Acne Scars: Types, Causes, Diagnosis, and Treatment (2026 Guide)
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
Roughly 80% of people between ages 11 and 30 develop acne, and about one in five of those people go on to form scars. Scars form when inflamed acne damages the pore wall and the body's collagen-based repair process produces either too little tissue (leaving a pit) or too much (raising a bump). There are four main scar types — ice pick, rolling, boxcar, and hypertrophic/keloid — and a dermatologist can identify them with a simple visual exam. Treatment ranges from over-the-counter creams with acids or retinoids to in-office procedures such as laser resurfacing, microneedling, steroid injections, and dermal fillers, and starting early gives the best chance of reducing visible scarring.
Quick Answer: Acne Scars in Four Points
How common are acne scars? About 80% of people ages 11–30 get acne, and 1 in 5 of them develop scars; nearly 90% of teenagers experience acne.
How do acne scars form? Inflamed acne breaks down the pore wall; the skin repairs itself with collagen, and too little collagen creates a depression while too much creates a raised scar.
What are the four types? Three depressed (indented) types — ice pick, rolling, and boxcar — and one raised type, hypertrophic or keloid scarring.
What treats them? Skin must be blemish-free before treatment starts; options include OTC creams (alpha hydroxy acids, lactic acid, retinoids, salicylic acid) and in-office procedures such as chemical peels, laser resurfacing, microneedling, steroid injections, dermal fillers, excision, subcision, punch grafting, and cryosurgery.
What Is an Acne Scar?
An acne scar is a permanent-looking mark that remains after inflamed acne heals. It forms because of how your skin repairs itself after a blemish, not because of the pimple itself. Acne scars appear mainly on the face, chest, and back — anywhere the skin contains sebaceous (oil) glands, with the face, back, and chest being the most common sites.
Having acne does not guarantee you will scar. And if you do scar, not every scar is permanent — treatments exist that can nearly remove some scars or help the skin rebuild itself with its own collagen.
How Common Are Acne Scars?
Acne is the most common skin condition in the world. The numbers put the scale in perspective:
Population group | Likelihood of acne | Likelihood of scarring |
People ages 11–30 | About 80% will get acne | 1 in 5 (20%) of those with acne develop scars |
Teenagers | Nearly 90% will get acne | Higher risk, since severity often peaks in the teen years |
The takeaway is straightforward: acne scars are very common, and most people you know either have them or have had them at some point.
How Does Acne Cause Scars?
From Clogged Pore to Inflamed Lesion
A pimple grows when bacteria, oils, and dead skin fill up and inflame a pore. Your skin sheds roughly 40,000 cells every hour, and sometimes those dead cells clog a pore. Small clogs become whiteheads or blackheads. When a pore becomes inflamed instead, it can develop into the lesion types most likely to scar.
The acne types most associated with scarring are summarized below.
Acne type | What it looks like | Scarring tendency |
Whiteheads and blackheads | Small clogged pores | Usually heal smoothly |
Papules | Pink to red bumps that hurt when touched | Can scar |
Pustules | Pus-filled; red at the base, white or yellow at the top | Can scar |
Nodules | Solid, larger, deeper lesions that hurt more | Higher risk of scarring |
Cysts | Deep, painful, pus-filled | Most likely to scar |
The Collagen Repair Process
Your skin has three main layers: the outermost epidermis, the dermis beneath it, and the deepest hypodermis. When an acne pore swells, the wall of the pore can break down. Small blemishes create shallow scars that heal quickly. But when the contents of a blemish spill into the surrounding tissue, deeper scars form. The skin's response is to repair the damage by forming new collagen fibers.
This repair process produces two main scar outcomes, as illustrated below.
If the repair produces a loss of tissue, the result is an indentation in the skin surface. If the skin produces too much collagen, the scar rises above the surface. A raised scar is actually a sign of your skin doing its repair job — perhaps too well. Collagen is the body's repair tissue, and overproduction of it creates raised scars.
What Are the Types of Acne Scars?
Most people with acne scarring have more than one type at once; it is rare to have only one scar pattern. Each type can be treated with varying degrees of success.
Depressed (Atrophic) Scars
Scar type | Appearance | Where it typically appears |
Ice pick | A hole wide at the top that narrows to a point deeper in the skin, like an ice pick tool | Forehead and upper cheeks, where skin is thinner; common and among the most challenging to heal |
Rolling | Wide indents with sloping edges that make the skin look uneven and wavy | Lower cheeks and jaw, where skin is thicker |
Boxcar | Round indents with sharper edges that go deep into the skin | Lower cheeks and jaw |
Raised Scars
Hypertrophic and keloid scars rise off the skin. They form when collagen, the fibrous repair tissue in the skin, overgrows in the affected area. These scars most often appear on the chest, back, shoulders, and jawline, and they can be itchy, tender, or painful.
