Acne scars: which treatment options are there?

Not every “acne scar” is the same

Most people who come in describe everything acne leaves behind as a “scar”. In practice, though, there are two separate groups, and the approach is completely different. The first is true pitted scarring caused by a loss of tissue. The second is colour change without any loss of tissue: brown marks (post-inflammatory hyperpigmentation) and, particularly in fair skin, pink or red marks. Colour changes often fade on their own over time, whereas pitted scars generally don't improve by themselves.

The main types of pitted scar

• Ice pick scars: narrow, deep scars that look like small punctures. They may respond only modestly to surface treatments.
• Boxcar scars: round or oval depressions with sharp edges and a flatter base.
• Rolling scars: broad scars with soft edges that give the skin a wavy look. Fibrous bands beneath them tether the skin downwards.

Most people have a mix of these types. The type of scar, its depth and its distribution determine which method may help, and to what extent.

How are scars assessed at the consultation?

Looking at scars straight on isn't enough. Under light coming from the side, the depth and edges of the depressions are much clearer. Gently stretching the skin to see whether a scar flattens helps distinguish rolling scars from the others. Skin type, a tendency to pigmentation, previous treatments and the current state of the acne are also noted. Once all this is pieced together, we discuss which method could be planned, in what order and over how many sessions.

Timing: active acne comes first

Starting scar treatment while new spots keep appearing limits the result and does nothing to prevent new scars forming. If acne is active, widespread, painful or cystic, a dermatology assessment and treatment are needed first. Once the acne is under control, planning scar treatment becomes far more meaningful.

If you are taking an oral acne medicine (such as isotretinoin) or have recently stopped, be sure to mention it at your consultation. These medicines can affect how the skin heals, so the physician will assess the timing of procedures such as microneedling and peels separately, and, if needed, decide together with the dermatologist managing your treatment.

Options for pitted scars

Microneedling

Microneedling creates controlled micro-channels in the skin with very fine needles to stimulate the skin's own repair process. It may help boxcar and rolling scars look smoother. Most plans involve several sessions a few weeks apart, and improvement appears gradually over months. Redness and sensitivity for a few days after each session are to be expected.

Combining with PRP

PRP is platelet-rich plasma prepared from your own blood. When used alongside microneedling, the aim is to support the healing process. I'd like to be clear that this combination isn't necessary for everyone and that results vary from person to person; it's something we discuss at the consultation. If you are weighing PRP against other injectable options, see mesotherapy vs PRP.

Chemical peel

A chemical peel renews the skin's surface and may help soften differences in texture and tone. For superficial scars and the colour changes that often accompany them, peels can be scheduled between or after microneedling sessions. The type and depth of peel are chosen according to your skin type and tendency to pigmentation.

The order of these methods matters too. In some plans, a few sessions of microneedling come first to improve texture, with a peel added afterwards for any remaining tone differences. In others, if superficial scars and marks dominate, we start with peels. Enough time is left between sessions for the skin to recover; how long depends on the intensity of the treatment and how your skin responds. The plan is updated at each session based on that response. Patience matters here, because tissue renewal continues for weeks and months after each session, and the final assessment is usually made some time after the plan is complete. For patients travelling to Istanbul, this is why a multi-session plan is best mapped out in advance, ideally through an online consultation.

For post-acne marks

With brown marks where there's no loss of tissue, sun protection comes first, as sun exposure can make these marks linger. In suitable people, methods such as peels and pigmentation-focused mesotherapy may be planned as part of pigmentation treatment. In darker skin tones, aggressive treatments can trigger new pigmentation, so the method and intensity are chosen with particular care.

Protecting your skin between sessions

In scar treatment, the result is shaped not only by what happens in each session but also by how you care for your skin in between. After microneedling or a peel, the skin is temporarily more sensitive and more vulnerable to the sun. Being gentle with it during this time supports healing and reduces the chance of new pigmentation.

• In the first days after a session, pause make-up and products containing acids or retinoids for as long as your physician advises
• Wear a broad-spectrum sunscreen every day, even when it's cloudy
• Don't squeeze spots or pick at scabs; this habit can create new scars
• If your acne flares up again, let us know rather than waiting for your next session

Realistic expectations

Some scar types — particularly very deep, narrow scars or prominent raised (hypertrophic or keloid) scars — may need methods beyond medical aesthetic treatments. In that case, referring you to the appropriate specialty is part of the right plan. For an overview of scar types and options, see our acne scars page.