Beauty Tips & Tricks

Skin Care

Your Complete Guide: How to Get Rid of Acne Scars & Dark Marks

12 Sep, 2017
By Daniela Massenz
Few of us get through life unblemished. Happy for us, nowadays our acne scars don't have to be a life sentence.
Chances are you're going to have some acne at some time in your life. For the lucky ones, it will be a brief blip during the teen years, and you’ll sail on unblemished into the rest of your life.
For many of us, however, especially if we've had severe cystic acne, it may leave a permanent reminder - scars that can affect us both physically and emotionally and put a serious damper on our social life.
The amount of scarring after our acne depends on the severity of the acne, how it was treated (and how early), as well as our personal skin make-up.
It's a no brainer to understand that preventing scarring is far preferable to correcting it - this means actively treating acne early, for as long as needed, to prevent or lessen skin inflammation that leads to scarring.
The hard truth is that some of us are unluckily more prone to scarring than others. If you scar badly from an injury, the chances of scarring from acne are pretty good, so take action ASAP.
To treat and hopefully prevent it effectively, we have to know what we’re dealing with...

Anatomy of A Scar

Basically, if you injure yourself, your body will repair itself by knitting the tissues together, and you will be left with a reminder in the form of a scar. How you scar depends on the injury, its treatment and your personal genetics.
The mechanics are still not entirely understood, but great advances in research and scarless healing (or less severe scarring) is showing great promise, and unlike a few years ago, there is a lot we can already do to make new and even old scars less visible.
There’s no single magic bullet, however, as the different types of scars need different solutions.
  • Atrophic scars appear as sunken depressions in the skin, because the skin hasn’t produced enough collagen while your blemishes were healing. There are three main types:
    • Ice pick scars: jagged-edged and deeper than their width.
    • Boxcar scars: Wide rectangular hollows with steep, defined edges.
    • Rolling scars: Broad hollows with rounded, sloping edges.

  • Hypertrophic scars are thick and stand out above the skin. They’re often red or pinkish. It may appear as though you still have acne.

  • Keloid scarring is hard and smooth and stands out above the skin. It occurs when the skin overproduces collagen during the healing process. This tough scar is usually genetic and tends to form most commonly on dark brown and black skin (about 1 in 6 people with black skin and acne vs 1 in 20 people with white or Asian skin types, according to American research). These require more specialist treatment than ordinary acne scars, as the wrong treatment could cause more scarring.

  • Post-Inflammatory Hyperpigmentation (PIH) is commonly considered acne scarring, but is actually discoloration of the skin (darker than your natural skin tone) where it has healed, caused by inflammation during healing. It can affect all skin tones, but is more common among people with darker complexions. With the right treatment and sun protection, you can fade them early – left untreated, it can take up to 18 months - but exposure to UV rays can make them worse.

  • PIH is different to red or purple marks that remain on the healed skin (more common on lighter complexions), which normally fade after a few months. However, you can reduce their appearance more quickly with treatment.

What Makes Things Worse?

Apologies for repeating ourselves yet again, but picking at or squeezing pimples leads to worse inflammation and possible infection, which can cause more damage, as well as darker pigmentation.

It’s worthwhile investing in your skin early – far less expensive than scar treatment - by seeing a dermatologist and qualified therapist at a reputable skin-care clinic (especially one has dermatologists and aethetic doctors on call). Let them manage your acne with regular facials, professional extractions (which won’t cause inflammatory damage), microdermabrasion, gentle chemical peels, etc. They may also use red or blue LED lights to kill bacteria and reduce inflammation.

Carboxy therapy is an effective complementary treatment that improves the effect of other treatments. Tiny amounts of CO2 gas are injected into the target area, stimulating a healing response and helping to heal pimples and active acne by destroying the acne bacteria. It also helps prevent scarring and strengthens the skin.

If a real blinder raises its ugly head, you can nip it in the bud by asking your doctor for a cortisone injection. This will prevent inflammation that leads to scarring. However, don’t do this too often as it can in itself result in scarring.

Related: All About Acne: Myths, Facts and Best Advice

How to Treat Post-Acne Dark Marks

If your pigmentation is not too severe, you can DIY with good-quality skin care:
  • Sunscreen is an absolute must. Use a trusted range with both UVA and UVB protection at high levels.

    We recommend Bionike Defence Sun SPF 50+, La Roche Posay Anthelios SPF50+ Sun range, Bioderma Photoderm range, Vichy Capital Soleil and Eucerin Sun.
  • Skin brighteners. For brown marks, pigment-lightening ingredients like retinol, vitamin C, kojic acid, and licorice can help treat discoloration.
    From Dis-Chem, we recommend the following ranges: BioNike B-Lucent, Vichy ProEven, Uriage Depiderm Anti Brown Spots, Eucerin Even Brighter, Neutrogena Visibly Even, Dermactin Equatone and Olay Total Effects.

