are some of the surgery types available.
- Resurfacing:
Resurfacing is more helpful for shallower scars since it works by removing the top layer of skin so the body can create new healthy skin in its place. It is not a treatment that will get to the root of deep scarring after one session but will work better on scars that are only on the top layer of skin. - Laser resurfacing: Ablative laser resurfacing is a procedure that uses a wand-like laser instrument to remove the upper layers of skin from acne scarring. It can be referred to as “laser peeling” because it peels away the old skin to show newer skin underneath.
- Laser therapy: is when a beam of light is used to target and treat acne scarring on the skin.
- Chemical peels: Chemical peels remove the top layer of skin to help remove the damaged areas and encourage new skin and collagen growth underneath. The skin that regrows after is usually less scarred in appearance than the skin that was there previously.
- Dermabrasion: The American Society of Dermatology defines Dermabrasion as the surgical sanding or planing of the outer layer of skin on acne scars.
- Fillers A dermatologist can also inject different temporary or permanent filler types into deep scars to help make them appear to be less indented than they are. Most of these fade over time meaning they need to be redone every few months and they have different side effects that you should keep in mind before trying.
Fillers work best for depressed scars, but not super deep ice-pick scarring.
Dermatologists are able to perform the following types of resurfacing treatments:
Deep Acne Scar Treatment Results
A few years ago, I went through a time in my life where I had huge inflamed cystic acne all over my face, particularly on my forehead, cheeks and chin. It didn’t help the healing process that I picked at them, and was mentally not in a good place which also didn’t help the chemicals in my body or the healing process.
When the cystic, inflamed acne finally healed, I was left with deep indents on my forehead, cheeks, and chin, included pitted and ice-pick scars as well as rolling scars. Some were very deep, and others were more mild or medium.
I hated how I looked and couldn’t look people in the eye when talking anymore. I didn’t do much to treat them other than poorly attempt to cover them up for the first few years I had them.
Two years into having them I started at-home derma-rolling once a month + the Super Cop 2X copper peptide serum at night, and then later added in a morning Vitamin C + Exfoliation cream step into my routine.
Using these products has stimulated my skin’s own healing processes, helping to remove the damaged skin layers and stimulate healing on the layers below.
My whole face has been completely transformed over the past 2 years I’ve been doing this routine, with noticeable improvements each time I do it.
Even my deep scarring has improved to the point where I no longer notice it and I am now comfortable looking people in the eye again when I talk in my daily life, which I am very grateful for.
Here is a picture of my deepest scars, which were on my forehead and their healing process over time:
You can also view more before and after acne scar pictures here.