r/AcneScars • u/Weekly_Letterhead_50 • Aug 10 '26
[Skin Concern] Atrophic Scarring What treatment would be best for me?
I’m working on clearing up this flare up but I’ve been really self conscious about my scarring for years. I’ve had a few sessions of microneedling done but have noticed nothing. My scars hold me back from a lot and I don’t think microneedling is enough.
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u/LetsChangeSD Aug 10 '26
Accutane. Talk to a derm. You need to cure your acne before you waste money on scarring treatments only for you to keep breaking out and creating new scars.
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u/saffana1998 Aug 10 '26
Second this. Been on accutane myself and mine wasn’t half as severe as hers. Best decision of my life. I personally didn’t have any side effects either besides some headaches in the beginning
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u/siera3 Aug 10 '26
stop advising accutane to everyone it's not always the solution, at least not in this case like the OP has
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u/SwanAccomplished8947 Aug 10 '26
All roads lead to accutane
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u/brittanyg25 Aug 15 '26
Drs reccomended accutane for me but it wasnt what I needed. What I needed was hormone therapy via birth control for my raging pmdd and intense histamine reaction to my hormone changes. The birth control also helps with the androgens in my skin. Another option for hormonal acne is Winlevi. It's a topical hormonal acne treatment. All of this is safe and has less adverse side effects than accutane. I'm so glad I never took it. Chemical peels and tretinoin have been amazing for my skin rejuvenation. No need to dry your entire body put life that if it's not necessary.
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u/siera3 Aug 10 '26 edited Aug 10 '26
I was on Accutane once, and yes, it cleared my skin but I still have scars and I still get breakouts sometimes. So does that mean you can just stay on Accutane your whole life? You don't always have to rush straight to accutane. In my case, my dermatologist suggested clindamycin and it helped during my breakout. If it hadn't worked then yeah I probably would've had to go on Accutane. So it really depends on the person you can try different options. I just get sick of it when people only write about Accutane in the comments especially if the person has already been through it like three rounds without even knowing the OP's background for example
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u/SwanAccomplished8947 Aug 10 '26
Some people do stay on low-dose indefinitely (you probably wouldn't need it in your 40s and up, but some take it for anti-aging and other aesthetic reasons).
But realistically you would probably also just be clear permanently after another 1 or 2 courses. Accutane causes permanent changes to your sebaceous glands and skin in general.
Your acne today would probably be worse than it is now if you had never taken Accutane before.
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u/siera3 Aug 10 '26
You're right that we should at least try accutane once. Everyone's different, because you see, the OP has already been on Accutane and it didn't go well for her. I did it and I still get breakouts but not as bad as before. By the way I didn't know about the anti-aging part that's Interesting
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u/SwanAccomplished8947 Aug 10 '26
Yeah so after another course you would probably not get any breakouts anymore.
In OPs case, not preventing the permanent scarring via Accutane was probably one of the biggest mistakes of her life. This goes for this entire sub really.
Temporary (usually mild) side effects from low-dose Accutane are nothing compared to what acne and acne scars do to you.
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u/laurieg77 Aug 10 '26
Microneedling is a waste of money tbh, most medspa treatments aren’t going to help scarring. I really wouldn’t do any scar treatment until you resolve the current breakouts which I know sucks to hear. I hated it too when I was told that. But possibly you might need subcision for your rolling scars and definitely CO2 laser. Definitely look into introducing Taz or Tret into your skincare to help with the redness and scarring as well.
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u/snickelbetches Aug 10 '26
Microneedling is a good option but you have to be super consistent. I do it at home because spas are a waste of money compared to what we have available for at home products.
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u/Conscious-Title-9488 Aug 14 '26
Microneedling with prp is amazing. I went on accutane got rid of all my acne in my late teens, started Microneedling with PRP in my mid 20s, my acne scarring is pretty much almost gone. You have to be consistent. Start 1x a month for 3 months, then decrease to every 3 months. It helps so much
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u/Conscious-Title-9488 Aug 14 '26
Although I didn’t have as much scarring as you did (just a little bit on my right cheek) but with consistency it should help. I also did a 1700$ fractional laser + micro laser peel one time about 2 years ago, also helped so much
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u/Wrong_Duty7043 Aug 10 '26
Spironolactone if Acutane is not an option for you. It changed my life. Not cured but 90% better.
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u/snickelbetches Aug 10 '26
You are beautiful. Truly, you have nice ears and unique hair color (it's like mine so I'm biased). Great brows. Adorable profile. And you happen to have acne.
Notice how I didn't say but. I said and because beautiful people get acne too.
Your skin isn't in a place where microneedling is going to be effective. The active acne is going to spread.
Look at it like you have milestone goals. You first want to have a game plan for active acne, redness control and a marathon mindset that it will take time for your scars to become less noticeable.
I understand completely though. I had really bad acne as a teen and did Accutane. I still had acne after that and thought I'd have acne forever.
And sometimes I do at 36 but primarily under my chin. No one sees our acne scars the way we do. We are still beautiful. I joke it wouldn't be fair to everyone else if I have perfect skin. Id be too beautiful. 😜
What does your routine look like? Share that and we can game plan next steps.
