Pits ("icepick")
Narrow deep indentations, similar to an enlarged pore or a pinprick mark.
CONDITION / SKIN AND SCARS
Acne scars (post-acne).
Scars after acne (post-acne) — pits, sunken areas, less often thick scars remaining at the site of deep pimples. It is impossible to remove them completely, but laser and other methods can make the skin smoother and the scars less noticeable.
CONCEPTUAL VISUALIZATION- What it is
- Traces at the site of deep pimples: pits, sunken areas, less often — thick raised scars.
- How common
- In a review of 37 studies (24,649 patients with acne), scars were found in 47%.
- How we treat
- First, acne is stopped, then — laser, light, and other methods, often in combination.
- Who treats it
- Dermatologist; if necessary — together with a plastic surgeon.
01 / WHAT IS ITWhat is
What is
Scars after acne.
Acne is the inflammation of sebaceous glands and hair follicles of the skin. A scar may remain at the site of inflammation: sunken (atrophic) or, more rarely, raised — hypertrophic or keloid.
Scars after acne are common. According to a review in JAMA, acne affects about 85% of people aged 12–24 years and can leave permanent scars. In a meta-analysis of 37 studies (24,649 patients with acne), 47% had scars.
It is worth distinguishing scars from spots. Red or brown spots at the site of pimples are changes in skin color; a scar is a change in its surface: a pit or a bump. Sometimes both occur together, and they are treated differently.
Scars on the face affect well-being. Acne is associated with anxiety, depression, and suicidal thoughts — this should be told to a doctor, not endured.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWhich are
Which are
Scars after acne.
The most common type is atrophic, meaning sunken scars. They are divided into three types, and the choice of methods depends on the type, severity, and number of scars.
Sunken areas ("boxcar")
Wider indentations with clear, almost vertical edges.
Waves ("rolling")
Gentle depressions without clear edges: the skin looks bumpy.
Raised scars
Thick, dense scars. If the scar extends beyond the former acne lesion — it is a keloid.
Keloid scarRed or dark spots
Flat spots in the place of pimples, without a pit. Sometimes they are called flat scars; they are treated differently from pits.
mood
The person avoids mirrors, photos, and meetings. It is worth telling the doctor about this.
03 / REASONSWhy pimples
Why pimples
leave scars.
Scarring after acne can usually be prevented if acne is treated early and effectively — this is what dermatologists who created a risk assessment tool write. The problem is that people often do not seek help in time.
Severe acne
The more severe the acne, the higher the risk of scarring: in a meta-analysis of 37 studies, acne severity was one of the three risk factors.
Prolonged acne
The duration of acne is one of the four risk factors in the tool created by expert dermatologists.
Heredity
The risk is higher if there was acne or scarring in the family.
Popping
Pimples should not be popped or scratched: this can cause scarring.
Sex
In a meta-analysis, scars were associated with male sex.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Acne scars do not require emergency care: this is a planned situation. But during acne treatment with medication or after procedures, there are signs that should not be waited on.
103 immediately if:
- Sudden swelling of the lips, tongue, or throat;
- it is difficult to breathe or breathing is very frequent;
- Throat tightness, difficulty swallowing;
- Lips, tongue, or skin turning blue, gray, or suddenly pale;
- Sudden severe confusion, drowsiness, or dizziness;
- The person has fainted and does not regain consciousness;
- The person has seriously harmed themselves or feels they might do so right now.
Do not delay a visit to the doctor:
On the same day: During isotretinoin treatment, severe abdominal pain with nausea or vomiting, thoughts of self-harm, or other serious side effects occur; a scar or skin after the procedure is swollen, painful, warm to the touch, or oozing pus. Soon — see a dermatologist: Acne is deep, painful, or already leaving scars; treatments you have tried yourself do not help; acne is affecting your mood. Planned: Acne has cleared, but scars remain and bother you — schedule a consultation.
05 / DIAGNOSTICSAs defined,
As defined,
what to treat
- Conversation
Are there still pimples, how and with what was acne treated, whether isotretinoin was taken and when the course ended, what procedures have already been done.
- Skin examination
The doctor assesses whether acne is still active, which types of scars prevail, how many there are and how deep they are, whether there are spots and raised scars.
- Skin type
The choice of procedures and their schedule depends on the skin type: IPL, for example, is selected according to skin type.
