The aim of good acne management is the avoidance of permanent acne scars. These are the depressions in the skin which will not level off with normal skin care. They can take the form of shallow depressions, rolling scars, punched out lesions or deep ice picks.
The dark pigmentation following acne will resolve with time (3 to 6 months). The recovery will be faster with the regular use of skin lightening creams and chemical peels.
Soft acne scars can appear less obvious after treatment with microdermabrasion (about 25 weekly sessions are needed) and TCA peels. Deep ice pick scars may require punch biopsy to remove the tunnel of fibrosis. Subcision has also been used to dissect the fibres that hold the scarred skin down.
Up till recently, the gold standard for removal of acne scars has been laser resurfacing. This process removes the skin from the entire face and it recovers without evidence of acne scars. However, the recovery takes months and can be associated with pigmentary changes. Scar removal may also be incomplete.
Fractional lasers and microneedle dermaroller therapy are newer (low downtime) options for acne scar reduction. A few sessions are needed for either option.
Although no one should ever promise baby smooth skin, there are treatment options available that can improve scarring by more than 50%.