The right approach depends on which type of acne scarring you have — because different scar types respond to different interventions.
1. Post-inflammatory hyperpigmentation (PIH). The most common. Flat brown or reddish marks where a pimple healed. Not true scarring — just melanin overproduction after inflammation. Fades over months on its own; much faster with:
- Daily broad-spectrum sunscreen (non-negotiable — sun deepens PIH)
- Topical retinoids (accelerate turnover)
- Vitamin C serum (brightens)
- Azelaic acid or niacinamide (both work)
- Prescription hydroquinone for stubborn cases
2. Rolling scars. Wave-like depressions from tethered fibrous tissue. Respond to subcision (breaking tethers), microneedling, radiofrequency microneedling, and fillers.
3. Boxcar scars. Wider, box-shaped depressions. Respond to TCA CROSS, ablative laser resurfacing, punch elevation.
4. Ice-pick scars. Narrow, deep, V-shaped scars. Most stubborn. TCA CROSS or punch excision are best options.
5. Hypertrophic or keloid scars. Raised scars, common on chest and back. Intralesional steroids, pulsed dye laser, silicone sheeting.
The internal environment matters too: elevated hs-CRP and HbA1c slow healing and can worsen scarring. Adequate zinc, vitamin D, and protein support scar remodeling. Blood work quantifies your healing environment.