ask mGm – severe acne scarring

Hello lovely readers and welcome to the ask mGm section where you can send us questions and we and other readers will do our best to answer them. Here is our first!

BadSkinBeauty :

I had troublesome acne for about 5 years and then it went away but not completely. I still do break out when stressed or sometimes when the monthly dragon comes a-visiting. My problem however is with the scars…ice-pick, rolling, whatever…and huge pores. I have tried chemical peels, micro-derma abrasion, derma roller etc. (basically whatever the sales reps shoved at me).

I don’t see much improvement…you have any products or treatments that you might think would benefit me? Thank you!

Thanks for the question BadSkinBeauty. Here is our answer.

The science behind scarring

Acne scarring is a condition of the skin that can result from the body’s natural response to an inflamed lesion. What does this mean?

Well, if you have a pore that becomes blocked (with dead skin, sebum and bacteria – hello pimple!), it could become enlarged. If the pore then breaks the skin wall around it, it damages nearby healthy tissue and causes inflammation. Because this is essentially a wound or injury, your body will send out a small army of proteins (called collagen) to heal and repair it. This process isn’t always perfect and most times, there will be some superficial scarring and/or hyper-pigmentation or redness.

Enlarged pores can also result from this inflammation and healing process.

Sometimes, the scarring is more than superficial and can result in raised bumps (keloids) from too much collagen tissue or depressions (atrophic scars, from loss of tissue) of the skin. If this is present on the face, it can make you feel self-conscious and impact self-esteem.

This post aims to address atrophic scars as this is what BadSkinBeauty has described.


Atrophic scars are pits in the skin stemming from missing connective tissue. As such, they are much more difficult to treat because unlike keloids, there is no excess tissue to be shrunk. Not to be discouraging, but in many cases, it is impossible to eliminate ice-pick scars. However, there are different things you can do to reduce the scarring and improve its appearance. Of course, if the scars are causing you physical discomfort, then you should see your doctor.

BadSkinBeauty has tried several treatments including chemical peels, microderms and derma rollers without success. This would suggest that greater intervention is required as the scars may be fairly deep and the methods above are more geared towards more superficial skin concerns*.

Below are some options.

  1. Dermal fillers come in different varieties and are injected under the skin to fill-in pits from scarring. They return the skin’s plumpness and are a relatively quick and painless treatment. They can last between 12-24 months depending on type and are a non-invasive option. Permanent fillers are available but carry greater risk. You can also potentially combine dermal fillers with laser treatments (see below).
    You would need to consult with a dermatologist to explore this option further.
  2. Fat grafts are similar to dermal fillers but have a permanency to them. However, this can have varying results as biological fat can change over time and produce a lumpy look. Results will take months to show. Unless you have complete faith in your plastic surgeon, this is not your best option. And yes, that’s a plastic surgeon you would need to consult with.
  3. Laser treatments, specifically fraxel laser, require the application of a special laser (again, there are different kinds that address different needs) to the affected skin. The light energy is applied in tiny pin points and absorbed by the tissue. Rather than take off layers of skin (which can cause painful redness and crusting), this process stimulates collagen growth in the damaged area.
    Fraxel lasering involves a series of treatments (3-5) spread out over several weeks and results can be expected around the 6 month mark. If you have ongoing acne concerns, fraxel can exacerbate this.
  4. Skin needling is performed by puncturing the skin several times using tiny needles attached to a roller. The piercing on the skin tissue mimics (?) an injury and stimulates collagen production. It causes some discomfort and redness but this usually subsides within a day or two. At home use derma-rollers are different to those used in skin clinics as they use much shorter needles (0.2mm vs 3mm) – this may not be enough if your scars are deep. It is advisable that you have skin needling done professionally.
  5. Subcision is a viable option if the scar is tethered. That is to say, if the connective tissue under the scar is ‘pinching’ it down, the tissue can be released through this method and the depression can come up to the skin surface. This treatment may need to be paired with dermal fillers. This is a surgical procedure performed under local anaesthetic and can leave bruising for about a week.
  6. Excision is another surgical treatment. It involves cutting out the scar tissue using a scalpel or surgical punch. The surrounding skin is then sutured together and allowed to heal. The new scar that forms will be light. This procedure is also performed under local anaesthetic and can leave bruising for about a week.
  7. Dermal grafting is a fancy way of saying healthy skin is harvested from another part of your body and grafted on to the problem area. It is a complex but effective treatment although it carries certain risks such as differences in skin colouring and texture. As a surgical treatment, there is some downtime involved.

You may notice the options above aren’t exactly simple. They carry higher costs and risks and results will take time. However, if you have tried different over the counter treatments in vain and are really troubled by your skin, it may be worthwhile exploring the above treatments.

Some reduction in the appearance of scars is possible through makeup including use of silicon primers, heavier coverage foundations and optical blurring creams. They won’t make the scars disappear completely, but they can help to some degree. You may also wish to consider contraceptive pills as a way of alleviating ongoing acne problems as they can help streamline any hormonal factors. You should see your doctor about this.

At the end of the day you will have to weigh up what it is worth to you. Not just from a budget perspective, but also whether the scarring bothers you enough to take treatment to the next level.

I understand that skin imperfections can very frustrating and damaging to self-confidence. It is important to remind yourself that you are much more than just your skin and remember to take a step back and focus on the qualities that you love about yourself.
And by all means, if it gives you greater peace of mind and boosts your self-esteem, explore your treatment options.
You have but one life and only you can live it so live it well!


*mGm is not a dermatologist and this opinion is based on personal experience and research, without sighting BadSkinBeauty’s skin. Suggestions provided in this post may not be appropriate for you and you should seek medical advice if you have serious skincare concerns.
ask mGm – severe acne scarring

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