How Are Acne Scars Diagnosed?
The Visual Exam
Diagnosis is simple: a visual examination by a dermatologist is enough to determine whether you have acne scarring and what type it is. A dermatologist will examine your skin and confirm whether the lesions are consistent with acne or another skin process, then identify the scar types present.
The Four-Grade Severity Scale
Dermatologists can also grade how severe the scarring is. One widely used measurement system defines four grades:
Grade | Severity | Description |
Grade 1 | Macular | The scar is red but flat |
Grade 2 | Mild | The scar can easily be covered by makeup or facial hair |
Grade 3 | Moderate | The scar is "obvious at a social distance" and not easily covered by makeup or facial hair |
Grade 4 | Severe | Scarring is very evident at a social distance greater than 50 centimeters (1.64 feet); makeup or facial hair is unlikely to cover it |
What Are the Treatment Options?
A dermatologist will determine your scar types and recommend the best treatments based on your goals and the location of the scarring. One point matters above all: get in touch as soon as possible, because delays in treatment increase the severity of acne scarring.
Rule One: Clear the Active Acne First
Your skin must be blemish-free before scar treatment begins. Medications and treatments used on active acne can interfere with medications and treatments used on scars. So treating any ongoing breakouts comes first.
At-Home Treatments
Over-the-counter creams are the best at-home option. Ask a dermatologist which products suit your skin type and scar type. Effective OTC creams contain one or a combination of the following active ingredients:
At-home option | What it does |
Alpha hydroxy acids (AHAs) | Help shed surface skin and smooth texture |
Lactic acid | A gentle acid that exfoliates and improves texture |
Retinoids | Promote skin turnover and collagen remodeling |
Salicylic acid | Exfoliates and helps unclog pores |
Makeup and facial hair | Cover-up options; many effective over-the-counter makeup products exist |
In-Office Procedures
There are many cosmetic procedures available, and it is not unusual to need repeat sessions or two or more procedure types to restore the skin. The main categories are shown below.
Resurfacing procedures remove or remodel the top layers of skin so smoother skin grows back:
Procedure | How it works |
Chemical peels | Special chemicals remove the top layer of old skin; the new skin that grows in is smoother with fewer scars |
Dermabrasion | A special tool produces friction to remove the top skin layers, much like a sander on wood |
Microdermabrasion | A machine removes the upper layer of skin |
Laser resurfacing | A laser delivers heat to the scarred collagen beneath the skin; the body's wound-healing response creates new, healthy collagen. Comes in ablative and non-ablative forms — your dermatologist chooses which suits your skin and scar type |
Other procedures target raised or depressed scars directly:
Procedure | How it works |
Steroid injections | Steroids are injected into a raised scar; they soften the fibrous tissue and flatten the scar |
Dermal fillers | A substance is injected under a depressed scar to lift the skin upward |
Microneedling | Small needles purposefully injure the skin to stimulate collagen production that smooths scars; can be done alone or with heat (microneedling radiofrequency), which has shown textural improvement from acne scarring and may prevent further acne |
Excision | The dermatologist cuts out the acne scar and closes the wound with stitches |
Subcision | A needle breaks apart the fibrous bands that pull scar tissue down into deeper skin layers; the skin is released so it returns to the surface and lays smooth naturally |
Punch grafting | The scar is removed as in excision, then a skin graft — typically taken from behind the ear — fills the area where the scar was removed |
Cryosurgery | Liquid nitrogen freezes raised scar tissue; the tissue dies and falls off |
Minor Surgery for Acne Scars
Sometimes minor surgery is considered for certain scar types. These procedures lift scar tissue closer to the skin surface to make indentations less noticeable, and they may remove the scar entirely or break up scar tissue so new collagen can form and smooth it. Surgery is performed in the dermatologist's office: you remain awake while the treatment area is numbed, and other acne scar treatments often follow the surgery.
Side Effects and Body Locations
Minor discomfort during and after treatment is common. Other possible complications include changes in skin color, making scars appear darker or lighter. And the treatments used on the face will not necessarily be used on the back or chest — your dermatologist decides based on the scar type and its location. The same treatments used on adults can be used on teenagers.
How Long Do Acne Scars Last?
How long scars last depends on the scar type and the treatment used, so ask your dermatologist about the expected recovery time. Remember that not all scars will go away permanently. Without treatment, acne scars are likely to remain for the rest of your life. Even with treatment, acne scars are difficult to heal completely — there is no 100% guarantee of total removal — but most treatments reduce the size of the scars and make them less visible.
How Can You Prevent Acne Scars?
