Severe Acne Scars: What to do if you have Bad Acne Scars

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Bad Acne Scars

Severe acne scarring is more common than you might think. A Clinical Aesthetic Dermatology study found that acne vulgaris affects, “up to 80 percent of people ages 11–30 and five percent of adults 30 years and older in the United States.”

The Cleveland Health Clinic clarifies that number saying that 1 in 5 of those who get acne, also get acne scarring.

This means if you are one of the 80% of the US population affected by acne, and one of the 20% of acne sufferers who get acne scarring, you are by no means alone.

A large percentage of people in the US have acne and acne scarring. There are different types of acne scarring, and these can range from mild technically “not scarring” that is just skin discoloration, to mildly depressed or raised scars, to severe, deep, pitted and indented scars.

What are Severe Acne Scars?

Healthline explains the different types of bad acne scarring:

Atrophic Acne Scars
Atrophic scars are indented scarring that forms while the inflamed acne is healing and the area is not producing enough collagen. Indented scarring can be mild to severe, and mild forms are easier to treat because they affect fewer layers of skin.

3 types of Atrophic, indented scarring are:

Boxcar Acne Scars
Boxcar scars are wide with sharp edging, and can be shallow or deep. They are easier to treat and less severe, the shallower they are.

Ice Pick Acne Scars
Ice-pick scars are very narrow and deep. They look like a small deep hole in the skin and are the most difficult scar type to treat because they go so deeply into the skin and affect many skin layers.

Rolling Acne Scars
Rolling scars are a collection of multiple acne scars that tend to be wide and shallow with rounded edges and an irregular, rolling appearance.

Hypertrophic Acne Scars
Raised scarring is known as hypertrophic, and it is more common on chest and back acne. The raised scars are caused by the production of excess collagen during the acne healing and have a raised appearance above the skin’s surface.

Acne Discoloration Spots
When acne heals and leaves behind a red, brown, white or other discoloration mark, it is technically not classified as scarring but is known as hyper or hypo pigmentation. The discoloration will usually fade on its own but can also be helped with treatments and serums.

All types of indented, raised and discoloration acne scarring can range from very mild to very severe. The more severe the case, the more time and effort it will take to treat. The good news is all types are treatable, and there are things you can do to help improve the scarring in each case.

Is Bad Acne Scarring Treatable?

The Cleveland Health Clinic Interview with Dermatology MD Dr. Kassouf explains that it is possible to treat bad acne scarring and see good results. In the words ofDr. Amy Kassouf, ““I’m always amazed at how much healing the skin can do once you get the inflammation under control. My patients may be discouraged, but I’m not.” So yes, the good news is that you can treat and help acne scars heal.

I’ve personally seen others treat and improve their own acne scarring, and I’ve also been able to slowly, over time get rid of my own acne scarring, so there are ways to see skin improve and heal.

How to Treat Bad Acne Scarring

There are quite a few options when you want to treat your acne scarring, no matter how severe it is. The more severe cases will take longer to treat and be more difficult to treat, but there is something you can do for every type of scarring.

The American Association of Dermatology explains there are many different treatments for the different scar types:

Indented Acne Scar Treatment

When treating depressed acne scars, multiple acne scar treatments lead to better results, although you need to give your skin time off between treatments to fully repair and heal:

Collagen-induction therapy

Collagen-induction therapy is also called micro-needling, and can be done in a dermatologist office or at-home using an at-home acne scar derma-roller.

In micro-needling, the needles are rolled across your skin which creates small punctures. When the skin heals from these micro-holes it makes collagen, which allows the acne scars to reheal smoothly. Most people see improvements in skin texture after every treatment, and large improvements are seen every 6 months or so.

The skin gets red and needs to be kept out of the sun and cared for while healing for a few days after each micro-needling treatment.

You can also apply Vitamin C serum for acne scars during the day and Copper Peptide serum at night to see the best results with skin repair and collagen production.

Micro-needling is best for depressed acne scars, and is safe for all skin color types. It is not a treatment for hypertrophic raised scars.

Professional Treatments Only Available at a Dermatologist Office

Surgery: There are different subcision and surgery procedures a dermatologist can use to treat severe acne scarring and make it less noticeable. Surgery can only be performed by a professional dermatologist..

There are multiple procedures that resurface the skin by removing the top layer of skin so the body can make new skin cells in its place to reduce the acne scarring.

These are the resurfacing procedures dermatologists use as treatment of indented scarring:

Laser skin resurfacing

Chemical peels



Resurfacing is the best for shallow and mild scars that aren’t very deep, because it only treats the top few layers of skin and some middle layers, so it is not able to reach deeply enough to treat very deep scarring.

Fillers Fillers can be injected by a dermatologist to make scarring look less indented, and most are a temporary solution that needs to be redone every 6 to 18 months. There are different benefits and risks with fillers so you have to talk to your dermatologist to make an informed decision if they could be right for you.

Fillers work best for depressed scars, but not super deep ice-pick scarring.


Cryosurgery can be a good treatment for those with raised scarring to help them stop itching and shrink and flatten them. This treatment type freezes the skin acne scar tissue which makes it die and fall off over time. Multiple treatments are recommended for best results and can include additional corticosteroid injections. One con of this treatment type is it may cause permanent light spots on the treated skin areas.

This is not a good treatment for those with darker skin because it can cause the skin spot lightening.

Prescription scar creams, gels, and silicone dressings
If you have raised scarring, a dermatologist can prescribe creams and gels you can put on your raised scarring to help treat it. Specifically silicone dressings have been shown to help treat raised scarring.

The gels and creams will help with discomfort and scar size but this type of treatment is unlikely to completely diminish the raised scar.

Bad Acne Scar Treatment Results

Is it possible to see results for the treatment of bad acne scarring? The answer is yes, over time, you can see results for all types of scarring, no matter how mild or how deep.

The skin heals in layers, which is why it takes much longer to treat deeper scarring, but you will see results when treating even severe scarring over time.

Personally I had incredibly severe indented acne scarring all over my face, and have used collagen-induction therapy, AKA at-home micro-needling combined with Copper Peptide cream at night and Vitamin C serum + an exfoliation cream each morning.

Over a year’s time period my skin has shown dramatic improvements and I am finally happy with how my face looks again as well as able to confidently look people in the face again (finally).

If there is one thing I could go back in time and tell myself, it would be to never ever pick my face or acne scarring, which I did do and it made it 10X worse, and I would tell myself to not be stressed or depressed so I wouldn’t get as much cystic acne. Then, after, if I did still have scarring, I would tell myself right away about at-home microneedling, Vitamin C and Copper Peptides, as well as the importance of keeping skin not-inflamed and moisturized during the healing process.

Well, we can’t go back in time, can we? So the next best thing is to just do the best we can to work with what we have and help our skin heal.

Here are my very severe acne scars at their worst, and here they are during the healing process:

bad acne scars

More acne scar before and after pictures are available here.

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