Many people are bothered by depressed marks left after acne subsides, feeling self-conscious every time they look in the mirror. The first questions that often come to mind are, "Will this scar really improve with treatment, and will it reappear?" To answer directly, acne scars can deepen again if the underlying cause, inflammation, is not managed. Therefore, it's crucial to address both scar removal and recurrence prevention simultaneously.
Dry and cold winter weather, with its indoor-outdoor temperature differences, can make skin sensitive, worsening troubles and making it a season prone to acne scars. If acne-related troubles occur, the best approach is to manage them early, before scars and marks set in.
First, a distinction is needed: Is it a scar or a mark?
Accurately knowing whether what's left on your face is a true scar or a red mark is the starting point of treatment. Both scars and erythema are sequelae of acne, and inflammatory acne often leaves both marks and scars.
Acne scars are formed when inflammation persists for a long time, leading to fibrosis in the dermis. While commonly believed to be caused by picking, the more significant cause is the severe and prolonged inflammation of acne itself.
What is commonly referred to as an acne mark is medically called acne erythema. This is a state where the skin remains red in the area where acne has subsided, indicating that fibrosis is less advanced and inflammation is still present. The general characteristic of inflammation is vasodilation, which causes the redness.
What happens if red marks are left untreated?
Erythema, which can lead to red acne scars, often fades over time if the inflammation is not severe. However, if the inflammation is severe, red marks can persist for a long time and eventually progress to depressed scars. Depending on individual constitution, brown secondary pigmentation may also occur along with red marks.
| Category | Condition | Treatment Direction |
|---|---|---|
| Acne Erythema (Mark) | Before fibrosis, residual inflammation | First, calm the marks |
| Depressed Scar | Dermal fibrosis in progress | Treat scars after clearing marks |
In the early stages of acne, most are in the mark stage. Appropriate management at this time can largely prevent progression to depressed scars.
If inflammation is severe or chronic, depressed scars and marks may be present simultaneously. In such cases, it is advisable to treat the marks first, then address atrophic acne scars. If acne continues to erupt, acne treatment should also be performed concurrently.
You can easily ask any questions you have via chat consultation about acne scar treatment direction.
The most important thing in treatment: early intervention
Early treatment is the most crucial aspect of acne scar treatment. The sooner it is managed, the more scars can be prevented. However, once scars have set in, the timing of treatment is less critical, and treatment can be performed at any time.
However, if acne continues to occur, additional scars will form, so it is important to combine acne treatment. In fact, acne scar treatment is one of the most challenging areas in dermatology.
Fractional laser is a representative scar laser, but it is commonly reported that even after 10 or more treatments, satisfaction is often not achieved. Especially severe scars fall into the category of intractable treatment, so prevention is paramount.
Treatment methods vary by scar stage
If scars inevitably remain, long-term treatment is required, and various methods are utilized together as much as possible. General and procedural treatments are summarized as follows:
- Laser treatment: Using Fraxel, similar fractional lasers (Ultrapulse Encore), etc.
- Procedural treatment: Subcision, Suture-Free Punch, etc.
- Peeling treatments: Dot Peeling, laser dermabrasion, etc.
- Combination treatment: When scars of different types are mixed, combining laser and procedural treatments.
The approach varies depending on the severity of the scar. For mild cases, laser treatment alone can be helpful. For severe cases, combination treatment with laser and procedural treatments is reported to be more effective than simple laser treatment. For very severe cases, laser dermabrasion may also be considered.
Treatment intervals vary depending on the intensity of the laser and procedure. Fraxel or similar fractional lasers are usually performed at 1-month intervals, procedural treatments at 2-month intervals, and laser dermabrasion at 6-month intervals. After the procedure, it is necessary to apply sunscreen diligently and protect the skin from sunlight.
However, no matter how well scar treatment is performed, it is difficult to restore the skin to 100% normal. Therefore, it is realistic to aim for an 80-90% improvement from the current state. Please also remember that individual differences may exist.
Can I receive treatment while taking acne medication?
Many people taking acne sebum control medication worry about its impact on laser or scar treatment. Receiving scar treatment while taking medication is generally not a significant problem. In fact, it has the advantage of reducing the possibility of new acne outbreaks, allowing for focused scar treatment.
However, it is good to be aware of precautions when taking medication:
- Increased photosensitivity may occur, so pay more attention to UV protection.
- Skin dryness may increase.
- Long-term use of isotretinoin can reduce sebum secretion, leading to dryness of the skin and mucous membranes (lips, oral cavity, eyes).
- If dryness and redness are severe, consider Gold PTT treatment without medication.
In the clinic, for those with prominent dryness and redness, we discuss approaches that reduce the burden of medication.
Ultimately, the key is inflammation control and recurrence prevention
Customized acne scar treatment's core lies in managing inflammatory acne, the root cause. If inflammatory acne is not properly treated and is left unmanaged, various sequelae can follow. Whether scars remain or not can depend on how acne is controlled when it occurs.
Furthermore, acne scars usually have varying depths, requiring combination treatment that combines laser and procedural treatments. This approach aims to enhance treatment effectiveness by addressing not only deep scars but also large and small scars simultaneously. Since the appropriate laser and treatment method must be applied considering the size and area of the scar, as well as the skin condition, we recommend consulting sufficiently with an experienced dermatologist before receiving treatment.
If the root cause of acne scars is not addressed, recurrence can lead to deeper scars. Consistent treatment must be accompanied by efforts to improve unhealthy lifestyle habits.
If you are curious about the scar treatment sequence suitable for you, please feel free to ask via chat consultation for scar treatment by condition.
Chief Director Lee Sang-Joo (MD, PhD, Yonsei University College of Medicine and Graduate School, Completed Dermatology Residency at Severance Hospital, President of the Korean Dermatological Association) Chief Director Lee Sang-Joo's Profile First Published 2023-12-29 / Last Reviewed 2026-06-16
This content is for general information purposes only. Treatment responses and outcomes may vary individually. We recommend consulting directly with medical staff for an accurate diagnosis and treatment plan.