Prevention starts with treating acne as soon as possible — the longer you wait, the greater the likelihood of scars. Five habits measurably reduce your risk:
Prevention habit | Why it helps |
Wear sunblock | Too much sun can darken scarring; the darker your skin color, the more obvious scars will be |
Don't pick, scratch, or squeeze | Extra damage promotes inflammation, which makes scars worse |
Treat acne immediately | The longer the wait, the more likely scarring becomes |
Don't smoke | Tobacco smoking raises your risk of scarring — not just acne scars, but scars on the body in general |
See a dermatologist early | Getting acne treated professionally before it scars gives the best outcome |
Your DNA also plays a role: your genes determine how well your skin heals, how much collagen is produced, and the depth of the acne lesions — all of which control scar severity. But smoking, squeezing, and picking can still make scarring worse, so keep your hands away from your face.
Living With Acne Scars
Acne scars can cause psychological distress and self-esteem issues and can interfere with your social life or relationships. That is why it is important to eliminate acne before it has a chance to scar, and to return for scar treatment in the early stages, when you have the best chance of reducing skin damage.
If scarring has already occurred, you are not powerless. Some people choose to live with their scars, and others decide that the scars interrupt daily life too much. You can decide to get treatment, or decide not to — you have options and you are in control. Stay in touch with your dermatologist, ask about treatment options and the expected results of no treatment, and raise any questions or concerns.
Conclusion: Start Early and Work With a Dermatologist
Acne scars are a common, treatable condition. The single most important step is timing: delays in treatment increase the severity of acne scarring, and scars left untreated are likely to persist for life. If you have active acne, treat it now before it scars. If scars have already formed, a visual exam can identify their type and grade, and a treatment plan — from OTC creams to in-office procedures — can meaningfully reduce their visibility.
Your next step: If you have acne that is inflaming, deep, or leaving marks, book an appointment with a dermatologist. Bring a photo history of your breakouts if you can, and ask which of the four scar types you have, what grade your scarring is, and whether your skin is ready for scar treatment. Starting early gives you the best possible result.
Frequently Asked Questions (FAQ)
How common are acne scars?
Very common. About 80% of people between ages 11 and 30 will get acne, and one out of five of that population will develop scarring. Teenagers are hardest hit, with nearly 90% getting acne.
Do all acne scars stay forever?
Without treatment, acne scars are likely to last for the rest of your life. Not all scars are permanent in the strict sense — treatments can nearly remove some and improve others — but even with treatment there is no 100% guarantee of complete removal; most treatments reduce scar size and visibility.
Why do some people scar and others don't?
How your unique body responds to a wound determines if and how much scarring occurs. The repair process involves collagen: too much collagen produces raised scars, while tissue loss produces pits and indentations. Your genes influence healing ability, collagen production, and lesion depth.
What do the four acne scar types look like?
Ice pick scars are holes that are wide at the top and narrow to a point, common on the forehead and upper cheeks. Rolling scars have sloping edges that make the skin look wavy, on the lower cheeks and jaw. Boxcar scars are deeper indents with sharper edges. Hypertrophic and keloid scars rise above the skin from excess collagen, usually on the chest, back, shoulders, and jawline.
Can I treat acne scars at home?
Over-the-counter creams are the best at-home option and can contain alpha hydroxy acids, lactic acid, retinoids, or salicylic acid, alone or in combination. Choose a product suited to your skin type and scar type, and note that makeup and facial hair can also cover scars while you pursue treatment.
Do I need to stop having breakouts before scar treatment?
Yes. Your skin must be blemish-free before you start treating acne scars, because medications and treatments used on acne can interfere with those used on scars.
How does a dermatologist diagnose acne scars?
A visual examination by a dermatologist is enough to diagnose acne scarring and identify the type. The dermatologist can also grade severity on a four-point scale from macular (red but flat) to severe (very evident at a distance greater than 50 centimeters, or 1.64 feet).
What in-office procedures treat acne scars?
Resurfacing options include chemical peels, dermabrasion, microdermabrasion, and laser resurfacing (ablative or non-ablative). Other procedures include steroid injections to flatten raised scars, dermal fillers to lift depressed scars, microneedling (alone or with radiofrequency), excision, subcision, punch grafting, and cryosurgery. Repeat or combined procedures are common.
Do acne scars hurt or itch?
Depressed scars are usually painless, but hypertrophic and keloid raised scars can be itchy, tender, or painful, most often on the chest, back, shoulders, and jawline.
What makes acne scarring worse?
Smoking, squeezing, and picking at acne all worsen scarring by increasing inflammation and skin damage. Keeping your hands away from your face and treating acne promptly are the most effective controllable steps.
References
Disclaimer: This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions about a medical condition. Never disregard professional medical advice or delay seeking care because of something you read here.
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