Acne Scars

The flat marks fade and the scars do not, so which of the two you have decides whether waiting is sensible. A red or brown mark left after a breakout is a change in colour with the structure of the skin intact. The red comes from a change in the small blood vessels with thinning of the epidermis above them, and the brown is melanin laid down in skin that was recently inflamed. Colour changes from acne improve with time, and that can take months or longer, longer again in darker skin and longer still on a face that gets no sun protection. A scar is different, because tissue has been lost or added. Acne scars can fade, and they rarely go away completely on their own. A depressed scar is the finished result of the repair rather than a stage on the way to one, and the skin around it loses collagen with age, so the same scar can read more strongly at fifty than it did at twenty. Raised scars are the one case where waiting is reasonable, since a hypertrophic scar is more likely to regress than a keloid. Run a fingertip over the area with your eyes closed: colour you cannot feel will keep fading, and a dip or a ridge you can feel is what treatment is for.

No, and treating them as scars means paying for the wrong thing. The clinical names are post-inflammatory erythema for the red and post-inflammatory hyperpigmentation for the brown. In both, the skin came through with its collagen intact and only its colour changed. That is why the two need opposite treatment. A scar needs collagen built into a depression, which means needles or energy. A mark needs its colour broken down, which means light taken up by the vessels or the pigment, peels, or topicals working on melanin, and a mark will also clear on its own with time and sun protection. Pigment is more stubborn in darker skin, where post-inflammatory pigmentation is more intense and persists longer than it does in lighter skin, and ultraviolet light darkens the patches further, so sun protection changes the timeline more than any product does. Marks and scars sit side by side on a face that has had significant acne, and they can occupy the same spot: a dip in the surface with a brown mark lying flat inside it. Clearing the marks first shows how much real scarring is there, which is a cheaper way to find out than a course of treatment aimed at scars that turn out to be pigment.

Rolling scars and shallow boxcar scars improve over a course of treatment, and sharp narrow ice pick scars respond least to anything we offer. The difference is depth and shape. Ice pick scars are under two millimetres across with a sharp margin extending to the deep dermis, and that depth of involvement makes them resistant to conventional skin resurfacing. Boxcar scars split by depth: the shallow ones respond to resurfacing treatment and the deeper ones, with their sharply cut vertical edges, resist it. Rolling scars are held down from underneath by fibrous tissue anchoring the dermis to the layer below, so correction has to address that pull as well as the collagen at the surface. Microneedling and RF microneedling stimulate collagen production in the depression and work best on rolling and boxcar scarring. The improvement builds over the weeks after each session and keeps developing after the course finishes, since collagen remodelling continues past twelve months, so judging a result a fortnight after the last appointment undersells it. The honest target is a clear improvement in how light falls across the skin rather than a flat surface. Raised scars are a separate case: they are the result of too much collagen, so building more collagen is not the answer.

No, active acne is treated before scar treatment starts, and the order is not a preference. Resurfacing or needling a face that is still producing nodules and cysts means new scars form in the same area while the old ones are being corrected, so you pay twice for the same patch of skin. Treating inflamed skin also raises the chance of the treatment leaving pigment change behind it. Prescription acne treatment comes from a doctor who prescribes it, so the sequence runs in that order: get the acne treated, hold it clear, then look at what scarring is left. The wait is not wasted time, because the flat red and brown marks fade during it and what remains at the end is the real scarring, which can be less than the mirror suggested while the acne was active. Some treatment can run alongside acne that is mild and settled. Salicylic acid is oil-soluble and works inside the pore, so salicylic peels do useful work on breakouts and on the marks they leave, repeated every two to four weeks. For severe or cystic acne, peels sit alongside medical treatment rather than instead of it. What does not run alongside active acne is anything that resurfaces or needles the skin.

Cost depends on which scar types are present, because the treatments that correct them are priced differently and used in different amounts, so a figure quoted before anyone has looked at your face would be a guess. Microneedling and Intensif are priced by session and by course, since collagen builds across a series rather than in one appointment, and scarring takes more sessions than surface texture does. A face that also carries red and brown marks needs IPL or peels alongside the needling, which is a second line on the plan rather than a different one. A face whose scarring is mostly ice pick needs something other than microneedling, and that changes the arithmetic again. Area matters as well, since scarring across both cheeks, the temples and the jawline takes longer per session than one cheek. Then there is how long the result holds. Collagen built by a course of RF microneedling continues to improve for up to a year after the final session rather than wearing off, so the cost sits against years instead of months. Products are a separate cost and the part that protects the result, because a retinoid and a daily sunscreen keep the marks fading between appointments. Consultations are complimentary at both clinics, and the plan and its cost are set out for your own skin there.