Acne Scars: What They Are and What They Aren’t

As an esthetician, I often hear patients say, “I have so many acne scars!” But when I take a closer look, many times they don’t actually have scars, they have what we call acne marks. These marks can fade with the right skincare, while true acne scars are deeper changes to the skin’s texture. In this blog post, we’ll break down what acne scars really are, what causes them, how to treat them, and how to tell the difference between scars and common lookalikes like dark spots or red marks. Let’s dive in!

What Are Acne Scars?

Acne scars are indentations or raised areas that form in the skin after experiencing acne. They happen when your skin tries to heal deep breakouts like cysts or nodules. During this healing process, your body either loses too much collagen (which leads to indented scars) or produces too much collagen (which leads to raised scars). These scars change the texture of your skin and usually don’t go away without professional treatment.

What Causes Acne Scars?

Not every pimple leads to a scar. Acne scars usually come from:

• Severe or cystic acne

• Picking or popping pimples

• Delays in treating active acne

• Genetics (some people are more prone to scarring than others)

When your skin is injured deeply, it triggers inflammation. That inflammation can damage the deeper layers of your skin, leading to scarring as your body repairs itself.

What Makes Acne Scars and Acne Marks Different?

Acne scars and acne marks may look similar at first, but they’re actually very different. Acne scars are deep changes to the texture of the skin that happen when inflammation damages the skin’s structure. These scars can be sunken or raised and tend to stick around unless treated with professional procedures. On the other hand, acne marks are temporary discoloration that appears after acne heals. They don’t affect the skin’s texture and usually fade over time, especially with the right skincare. Understanding the difference is important because it helps you choose the right treatment. Scars need more intensive options, while marks can often be treated topically or with light-based treatments.

Types of Acne Scars

Let’s look at the main types of scars caused by acne:

1. Ice Pick Scars

These are deep, narrow scars that look like small holes in the skin—almost like someone poked the skin with an ice pick. They're the most difficult type of acne scar to treat.

2. Boxcar Scars

Boxcar scars are wide, shallow depressions with sharp edges. They often appear on the cheeks or temples and can be more noticeable in certain lighting.

3. Rolling Scars

These scars are wide and uneven, giving the skin a wavy texture. They’re caused by damage under the skin that tethers it down.

4. Hypertrophic or Keloid Scars

These are raised scars caused by too much collagen during healing. They’re more common on the chest, back, shoulders, and jawline.

How to Treat Acne Scars

While acne scars can be permanent, there are many ways to improve their appearance. Two of the most effective professional treatments are microneedling and resurfacing lasers.

Microneedling

Microneedling uses tiny needles to create micro-injuries in the skin, which helps stimulate collagen and smooth out the texture over time. It’s great for rolling and boxcar scars and has very little downtime.

• Best for: Rolling scars, boxcar scars

• Downtime: Mild redness for 1–2 days

• Number of sessions: 4–6 treatments, spaced 4–6 weeks apart

Resurfacing Lasers

Resurfacing lasers remove damaged layers of skin and stimulate new collagen growth. One of the most advanced options is the Halo laser, which combines both ablative and non-ablative wavelengths to target deep scars and improve skin texture with less downtime than traditional lasers. Other options include fractional CO2 and erbium lasers.

• Best for: Ice pick, boxcar, and rolling scars

• Downtime: Varies from a few days to over a week, depending on the laser

• Number of sessions: Usually 1–3, depending on scar severity

Other treatments that may be used alongside these include:

• Chemical peels

• Subcision (a needle is used to release scar tissue under the skin)

• Dermal fillers (to temporarily lift indented scars)

Common Skin Conditions That Look Like Acne Scars

Here’s the thing: not every mark left behind by acne is a scar. Many people confuse discoloration or redness with scarring, but these issues are temporary and can fade with time and the right care.

1. Post-Inflammatory Hyperpigmentation (PIH)

PIH shows up as dark brown, purple, or gray spots after a breakout heals. It happens when inflammation causes your skin to produce extra pigment. It’s more common in deeper skin tones.

• Texture: Smooth

• Color: Dark brown, purple, or gray

• Fades on its own: Yes, but slowly (can take months)

How to Treat PIH

To fade PIH, look for pigment-inhibiting and brightening ingredients like:

• Kojic acid

• Vitamin C

• Alpha arbutin

• Tranexamic acid

• Azelaic acid

Professional options like chemical peels and laser treatments can speed up results by exfoliating the skin and breaking up pigment.

2. Post-Inflammatory Erythema (PIE)

PIE appears as red, pink, or purplish spots where acne used to be. This is leftover inflammation and visible blood vessels—not pigment. It’s more common in lighter skin tones.

• Texture: Smooth

• Color: Red or pink

• Fades on its own: Slowly, but yes

How to Treat PIE

Focus on anti-inflammatory and calming ingredients like:

• Azelaic acid

• Centella Asiatica (Cica)

• Green tea extract

• Licorice root

In-office treatments like Broad Band Light (BBL) or vascular lasers (such as pulsed dye lasers) are highly effective at clearing up lingering redness.

3. Enlarged Pores and Uneven Texture

Sometimes people think they have acne scars when they’re really seeing large pores or rough skin texture. These aren’t true scars but can still be improved.

Helpful treatments include:

• Microneedling

• Resurfacing lasers (like Halo)

• Chemical peels

• Retinoids (to smooth and renew skin over time)

Final Thoughts

Understanding the difference between acne scars and acne marks is the first step to clearer, smoother skin. True scars affect the skin’s structure and require professional treatments like microneedling or resurfacing lasers such as the Halo laser. Acne marks—like dark spots (PIH) or redness (PIE)—don’t change your skin’s texture and can often be treated with the right skincare ingredients and professional treatments. If you’re unsure what you’re dealing with, consider seeing a licensed esthetician or dermatologist for a consultation. Knowing what’s really going on with your skin can save you time, money, and frustration—and get you on the right path to healing.