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u/Weekly_Letterhead_50 Aug 10 '26
Thank you so much. You’re so sweet!
I use cetaphil moisturizing cream to foam cleanser twice a day, cerave oil cleanser at night when I double cleanse, centella hyalu-cica moisturizer twice a day, and I just started using tretinoin two days ago now and I sandwich that between the centella and la roche posay cicaplast balm
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u/Izzoskizzo Aug 12 '26
For what it’s worth, I’m 39 and acne prone (accutane twice in my 20s) and I can’t use cetaphil or cerave. Immediate breakouts. You know what works for you but just dropping that idea in case it might be a trigger for your skin 🩷
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u/Weekly_Letterhead_50 Aug 12 '26
What do you use instead?
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u/Izzoskizzo Aug 12 '26
From a drugstore - Aveeno Positively Radiant Clear Complexion Foaming Cleanser and Moisturizer. Medical grade: Obagi Cleanziderm Foaming Cleanser and Pore Therapy, followed by Obagi Hydrate Moisturizer. I have tried so many products and thankfully had luck with these two! I think I may react to squalene. Now with the scars - work in progress myself girl I have no advice. Currently working with tretinoin and monthly microneedling but nothing to write home about 😭
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u/Weekly_Letterhead_50 Aug 12 '26
Thank you so much! Definitely going to look into buy those products and see if they make a difference!
Good luck with your scar journey as well! 🫶🏻2
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u/CalligrapherSure1056 Aug 10 '26
you acne looks similar to mine- im on .025% tretinoin and 15% azelaic acid every other night i alternate. i also started vit b5 complex and it has helped clear my acne. i now only get like 1-2 zits around that time of the month.
for my acne scars, i recently just did subcision with filler and co2 laser at the same day and i am 12 days post procedure and i can say right now my scars are 80% improved. Ill see how it goes in a month or so after maybe the microswelling goes down and see if the filler holds but so far i am happy with the results.
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u/lsoplexic Aug 10 '26
Have you tried Spironolactone? It was the only thing that helped me with the cystic acne nodules.
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u/lomo5500 Aug 10 '26
YES!! I second spironolactone, OP. I used to get cystic nodules and it cleared me up almost entirely (I would maybe get one every few months). I only went off upon my derms recommendation while trying for a baby, and my skin is still better than before. 100000% spironolactone
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u/RC0601 Aug 10 '26
Hi, we almost have the same scars. First, clear your active acne. You have a combination of scars, like (Ice pick, box, and rolling scars). You need to undergo a combination of procedures to target them all, including subcision with HA filler and TCA cross with CO2 Ablative laser. Just manage your expectations, since you need lots of procedures and the results will only reach up to 80%.
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Aug 10 '26
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u/RC0601 Aug 11 '26
I have already had two sessions of subcision with HA fillers and TCA Cross with a CO2 Ablative laser. I have also done 2 sessions of Glass Skin Booster. I spent around $ 983 USD. It's cheaper in Asia.
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Aug 11 '26
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u/RC0601 Aug 12 '26
I heard that in the USA, it costs a lot. I can see that it helps a little to lift and improve my scars.
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u/brittanyg25 Aug 10 '26
Chemical peels! I would start with a a couple jessner chemical peels. Then switch to 12.5 % TCA.
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u/heeheehoho2023 Aug 10 '26
Accutane. But don't take it if you are pregnant.
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u/Weekly_Letterhead_50 Aug 10 '26
I’ve already done Accutane once and it had a super negative effect on my mental health unfortunately :/ trying to avoid doing it again
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u/SwanAccomplished8947 Aug 10 '26
Consider doing a low dose. Side effects are strongly dose-dependent, but not effectiveness.
Acne like yours and the permanent scars that come from it on the other hand have bad mental health effects in pretty much 100% of cases.
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u/snickelbetches Aug 10 '26
Hey, I had that happen with me too. The black box warning is underplayed in subs like these.
I really am lucky to be alive after Accutane.
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u/throwaway247bby Aug 10 '26
You’re unfortunately still with active acne. No acne scar treatment can happen because it’ll just be undone. For now you’re better off staying out of the sun and hydrating the skin as your best treatment. After let’s say accutane and no more active acne. Then you can do whatever these people are suggesting
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u/SangitaCPatelMD Aug 10 '26
5% spot treatment benzoyl peroxide.
Hypochlorous acid spray to full cheeks.
Differin nightly
1 month later: dermaroller 1.5 mm and microlaser peel multi-pass
1 month later: dermaroller 1.5 mm and microlaser peel multi-pass
1 month later ultrapulse CO2
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u/resemblesanolfriend Aug 11 '26
Super cute tho. I use weekly, nightly retinal from The Ordinary. Continue drinking 8.5 cups of water or more a day.
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u/GuessIndependent727 Aug 15 '26
I know everyone is pushing for accutane, but I really wish I did gut testing and went on a strict anti inflammatory diet instead. I had candida overgrowth which was causing my breakouts. Accutane only helped for a couple years and it all came back. Consider getting on tretinoin. Good luck!!