- Photo
In standard angles — to plan treatment and compare changes between sessions.
06 / TREATMENTHow we treat
How we treat
Scars after acne.
It is completely impossible to remove scars: the goal is to make the skin smoother and the scars less noticeable. A systematic review of 89 studies notes that there are few high-quality studies, and combining methods usually gives better results than a single method.
01
First — stop acne.
As new pimples appear, new scars also appear.
- Treatment by a dermatologist.
- Active acne is treated by a dermatologist. The 2024 guideline of the American Academy of Dermatology recommends skin products (retinoids, benzoyl peroxide, antibiotics), and if necessary — pills.
- Isotretinoin.
- The guideline strongly recommends these drugs for severe acne, acne with scars, or acne that is very depressing. The course usually lasts about 3 months; the medication is prescribed only by a doctor, with regular tests.
- Important during pregnancy
- Isotretinoin must not be taken during pregnancy or when planning it: it can cause miscarriage or severe birth defects. Contraception is required at least one month before the course and one month after.
- Do not squeeze
- Squeezing and scratching pimples can cause scars.
02
Laser and light
First-line treatment for many types of scars.
- Fractional CO2 laser
- Used to make scars smoother and less noticeable. In a meta-analysis of 6 studies (467 patients) with raised scars after such a laser, the skin was smoother than after other methods.
- International consensus
- 24 dermatologists and plastic surgeons from 12 countries consider lasers and other devices as first-line treatment for various types of acne scars.
- Red and dark spots
- In a review of 9 studies, lasers improved the redness and pigmentation of flat acne scars; side effects were minor and temporary. Intense pulsed light (IPL) is also used for redness and pigmentation.
03
Other methods
The doctor selects them based on the type of scars and often combines them with laser treatment.
- Microneedling
- The skin is pierced with thin needles. In a meta-analysis of 12 randomized studies (414 participants), microneedling without radiofrequency gave better scar improvement than comparison methods, although patient satisfaction mostly did not differ.
- Subcision and excision
- Surgical methods for inflamed scars: subcision, excision, or lifting individual scars. There is less evidence for subcision than for lasers.
- Fillers and peels
- Hyaluronic acid-based fillers fill depressions, chemical peels smooth the surface. There is still less evidence for autologous fat (lipofilling).
- Raised scars
- Thick and keloid scars are treated differently: silicone, steroid injections into the scar, cryotherapy, laser.
04
Deadlines
- Procedures and isotretinoin
- Opinions differ here. A leaflet for patients from the British NHS advises against chemical peels, microdermabrasion, and laser hair removal during a course of isotretinoin. A 2017 systematic review with consensus found insufficient evidence that superficial peels, laser hair removal, or fractional laser should be postponed, but it does not recommend mechanical dermabrasion and fully ablative laser during the course. Therefore, the decision of what and when to do is made by the doctor, considering your course and skin.
- Several sessions
- The number of sessions is determined by the doctor after the examination and the plan is adjusted during follow-up check-ups.
- Sun protection
- After procedures and on scars — SPF 30 cream or higher.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Acne scars at the Doctor Valikhnovskyi Surgery Institute are treated under the direction of "Rehabilitation after aesthetic surgeries." Fractional CO2 laser and IPL device are the clinic's own equipment, and the plan is developed and managed by a dermatologist. Active acne must first be treated by a dermatologist.
CLINIC SERVICE
Rehabilitation after aesthetic surgery
Laser and IPL for scars, lymphatic drainage, physiotherapy, and dermatologist supervision after plastic surgeries.
View service
What we do for this condition
- Fractional CO2 laser — to make scars smoother and less noticeable, and the skin texture more uniform; the number of sessions is determined by the doctor.
- IPL — intense pulsed light — for redness and pigmentation of the skin and scars; the program is selected according to skin type.
- Dermatologist consultation and supervision — assessment of scars and skin, procedure plan, adjustments during follow-up visits.
- Selection of home care — sun protection, and for raised scars — silicone gel or sheets.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos of your face straight on and from the side in daylight — the doctor will preliminarily assess the scars.
- ConsultationDermatologist examination: whether acne is still active, types of scars, skin type, what medications you are taking.
- PlanFirst — control acne if it is still present; then — a course of laser or IPL, separately or combined.
