These are two conditions, not one, and the order in which they are treated matters more than almost anything else about them. Treating scars while acne is still active means new lesions keep forming and creating new scarring while old scarring is being worked on, and some scar treatments can worsen active acne by spreading bacteria across the skin.
Sam Assassa, MD is board certified in Internal Medicine and a member of the American Society for Laser Medicine and Surgery. He founded Beverly Hills Aesthetics in 1995 and has performed more than 25,000 aesthetic procedures.
Why Acne Comes First
Acne is a medical condition. It responds to medical treatment, and controlling it quickly is the best scar prevention available, because prolonged inflammation is what damages the dermis and creates scarring in the first place.
Every month spent on a regimen that is not working is a month still producing scars, and scars cost considerably more to treat than the acne did. That sequencing is covered in detail on the acne treatment page.
The Kinds of Acne Scarring
Once acne is controlled, the scars can be assessed, and this is where most treatment goes wrong. Acne produces several distinct kinds of scarring, they respond to entirely different interventions, and most people have more than one type on the same face.
Ice pick scars are narrow, deep, and steep sided. The hardest type to treat, because resurfacing the surface does not reach their base.
Boxcar scars are wider with defined edges and a flat base. They respond to resurfacing and microneedling, which soften the edges and raise the base.
Rolling scars are broad and shallow with sloping edges, tethered from beneath by fibrous bands. Surface treatment alone underperforms on them because the tether is what holds them down.
Raised scars, meaning hypertrophic and keloid, result from too much collagen rather than too little, and are treated in the opposite direction.
And what is not scarring at all: post-inflammatory hyperpigmentation, the darkening left after a lesion resolves. It has no textural component and fades over months. Patients frequently seek scar treatment for what is actually pigment.
What Treatment Can Realistically Achieve
Substantial improvement, not erasure. Scarring is a structural change to the dermis, and treatment reduces its depth and softens its edges rather than restoring the original tissue. Most patients with a well matched plan find their scarring far less noticeable, particularly in normal light. Anyone promising complete removal is overselling.
How Each Is Treated
For active acne: topical retinoids, antibacterials, oral treatment where appropriate, hormonal treatment in some patients, and corticosteroid injection for individual inflamed lesions. See the acne treatment page.
For scarring: subcision to release tethered rolling scars, laser resurfacing and microneedling for texture and edges, fillers or fat for depressed scars, and steroid injection for raised ones. See the acne scar treatment page.
Skin type affects the recommendation throughout, since patients prone to acne scarring are frequently also prone to pigmentary change.
Have Your Acne Skin Evaluated in Beverly Hills
Dr. Assassa will establish whether your acne is controlled, what kinds of scarring you actually have, and what order to treat them in. Request a consultation or schedule your appointment online.