Acne scars and other scars
Scars get softer and shallower over a course. The type of scar decides the tool.
Pits and dents left by acne, a line from surgery or a cut, a thick raised scar that itches, or a red or brown mark where a spot was: these are all called scars, and they are not the same problem. Acne scarring (post-acne atrophic scarring) comes in three shapes, each with its own treatment. Raised scars behave differently again. Flat red or brown marks are not scars at all and fade with the right skincare.
The honest answer up front: scars can be softened and shallowed, and none of this erases them. The right treatment for the type improves them over a course, and results keep building for months afterwards. At Nova the main tools are microneedling, a superficial peel series and PRP or PRF with microneedling, with referral to a plastic surgeon for the scar types that need surgical techniques. Active acne must be under control before any of it starts, because new spots make new scars.
What causes it
A scar forms when inflammation or injury reaches below the surface and the skin repairs itself with collagen laid down differently from the original. In acne, a deep spot destroys a small column of tissue; as it heals the skin either loses volume (a dent) or overbuilds (a lump). Picking makes both worse.
Dented acne scars come in three kinds. Ice pick scars are narrow, deep pits, like a hole made with a sharp point. Boxcar scars are wider with sharp vertical walls, shallow or deep. Rolling scars are broad and soft-edged, tethered from underneath, and they flatten when the skin is stretched. Most faces have a mix.
Raised scars are either hypertrophic, staying within the original wound and often settling over a year or two, or keloid, growing beyond it, commonest on the jawline, chest, shoulders and earlobes. Skin of colour carries a much higher keloid risk, which changes what we will do.
Then there are the marks that are not scars. Flat pink or red marks (post-inflammatory erythema) are lingering small vessels and fade within about a year. Brown marks (post-inflammatory hyperpigmentation) are pigment, slower to fade and commoner in darker skin. Both are on our pigmentation page.
What actually treats it
First, stop the acne. If spots are still appearing, every new one can scar, and NICE advises referral for acne that is causing scars. Prescription creams and tablets for acne are discussed at a consultation, and your GP can prescribe them. Long-term use of a prescription retinoid cream also softens mild dented scars over time.
Rolling and shallow boxcar scars are where clinic treatment does most. Microneedling, a course of three to six sessions at least three weeks apart, builds new collagen under the scar and smooths the edges. It works across skin types and is our usual choice for darker skin because it keeps the surface intact and carries a lower pigment risk than peels or light. Your own PRP or PRF can be added on the same visit. A course of superficial peels improves surface texture around shallow scars. A small amount of filler under a tethered rolling scar lifts the dent for the months it lasts.
Ice pick and deep boxcar scars need techniques that cut or lift the scar itself, and a superficial peel or needling will not reach them. We refer these to Mr Benedict Reed, our plastic surgery partner.
Raised and keloid scars are treated with silicone gel or sheets and, through your GP or a dermatologist, steroid injections into the scar. We do not needle or resurface skin that is keloid-prone without a specialist plan, because injury can make a new keloid.
Red marks after acne respond to IPL in lighter skin types. Brown marks respond to sunscreen, a lightening routine and gentle peels, not to light.
Surgical and injury scars that are flat and mature improve with microneedling and, where pigmented, the same pigment routine. Fresh scars are left to settle for several months first.
The order of work is redness first, then overall texture, then individual scars. Skin boosters improve skin quality around scars without filling them, and HIFU does not treat scars at all.
When to see your GP
See your GP if acne is still active and leaving scars, because that is a reason for dermatology referral under NICE guidance; if a scar is growing beyond the original wound, itching or painful, which suggests a keloid; if a scar changes colour, develops a lump or bleeds; or if scarring is affecting your mood or how you live, which matters as much as the skin. NICE also advises referral when severe acne scarring persists a year after the acne has cleared.
The honest limit
No treatment makes a scar disappear. A course of microneedling or peels softens rolling and shallow scars by a margin you can see, over months, and deep pits need surgery. We will not needle or peel over active acne, and we will not resurface keloid-prone skin without a specialist plan. New acne makes new scars, so the acne comes first. Results vary and cannot be guaranteed.
Skincare at home
Sunscreen every day: sun makes scars and the marks around them darker and slower to fade. A retinol at night, built up slowly, improves texture and softens mild scars over months; do not use retinol or any retinoid if you are pregnant, planning a pregnancy or breastfeeding. Vitamin C in the morning for the marks. For a fresh or raised scar, silicone gel twice a day for several months is the one home treatment with evidence. Leave scabs alone.
From the Obagi range we stock: Obagi Sun Shield Mineral SPF50 85g; Obagi Retinol 0.5 28g, moving up to Obagi Retinol 1.0 28g when tolerated; Obagi Professional-C 15% Serum 30ml; Obagi Hydrate 48g to keep the barrier settled during a course. After microneedling or a peel we use the Obagi Post Procedure Kit.
Common questions
Can acne scars be cleared completely?
No. They are softened and shallowed. Rolling and shallow boxcar scars improve the most with a course of microneedling or peels; deep ice pick scars need surgical techniques. Results build over months and vary from person to person.
Which treatment is right for my acne scars?
It depends on the shape. Rolling and shallow scars: microneedling, with or without PRP, and peels. Deep narrow pits: referral to our plastic surgeon. Raised scars: silicone and steroid injections through your GP. We look at the scars under good light and tell you which you have.
How many microneedling sessions for scars?
Usually three to six, at least three weeks apart, commonly monthly. Improvement shows gradually and keeps building for months after the last session. Results vary and cannot be guaranteed.
Does microneedling work on dark skin?
Yes, and it is our usual choice for darker skin because it keeps the surface intact and carries a lower risk of dark marks than peels or light. We screen for keloid tendency first and go gently.
Can you treat scars while I still have acne?
No. Needling or peeling over active spots spreads the problem and makes new scars. The acne is controlled first, with prescription treatment where needed, then we start on the scars.
Are the red marks after spots scars?
No. They are small lingering vessels and fade on their own within about a year. IPL speeds them up in lighter skin. Brown marks are pigment, not scarring, and need sunscreen and a lightening routine rather than light.
What about a keloid scar?
Keloids grow beyond the original wound and are commoner in darker skin. They are treated with silicone and steroid injections through your GP or a dermatologist. We do not needle or resurface keloid-prone skin without a specialist plan.
Related treatments
Book a free consultation. Or message us on WhatsApp: 077 21 400 600.
Nova Beauty Clinic is in East Finchley, three minutes on foot from East Finchley station on the Northern line, with a car park next door. People come to us about acne scarring from Hampstead, Highgate, Muswell Hill and Finchley, and from Hampstead Garden Suburb, Golders Green, Crouch End and Barnet.
This page is general information, not medical advice. What suits you depends on your own skin, health and history, which we go through at a free consultation before anything is booked.