    From medispas and doctors, we recommend SkinCeuticals Advanced Pigment Corrector and C E Ferulic, SkinMedica Lytera, Neostrata Enlighten and Lamelle Luminesce.
    For darker complexions, a dermatologist may prescribe hydroquinone. See here for more info on how to treat dark marks.
  • Topical vitamin C serum helps build collagen and promote healing. We like SkinCeuticals C E Ferulic Serum, Uriage Depiderm White Serum and Skin Republic’s 2 Step Brightening Vitamin C & Collagen Face Mask.

  • Vitamin A aka retinoid cream. This skin normalising vitamin has a powerful sebum normalising action. You can buy a quality skin cream or serum (like the Neutrogena Ageless or BioNike Defence Elixage ranges), or your dermatologist can prescribe the renowned Retin-A.

    Caution: retinoids make your skin super-sensitive to the sun, so you have to wear sunscreen and avoid excessive sunlight.

  • Chemical peels are in-salon treatments using ingredients such as glycolic acid, beta-hydroxy acid or TCA to give skin either a superficial or deeper exfoliation to remove dark spots. Ones we like: Lamelle Yellow Peel and Skinceuticals Pigment Balancing Masque.

Related: Pigmentation and Dark Spots Explained: Everything You Need to Know

How to Treat Acne Scars: The Low-Tech Options

Again, sunscreen is important here, and the earlier you tackle the scar (while it is still red and active), the better the result.
There is hope now for even old scars, unlike the old days, but you need to be realistic about your expectations. Depending on the type and severity of the scar, you can expect an improvement of between 30 and 70%. Anything more than that is a gift.
It’s quite likely that you’ll have a mixed bag of scars, so you may need different treatments for each, and you may need a series of treatments.
Consult a dermatologist or reputable aesthetic skin care clinic for treatment options according to your needs and budget:
  • For keloid and hypertrophic scarring, the treatment of choice by dermatologists is steroid creams or steroids injected directly into the skin to thin, soften and flatten raised scars. Skin Renewal also use Titan infra red light, Laser Genesis and Carboxytherapy treatments along with the steroid treatment.

    Unfortunately, this type of scar is prone to recurrence and will need a maintenance programme.  

  • With hollow atrophic scars, dermal fillers with hyaluronic acid can provide a temporary fix as they plump up certain scars (lasting between six months and a year).

The more permanent (and costly solutions) involve targeted in-clinic treatments that rev up collagen production:
  • Microneedling stimulates the skin's ability to repair itself. There are many options, which work by moving a sterile needle head over the targeted area, the microneedles create "mini wounds" that stimulate your body to release healing growth factors, triggering the production of collagen and elastin. This new, fresh collagen forms a smoother, more even appearance on the treated area over time.

  • Platelet-rich plasma treatments, aka vampire facials, make use of your own blood – it’s drawn, put in a centrifuge to separate the plasma, which is then injected back in to the targeted area to stimulate collagen production.
  • These options are most effective for boxcar and rolling scars.

Mini surgery options may be required for more severe scarring:
  • Icepick scars are more problematic because of their depth and they are usually wider at the top and narrower at the bottom. The best option may be a punch excision, where the scar is cut out using a minute ‘cookie cutter’ device, then stitched up, so you end up with a smaller, more even, much flatter scar.

  • Scar subscision can improve the appearance of very deep scars. A trained doctor will insert a special needle into the scar to break the tether that pulls the scarred skin downwards. Following this, other treatments will smooth out the scar tissue itself and leave its colour more even.

How to Treat Acne Scars: The High-Tech Options

Laser/light therapies have multiple functions, from stimulating collagen growth, to treating uneven skin texture, enlarged pores, scars, pigment problems and redness. For skins darker than medium skin tone, the laser options were few in the past, but happily this is changing. Here are a few of our best:
  • Pink or red acne marks can be lightened considerably with pulsed-dye laser (like V-Beam), which targets haemoglobin (red pigment).

  • For scars that are no longer red, Fraxel™ DUAL incorporates 2 lasers in 1 - used separately or together, depending on skin needs, and shows results in as little as 2-3 treatments, with hardly any downtime. It can treat all forms of pigmentation, skin texture and improve acne scars. 

  • The Laser Genesis five-in-one treatment reduces the size of the sebaceous (oil) glands, eliminating inflammation, reducing pore size and improving acne scarring and pigmentation. It is recommended for people with darker skins especially, and is even more effective when combined with Carboxy Therapy and Dermaroller skin needling, say the folk at Skin Renewal.

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