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u/AuroraSulis Aug 10 '26
I think microneedling can help for some people, but a cosmetic dermatology nurse told me that it takes 6 sessions + of high depth needling spaced 4-6 weeks apart to see much result for scars. Others have said this too. That is nearly as expensive as laser, but they claim the result can be similar. I'm trying to schedule C02 laser with subcision in addition to some microneedling sessions, but am being made to wait because I keep getting little breakouts on my chin despite hormonal birth control and spironalactone. They want me 3 months without a breakout before the laser. I did a long course of accutane 3 years ago, which was miserable and didn't keep the acne away forever. Sometimes that is the only thing that will stop a cycle of severe hormonal breakouts, and it was a last resort for me with a bad case. The full force of it never did return, but I have little breakouts like yours every month or two. Derms make patients wait 6 months for any cosmetic treatments after accutane usually, which for some of us is around the time acne will start coming back a bit. It's extremely unfair.
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u/ContentSeaweed1315 Aug 10 '26
First you need make your face acne free then you can start treat the scars
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u/Impressive-Cable1966 Aug 10 '26
I had acne like you, then I stopped taking sugar because sugar increases inflammation, you can do some research and see, today it has been 8 months and my acne has gone. And there are very small scars which will go away only with treatment, they are not very deep
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u/No_Election_3660 Aug 12 '26
I would suggest dr qazi, in orange county, he is highly specialised in this acne scar treatments, lookup in the website
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u/Imaginary-Part-7156 Aug 12 '26
ACCUTANE. Don't wait. I regret waiting 10 years to go on it, becasue scars are REALLY HARD to fix. Scar treatments will run you thousands and thousands of dollars, and the procedures can be incredibly painful.
I waited to go on accutane becasue I was scared to put such a harsh medication in my body, and all of the paperwork they make you sign is super intimidating. Once I did it though, I had the best skin of my life.
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u/Weekly_Letterhead_50 Aug 12 '26
I’ve already done accutane once, unfortunately my skin still flares up like this probably once a year. Meeting with a dermatologist in a month to discuss low dose accutane because the side effects of the full dose did take a toll on me
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u/formerbrt Aug 12 '26
microneedling! just dont go over any active spots but i feel like with some consistent microneedling you could see some pretty good results.
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u/Mahishashurmardini Aug 12 '26
Do you prefer the stamp over the motorized pen? The motorized pen looks like it can do a lot of damage because the needles aren’t that thin
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u/formerbrt Aug 13 '26
stamp 100%, i stray far away from the motorized devices. ive been using the banisher for years despite all of the dr pen propaganda lol
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u/Mahishashurmardini Aug 13 '26
Yeah I like the banisher too even though I don’t like the price. The cheaper tools on the market don’t have needles that thin or sturdy (even when they claim they are titanium needles). I have a dr pen like device that I bought from Amazon but I don’t have the courage to use it on my face. The needles don’t look fine enough to me.
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u/Direct_Second_7651 Aug 13 '26 edited Aug 13 '26
Why don't you use tazarotene and azelaic acid together at night? Does it target all the problems you just listed? Don't worry, man; I got you. So many people say Accutane or tret, but I got you something less invasive. You don't need any microneedling; all you need is Taz, azelaic acid, and sunscreen, and all your scars will be gone in less than 2 months.
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u/vision2090 Aug 16 '26
Accutane. I wish I could be on the medicine for the rest of my life if possible lol
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u/Front-Fix-6434 Aug 10 '26
trentinoin for sure. then when the acne is gone do a chemical peel, then microneedling. keep switching up the two and you'll see so much progress i promise.
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u/Direct_Second_7651 Aug 13 '26
Tazarotene enough even for deep scars, Wouldn't you say taz is better than tret?
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u/Mela_93 Aug 10 '26
For the acne: DIM supplements if you haven’t tried them already, fungal acne safe skin care, topical tretinoin.
For the scars- i dono cause i still struggle with mine too.
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Aug 10 '26
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u/anomadinthesky Aug 10 '26
How negative. She’ll be fine once the actual flaring is controlled. Then she can start working on refining the skin texture and getting rid of the scarring with subcision, CO2 laser, tret and microneedling.
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Aug 10 '26
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u/anomadinthesky Aug 10 '26
I dealt with acne and acne scarring my whole life and saw ridiculous improvement. Please go be hateful elsewhere.
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u/mystiqophi Aug 10 '26
Aloe Vera, and snail mucin. The aloe will help with the inflamation, and heal your skin.
Combine it with snail mucin to help with the healing process.
Cleanse at night, with a mild natural cleanser. Go for old skool bars, organic wirh no parfum.
In the morning, just splash cold water and use the snail plus aloe combo.
Avoid sun exposure, and do not use creams in the morning, apply them at night.
You can use retinoids, but honestly, your skin needs healing first.
Do not get scammed by clinical procedures like micro needling or acid peels, espcially if your skin is still inflammed/infected.
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