Your acne may have cleared years ago, but the scars it left behind can still feel very present. Uneven texture, pitted marks, or skin that never quite looks smooth can be a constant reminder of something you thought you had moved past. For many people, acne scarring affects far more than appearance. It can shape how confident you feel day to day, in ways that those who have never experienced it may not fully understand.
You may find yourself relying on make-up as a form of camouflage, avoiding close-up mirrors, or feeling uncomfortable in photographs, even when everything else feels good. These small, repeated moments can have a surprisingly big impact over time.
At Aesthetics by Dr Rachel, I offer doctor-led, evidence-based treatments designed to improve the appearance of acne scarring in a thoughtful, tailored way. Every plan is based on a detailed assessment of your skin, with a focus on improving texture, skin quality, and confidence gradually and safely.
Acne scarring is a long-lasting change in skin texture that can develop after inflammatory acne has healed. When acne affects the deeper layers of the skin, it can disrupt the normal collagen support structure. As the skin repairs itself, this healing process does not always occur in a balanced way.
If too little collagen is produced during healing, indented or pitted scars can form (atrophic scars). In other cases, the skin mounts an overactive repair response and produces excess collagen, leading to raised scars (hypertrophic scars). In both situations, the result is uneven skin texture that can remain long after active acne has settled.
Acne scars are different from the temporary marks that often follow a breakout. Flat red or brown marks, known as post-inflammatory erythema or hyperpigmentation, are colour changes rather than true scars and often fade gradually with time and appropriate skincare. True acne scars involve a structural change within the skin and usually require targeted treatment to significantly improve texture.
• Pitted or depressed scars (atrophic acne scarring)
• Rolling scars (wave-like texture, often on cheeks)
• Ice-pick scars (deep, narrow marks that can resemble enlarged pores)
• Boxcar scars (sharper-edged depressions on cheeks/temples)
• Acne that is now under control but has left lasting textural change
• A desire to improve skin texture without invasive surgery
• Uneven skin texture that makeup cannot fully disguise
Crepey skin develops as collagen and elastin levels within the skin gradually decline. These proteins are essential for skin strength, thickness and elasticity. As their production slows, the skin becomes thinner, less resilient and slower to bounce back when stretched. This loss of collagen and elastin is influenced by a combination of internal factors, such as natural ageing and hormonal changes, and external factors, including sun exposure and environmental stress. Understanding this process helps explain why effective treatment focuses on improving skin quality and supporting collagen and elastin renewal from within, rather than simply tightening the surface.
• Collagen production gradually decreases with age, estimated at around 1% per year from early adulthood, leading to thinner skin with reduced structural support
• Elastin fibres lose their ability to stretch and recoil effectively, meaning the skin is slower to snap back and more likely to remain creased
• Natural oil production slows over time, weakening the skin’s protective barrier and reducing moisture retention
• Cell turnover becomes less efficient, so damaged or ageing skin cells are replaced more slowly, contributing to a fragile, dull skin appearance
• Ultraviolet radiation is responsible for the majority of visible skin ageing, accelerating the breakdown of collagen and elastin within the skin
• The effects of sun exposure are cumulative, with damage building up over decades and often becoming more noticeable later in life
• Areas that are regularly exposed to sunlight, such as the face, neck, décolletage and arms, are often the first to develop crepey changes in skin texture and quality
• Declining oestrogen levels during perimenopause and menopause significantly accelerate collagen loss, with studies showing that women can lose up to 30% of their skin’s collagen within the first 5 years after menopause
• Reduced hormone levels affect skin hydration, thickness and the skin’s natural ability to repair and regenerate, contributing to increased fragility and crepey texture
• Significant or rapid weight loss can leave the skin loose and thinner, having lost the underlying structural support that maintains firmness
• Smoking accelerates the breakdown of collagen and elastin while also reducing blood flow and oxygen delivery to the skin
• Chronic dehydration can make the skin appear dull, thinner and more fragile, exaggerating crepey texture
• Poor nutrition, particularly diets low in protein, vitamins and antioxidants, reduces the skin’s ability to repair, regenerate and maintain healthy structure
Acne scarring develops as part of the skin’s healing response to inflammation. Understanding why scars form helps explain why early acne treatment and appropriate scar management are so important.
The more inflamed a breakout becomes, the higher the risk of scarring. Cystic and nodular acne develop deep within the skin and can cause significant damage to the surrounding tissue. As these lesions heal, the normal collagen framework is often disrupted. If the skin is unable to repair this structure evenly, indented or raised scars may form and remain in your skin.
