This page discusses types of acne scars as well as why and how they form.
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Discover newfound confidence with Acne Scar Treatments that restore and repair your skin.

Breakouts can come and go, but the damage it leaves behind can leave life-long scars that worsen as we age. If you are dealing with acne scars and are unhappy with the damage they have caused to your complexion, Reflections offers a wide array of treatment options to help restore clear, smooth skin.

“I did 2 microneedling sessions and I have noticed a big improvement in my acne scarring. I really appreciate all of the staff being so nice and caring… and answering all of my questions!”
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Types of Acne Scars

Rolling Scars

Rolling acne scars are characterized as broad depressions in the skin with rounded, sloping edges. When there are a number of these scars in the same region, it gives the skin a rolling appearance. These types of scars are common in people who have been afflicted by long-term inflammatory acne (cystic acne) and become more pronounced as the skin ages.

Boxcar Acne Scars

Boxcar acne scars are broad, box-shaped depressions that have deep, defined edges. They often resemble chicken pox scars. Because the edges of boxcar scars are deeper and steeper than those of rolling scars, it is harder to blend them into surrounding skin. These scars are caused by the breakdown of collagen and tissue in the skin by inflammation.

Ice Pick Acne Scars

Ice pick acne scars are deep and narrow and resemble a large, empty pore. As the name suggests, it can look as though the skin has been punctured with an “ice pick”. When the body doesn’t produce enough collagen due to an injury (like severe acne) depressions such as ice pick scars can form. This type of acne scarring is often the most difficult to treat.

Dark or Red Acne Scars

Acne often leaves behind red or dark spots, especially for patients with Hispanic, Asian, African and/or Middle Eastern/Mediterranean heritage(s). These skin types are more prone to pigment changes in general, and acne often leaves discoloration that is very difficult to remove on skin types 3-6. Our physicians understand how frustrating this discoloration can be, and how carefully it must be treated. Many traditional acne scar treatments, such as certain lasers, are either not suitable for these skin types or must be turned down to such a low power setting that the treatments are not very effective. That’s why our practice has invested heavily in a variety of treatments, including those that best treat our patients with sensitive skin.

What Causes Acne Scars to Form?

Cystic acne is often the culprit behind the worst cases of acne scarring we see, but even patients with only occasional or mild breakouts can experience severe acne scarring. This is particularly true when active acne is picked, squeezed or popped, creating further damage to the surrounding skin and tissues.

Cystic acne effects tissue deep in the skin and occur when clogged pores become filled with pus and bacteria. Inflammation in the pore can destroy collagen support and the normal fat layer just below the skin, creating pitted and indented scarring. As the body heals the acne pimple, it lays down scar tissue. This is a normal response by the body to try to make the area stronger than before. However, this scar tissue often leaves a thick, uneven skin surface. When the scar tissue attaches to both the top layer of the skin and the fascia below, the skin gets tethered down into an indented scar – ice pick, boxcar, or rolling scars are created this way.

How We Treat Each Type of Acne Scar Damage

Because acne scars take on many forms, there isn’t a one-size-fits-all solution. At Reflections, we offer an array of treatment options to target the underlying causes of your acne scarring. We offer cutting-edge treatments, combined in a thoughtful manner to maximize your results. To learn more about treatment options and technologies, please visit our Acne Scar Removal page.

Tethered and Misshapen Scar Tissue

Because acne scarring is due to damage of collagen in the deeper layers of skin and irregular scar tissue in the skin’s support layers, repairing this damage can create a smoother skin appearance. There are two ways we can treat firm, misshapen acne scars:

  1. We can remove the scar completely using surgical excision – this is typically reserved for the very worst of these scars
  2. We can break up the scar tissue and release the tethers, stimulate the body to lay down new healthy collagen support in that area, and replace the missing fat volume to support the skin from below and create a smooth surface.

For most patients, we recommend option 2. There are a variety of treatment technologies that can be used to accomplish this, which are laid out in detail on our Acne Scar Removal Page.

Missing Volume

Acne scars disrupt the normal fat layer that exists just below the skin. Aging also sees this layer continue to deteriorate. That’s why acne scars often appear to get worse over time, especially in our late 40’s and beyond.
Whenever volume is needed, there are 2 main options for replacing it – fat transfer and dermal fillers. Fat transfer removes fat from your love handles or abdomen and transfers it to wherever you need it most. This procedure offers very natural and long-lasting results because we’re making use of your own fat cells. Dermal fillers come in a variety of brands and types, and are injected to replace lost volume. These are very precise, quick and easy treatments.

Uneven Skin Texture and Thinned-Out Skin

Deep acne lesions will cause significant damage to the collagen support of the skin. As we age and lose more collagen, our skin will continue to thin and these gaps in the support below the skin will become more obvious. Luckily, there are many proven treatments that will stimulate your body to grow its own new, healthy collagen. Lasers and microneedling work by creating tiny collumns of microdamage which the skin responds to by laying down more collagen in the area, to fortify the skin. Radiofrequency and ultrasonic energy work by heating up the collagen bundles, causing them to be completely remodeled and repaired by the body. RF (radiofrequency)microneedling combines both radiofrequency heat and deep microneedling, making it one of our favorite ways to treat acne scars because of the big results it creates.

Why Trust Reflections to Help You Repair the Damage of Acne Scarring?

At Reflections, we employ a holistic view of acne scars and tools to treat each of the underlying causes at the source for healthy skin that ages beautifully. No matter what type of acne scars you have, our doctors can create a customized plan to address your current acne scars and also prevent future scarring.

To get started on your journey to smoother, clearer skin, schedule a free consultation today by calling 732-356-1666 or visit our Acne Scar Treatments page to learn more about your best treatment options.