- ProceduresLaser or IPL; the number of sessions is determined by the doctor based on scars and skin.
- ControlSun protection and follow-up examinations where the doctor adjusts the plan.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it possible to completely remove acne scars?
No. The goal of treatment is to make the skin smoother and the scars less noticeable. According to systematic reviews, combining several methods usually gives better results than using just one method.
Acne is still appearing. Can scars already be treated?
It is important to stop acne first — otherwise, new scars will appear. Whether procedures can be started simultaneously will be decided by the doctor after an examination.
Is it possible to undergo laser treatment during a course of isotretinoin?
This is decided by a doctor, because opinions differ. The 2017 consensus did not find sufficient evidence that fractional laser must be postponed, but mechanical dermabrasion and fully ablative laser during the course are not recommended. Patient guidelines are more cautious and advise avoiding peels, microdermabrasion, and laser hair removal during the course. Be sure to mention that you are taking these medications.
Are red and dark spots also scars?
This is a change in skin color, not its surface. Such spots are treated differently from pits: for redness and pigmentation, laser or IPL is used.
How many laser sessions will be needed?
It depends on the type and depth of the scars and the skin type. The doctor will indicate the number of sessions after an examination.
Is it okay to squeeze pimples?
No. Squeezing and scratching pimples is one of the risk factors for scarring.
I avoid people because of scars. Is this normal?
This happens often: acne is associated with anxiety and depression. Tell your doctor about it — in addition to treating your skin, a psychotherapist may help.
Sources
18 sources · guideline, international consensuses, systematic reviews, and NHSshowCollapse
- Energy-based devices for the treatment of Acne Scars: 2022 International consensus recommendationsLasers in Surgery and Medicine, 2022doi:10.1002/lsm.23484 ↗
- Guidelines of care for the management of acne vulgarisJournal of the American Academy of Dermatology, 2024doi:10.1016/j.jaad.2023.12.017 ↗
- Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus RecommendationsJAMA Dermatology, 2017doi:10.1001/jamadermatol.2017.2077 ↗
- Prevalence and risk factors of acne scars in patients with acne vulgarisSkin Research and Technology, 2023doi:10.1111/srt.13386 ↗
- Acne Scarring Management: Systematic Review and Evaluation of the EvidenceAmerican Journal of Clinical Dermatology, 2018doi:10.1007/s40257-018-0358-5 ↗
- A Review and Update of Treatment Options Using the Acne Scar Classification SystemDermatologic Surgery, 2019doi:10.1097/DSS.0000000000001765 ↗
- A systematic review and meta-analysis on the effects of the ultra-pulse CO2 fractional laser in the treatment of depressed acne scarsAnnals of Palliative Medicine, 2022doi:10.21037/apm-22-70 ↗
- Lasers for the treatment of erythema, dyspigmentation, and decreased elasticity in macular acne scars: a systematic reviewLasers in Medical Science, 2022doi:10.1007/s10103-022-03621-0 ↗
- Microneedling Monotherapy for Acne Scar: Systematic Review and Meta-Analysis of Randomized Controlled TrialsAesthetic Plastic Surgery, 2022doi:10.1007/s00266-022-02845-3 ↗
- Management of Acne Vulgaris: A ReviewJAMA, 2021doi:10.1001/jama.2021.17633 ↗
- Development of an atrophic acne scar risk assessment toolJournal of the European Academy of Dermatology and Venereology, 2017doi:10.1111/jdv.14325 ↗
- Evidence-based management of cutaneous scarring in dermatology part 2: atrophic acne scarringArchives of Dermatological Research, 2023doi:10.1007/s00403-023-02737-9 ↗
- A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniquesScars, Burns & Healing, 2017doi:10.1177/2059513117695312 ↗
- AcneNHS, 2026nhs.uk/conditions/acne ↗
- Isotretinoin (Roaccutane)NHS, 2026nhs.uk/medicines/isotretinoin-roaccutane ↗
- ScarsNHS, 2023nhs.uk/conditions/scars ↗
- AnaphylaxisNHS, 2023nhs.uk/conditions/anaphylaxis ↗
- Help for suicidal thoughtsNHS, 2024nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/help-for-suicidal-thoughts ↗
The figures on the page are from these sources.
Scars after acne
won’t leave you alone?
Send photos of the face straight on and from the side in daylight. The doctor will say what can be improved and where to start.