Picking, squeezing, or repeatedly touching spots increases inflammation and can push bacteria deeper into the skin. This creates additional trauma and significantly raises the risk of scarring. Even relatively mild acne can lead to lasting marks if lesions are repeatedly traumatised during the healing process.
The longer acne remains active and untreated, the greater the chance of scarring. Ongoing inflammation over months or years causes cumulative damage to the skin’s support structures. Early, effective treatment helps reduce both the severity and duration of breakouts, limiting the opportunity for scars to form.
Some people are naturally more prone to acne scarring than others. A family history of acne scars can increase your own risk. Genetics also influence how your skin produces and remodels collagen during healing, which affects how scars develop.
Darker skin tones are more likely to develop post-inflammatory hyperpigmentation alongside textural scarring. There is also a higher risk of raised scarring, including keloids, in some individuals. Understanding your skin type is essential when choosing treatments that are both safe and effective.
Not all acne scars are the same, and understanding the type of scarring present is essential when choosing the most effective treatment approach.
Based on their structure, acne scars are broadly classified into three categories: atrophic, hypertrophic, and pigment-related changes (dyschromic). Most acne scars (around 75–90%) are atrophic scars. These are indented scars that sit below the surface of the skin. Raised scars, known as hypertrophic or keloid scars, are far less common and occur when the skin produces excess collagen during healing.
Identifying your scar type allows treatment to be tailored accurately, as different scars respond best to different techniques.
Ice pick scars are the most common type of atrophic acne scar, accounting for around 60-70% of cases. They appear as narrow, deep, V-shaped indentations that extend into the deeper layers of the skin. They often resemble enlarged pores or small puncture marks.
Ice pick scars are usually less than 2 mm wide, but their depth makes them among the most challenging acne scars to treat. They are more common in areas of the face where the skin is thinner, such as the forehead and upper cheeks and tend to respond best to treatments that work deeper within the skin, rather than surface-level resurfacing alone. Ice pick scars are one of the more challenging types of acne scar to treat.
Boxcar scars account for around 20–30% of atrophic acne scars. They appear as round or oval depressions with clearly defined, sharp edges and a relatively flat base. These scars typically sit 0.1–0.5 mm below the surrounding skin, giving a pitted appearance similar to chickenpox scarring.
Boxcar scars can be shallow or deeper. Shallower boxcar scars often respond well to resurfacing treatments, while deeper scars usually require combination approaches to achieve meaningful improvement. Boxcar scars are more common in areas of the face where the skin is thicker, such as the lower cheeks and jaw.
Rolling scars make up around 15–25% of atrophic acne scars. They are wider than ice pick or boxcar scars, typically 4–5 mm or more across, with gently sloping edges that give the skin an uneven, wave-like appearance. Rolling scars develop when fibrous bands of scar tissue form beneath the skin, tethering the surface to deeper structures and pulling it downward. Because of this underlying tethering, rolling scars often respond particularly well to treatments that release these bands and stimulate collagen remodelling.
Hypertrophic and keloid scars are raised scars that sit above the level of the surrounding skin, unlike atrophic scars which are depressed. They develop when the body mounts an overactive repair response during healing and produces excess collagen and fibrous tissue at the site of an acne lesion.
Hypertrophic scars remain confined to the boundaries of the original acne lesion, while keloid scars extend beyond it into the surrounding skin. These types of scars are more commonly seen on areas such as the chest, back, shoulders, and jawline, where the skin is thicker. They are also more prevalent in individuals with darker skin tones.
Because raised scars behave differently from depressed acne scars, they require different treatment approaches and careful assessment to ensure treatment is both safe and effective.
Most people with acne scarring have a combination of different scar types rather than just one. It is common to see ice pick scars on the cheeks, boxcar scars on the temples, and rolling scars across the lower face. Because each scar type behaves differently and responds to different treatments, a thorough assessment is essential. This allows all scar patterns to be identified and a personalised treatment plan to be created that addresses each one appropriately, rather than taking a one-size-fits-all approach.
Effective acne scar treatment relies on matching the right technique to the right type of scar. There is no single treatment that works for all acne scars, which is why I carry out a thorough assessment of your skin and create a personalised treatment plan tailored to you.
Before treating acne scars, it is essential that any active acne is well controlled. This helps reduce the risk of new scarring developing while treatment is underway and allows us to achieve the best possible results.
If, after assessment, I feel that a treatment outside my clinic, such as laser therapy, would be more suitable or effective for your specific scarring, I will always discuss this with you and refer you on appropriately. My priority is ensuring you receive the most effective, evidence-based treatment for your skin, even if that means directing you elsewhere.
