Scarring

A scar is the skin's repair work made permanent. Any injury that reaches past the surface layer can scar: a deep spot, a graze, a surgical wound, a chickenpox lesion. The skin closes the gap with collagen laid down quickly rather than neatly, and what is left never quite matches the tissue around it. Most skin concerns are processes that treatment can interrupt. A scar is a structure that has to be remodelled, and remodelling is slow.

Types of scarring, and why the type decides the pathway

Scarring, particularly after acne, comes in distinct types. Ice-pick scars are narrow and deep, like a small puncture, and reach further down than most resurfacing can. Boxcar scars are wider, with defined, almost vertical edges and a visible rim. Rolling scars are shallower, with soft, undulating edges. They show as a generally uneven surface, not individual marks, and are most obvious under side lighting. Raised scars are the opposite problem: too much collagen, not too little. They divide into hypertrophic scars, which stay within the original wound, and keloid scars, which spread beyond it.

Some marks are not scarring at all. Flat red, brown or purple patches left where a spot has healed, with no change in the surface you can feel, are post-inflammatory colour change. They belong with pigmentation, and most fade on their own over months. Most people worried about acne scars have some of both. Treating colour change as though it were texture can waste a year.

What tends to make it worse

Picking is the big one. Squeezing a spot that would have faded in a fortnight is the most reliable way to turn it into a mark lasting months, or a depression that does not fade at all. Scarring also tracks how deep the inflammation went and how long it lasted. Deep nodular breakouts leave the most behind, and treating active acne is itself scar prevention.

Unprotected sun is the other aggravator. UV darkens the discolouration around a healing scar, making it far more noticeable than the texture alone would be, and the effect is stronger in deeper skin tones. Time helps. A scar keeps remodelling for a year or more, so judging it, or treating it aggressively, at three months is premature.

What a consultation looks at

Lighting matters as much as the skin. Flat overhead light hides textural scarring almost completely, so side lighting and photographs from a fixed angle show far more than a bathroom mirror. Your practitioner will also run a finger across the area, because texture is felt more reliably than it is seen.

The rest is your history: what caused the scarring and how long ago, whether the acne behind it has settled, how you have healed before, whether anyone in your family forms keloids, your skin tone and its tendency to pigment after injury, and what you have already tried. If acne-prone skin is still flaring, calming it comes first and the scar work waits, because fresh breakouts would undo it.

The pathways, and what each is and is not good for

Microneedling is the usual starting point for rolling and shallower boxcar scarring. Controlled micro-injury prompts the skin to lay down collagen beneath a depression, which may gradually lift it. It is a course of sessions spaced weeks apart. Skin peels act more on the surface, so they suit the colour side and shallow irregularity, not defined depressions. Polynucleotides are a repair-led route sometimes discussed for skin quality around a scarred area. Medical-grade skincare and daily sun protection sit underneath all of it, and where the concern is colour change alone they are often the whole plan.

Ice-pick and deep boxcar scars are where our treatments reach their limit. Needling across the surface does little to a scar that runs narrow and deep, and treating those scars needs techniques we do not offer. If that is what you have, we will tell you at consultation and point you towards options that might reach it. Progress with true scarring is measured in degrees of improvement over months, and results vary between individuals.

When it belongs with your GP

Some scarring is a medical matter first. Keloid scars that keep growing, spread beyond the original injury or become itchy and painful need a GP or dermatology opinion, because the treatments that keep them in check are prescription or procedural. Scarring from surgery, burns or significant trauma belongs in the same category while it is still red, raised and remodelling. Acne that is still active, deep or cystic needs medical treatment before anything cosmetic is sensible. Any mark that changes shape or colour, bleeds or will not heal is not a scar question at all, and needs a doctor promptly.

We assess scarring at our Bedhampton clinic, serving Havant, Portsmouth, Waterlooville and Denmead, and from 8 December 2026 at our new clinic on Jewry Street in Winchester. At either clinic, the first appointment establishes which type of scarring you have and what treatment may change.

Frequently asked questions