For anybody who has suffered with acne, knowing that healing your active breakouts is just the first step can be a frustrating thought—even when the worst of your acne is finally history, you then need to address the scarring.

Acne scarring can affect sufferers in a number of ways, and can manifest through minor (surface level), moderate or deep scarring, depending on several factors including the type of acne you had, and how you dealt with it. But one thing’s for sure: it can be difficult to budge.

“Acne scarring forms when inflammation damages the deeper layers of the skin, specifically collagen and the overall structure of the dermis—unlike pigmentation left behind after a breakout, true scars are a change in the architecture of the skin,” explains Cosmetic Doctor and Dermatology expert, Dr Sonia Khorana. “Once that structural damage has occurred, the body often replaces it with disorganised collagen, which creates the visible pits, dents or raised scars we see.”

Scarring therefore persists because of its depth in the skin, and the fact that while topical products can help at a surface level, anything deeper requires further action. Unfortunately, acne marks can also worsen as we age and affect collagen, too.

Despite this, there are options for acne scars that are considered ‘minor,’ ‘moderate’ or ‘deep.’ While some may require more investment—both in terms of time and money—there are ways to deal with stubborn marks left behind by blemishes.

Bear in mind that "treatments are selected based on the depth and type of the scar [and] there is no one-size-fits-all,” says Khorana, who recommends seeing a specialist first to determine your scarring is definitely from acne, and not anything else (such as post-inflammatory hyperpigmentation or erythema). Post-acne scarring, she notes, usually manifests through pitted depressions (atrophic scars: ice-pick, boxcar, rolling) or raised, firm scars (hypertrophic or keloid).

Options for minor scarring

When your scarring is relatively minor, chances are it’s mostly surface-level, and thus may respond to topical products containing specific ingredients. The first route to take, therefore, is trying skincare formulas containing active ingredients like retinoids, azelaic acid, niacinamide and vitamin C.

“Products containing these ingredients can soften the appearance of mild scarring over time, and keep the skin functioning optimally between clinic treatments,” notes Aesthetic Doctor, Dr David Jack, who also recommends trying a barrier-repairing moisturiser rich in ceramides and fatty acids to prevent skin from further scarring (skin that has a stronger barrier will be less prone).    

If topicals aren’t producing the results you desire, it may be time to try some light, relatively gentle treatments. These include chemical peels with AHAs and BHAs, which exfoliate to improve skin texture, and over time, encourage collagen renewal. Microneedling, says Dr Khorana, can also be suitable. "This creates controlled micro-channels to stimulate collagen and elastin,” she says, but does point out it will usually only work on superficial scarring.

Options for moderate scarring

For scarring that runs slightly deeper or hasn’t responded to topical treatments, peels or microneedling, you may wish to look at other aesthetic procedures. Most notably, fractional laser (CO2/erbium) is often a recommended course of action at this stage. It smooths texture and improves deeper pits, and also won’t affect surrounding areas of skin.

For Dr Jack, combining this type of laser with treatments like exosomes or polynucleotides, can be transformative. “The micro-injuries [from laser] stimulate collagen and elastin while regenerative actives such as exosomes or PDRN enhance cellular repair and calm inflammation, which is a crucial consideration in skin that’s been repeatedly inflamed from acne,” he says.

Dr Khorana suggests Subcision (a minimally invasive procedure where a small needle is used to break up scar tissue) for moderate scarring. She argues it “releases tethering bands under rolling scars [and] allows skin to lift and remodel.”

Options for deep scarring 

Subcision can also be used on deeper scars (often referred to as atrophic or ice-pick scars), says Dr Jack, and is often combined with dermal filler for best results. "This releases the fibrotic tethers that pull the skin down, before restoring lost volume with a hyaluronic acid dermal filler like Juvederm Voluma or Volift,” he shares. "It’s a relatively delicate process, but when done properly can dramatically smooth the surface.”

Dr Khorana’s treatments of choice are TCA Cross and CO2 laser. The former involves highly concentrated TCA (trichloroacetic acid, a chemical that causes layers of skin to peel off) being applied to the scar to induce collagen filling of very narrow, deep pits. "The use of a CO2 laser is the gold standard when deeper structural change is required,” she notes. This involves the use of a stronger laser to cause micro-injuries in the skin and stimulate collagen production to heal the area. This can resurface significant scarring that otherwise may not have budged.

Whatever you decide, it’s important to consult with an expert dermatologist or aesthetic doctor to find the best solution for you.