Microneedling works by creating thousands of tiny, controlled micro-injuries in the skin using fine needles. This stimulates the body’s natural wound-healing response, encouraging new collagen and elastin production. As fresh collagen forms, it helps to support the skin from below, gradually improving depressed scars and smoothing overall texture. Results are enhanced when microneedling is combined with clinical-grade serums, such as exosomes.
For acne scarring, I usually recommend a longer course of treatment, typically 5–6 sessions, rather than shorter maintenance courses used for general skin rejuvenation. Treatments are usually spaced 4–6 weeks apart, and for scarring I work at greater depths, often up to around 2.5–3 mm, depending on the area and your skin’s tolerance.
Microneedling is particularly effective for rolling scars, shallow boxcar scars, and overall textural improvement, and results can often be enhanced by combining microneedling with targeted chemical peels as part of a structured treatment plan.
Compared with laser treatments, microneedling is generally associated with a lower risk of post-procedural pain and post-inflammatory hyperpigmentation, particularly in patients with higher-risk skin types. This makes it a versatile and well-tolerated option for many people when treating acne scarring.
Chemical peels work by removing the outer layers of damaged skin, encouraging the growth of new, smoother skin beneath. I use professional-grade resurfacing treatments, including pHformula and trichloroacetic acid (TCA) peels, which can be carefully tailored to your skin type, scar pattern, and skin sensitivity.
Superficial peels are well-suited to mild scarring and overall texture improvement, while medium-depth peels, including targeted TCA peels, can address more established scarring and uneven skin texture. Chemical peels are also particularly helpful for fading post-inflammatory hyperpigmentation, which commonly accompanies acne scarring.
Peels are often used as part of a combination treatment approach, either alongside or between other treatments, to enhance results while maintaining skin safety.
PLLA biostimulators work by stimulating your own collagen production deep within the skin, making them particularly effective for atrophic acne scarring, especially moderate to severe rolling scars where structural support has been lost.
Results can be significantly enhanced when PLLA treatments are combined with subcision, which releases the fibrous bands tethering rolling scars down. Used together, this approach addresses both the mechanical pulling of the scar and the underlying collagen deficiency.
Once collagen has been stimulated, results can last up to 24 months, making PLLA an excellent option for longer-term improvement. As always, I will assess your scarring carefully and advise whether this approach is suitable, or recommend an alternative treatment if something else would be more effective.
Polynucleotides are regenerative treatments that work at a cellular level to support skin repair and improve skin quality. They stimulate fibroblast activity, encouraging new collagen production and improving overall skin resilience.
In acne scarring, I often use polynucleotides as a priming treatment before other procedures. By strengthening and stabilising the skin, they help prepare it for treatments such as microneedling, subcision, or biostimulators, and can also support recovery when used between or after treatments as part of a combination approach.
Exosomes are advanced regenerative treatments that work by delivering powerful cellular signalling molecules to the skin. When used in combination with microneedling, they help enhance the skin’s natural repair processes and support collagen regeneration.
Microneedling creates controlled micro-channels in the skin, allowing exosomes to be absorbed more effectively into the deeper layers. Once delivered, exosomes help signal fibroblasts to support collagen production, while also calming inflammation and promoting more efficient healing. This combination can improve skin texture, resilience, and overall scar quality over time.
For acne scarring, exosomes are particularly helpful as part of a combination approach, supporting both collagen stimulation and post-treatment recovery. By improving how the skin heals and remodels after microneedling, they can help optimise results and reduce downtime, making them a valuable adjunct in structured acne scar treatment plans.
For most people with acne scarring, the most effective results come from a carefully planned combination approach rather than a single treatment. Acne scarring affects different layers of the skin, so treatment needs to be strategic and layered, addressing both surface texture and deeper structural changes over time.
I design each treatment plan to work progressively through the skin, often starting by preparing and strengthening the tissue before moving on to more targeted interventions. This considered approach allows treatments to work synergistically, helping to achieve safer, more meaningful, and longer-lasting improvement.
Supporting your in-clinic treatments with effective daily skincare is an essential part of achieving optimal results. Ingredients such as retinoids help encourage cell turnover and support collagen production, while vitamin C provides antioxidant protection and helps brighten the skin. Niacinamide supports the skin barrier and can help reduce post-inflammatory marks.
I work with pHformula, whose formulations are designed to deliver active ingredients effectively into the skin, rather than simply sitting on the surface. Using the right skincare at home helps continue the hard work done in clinic, supporting skin repair, recovery, and long-term improvement.
Daily use of a broad-spectrum SPF is essential to protect healing skin and prevent further damage. I will always recommend skincare that is appropriate for your skin and treatment plan, to help optimise and maintain your results.
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