Laser treatment may cause some discomfort. While most patients are able to endure the procedure, ice packs and topical anesthetic cream can help alleviate the discomfort. Multiple treatments are typically necessary, and most insurances do not cover the procedure. Doctors recommend treatments in three- to six-week intervals; during this time, sun avoidance is necessary. Review risk, benefits, and alternatives with a physician prior to treatment. Combine laser treatments with photodynamic therapy (light-activated chemical using Levulan) for more noticeable results.

Remove as much unhealthy stress from your life as possible. Doctors aren't completely sure why, but they do know that there is a link between stress and skin disorders, specifically stress and acne. Somehow, the cells that produce sebum, which is the stuff that ultimately causes acne, become unregulated when a person experiences a lot of stress.[6]
You can apply all the topicals you want, but unfortunately, most treatments you'll find at the drugstore won't help with acne scars, Hellman says. However, she notes that derma rollers (at-home microneedling devices) may help with acne scarring. If you're on a tight budget, that should be your first stop. You can get one on Amazon for less than $20. (Use yours once a week followed by a Vitamin C serum for best results—here's how to pick the best ones.)
Scars (permanent): People who get acne cysts and nodules often see scars when the acne clears. You can prevent these scars. Be sure to see a dermatologist for treatment if you get acne early — between 8 and 12 years old. If someone in your family had acne cysts and nodules, you also should see a dermatologist if you get acne. Treating acne before cysts and nodules appear can prevent scars.
Rena Levi is known for her sensitivity towards clients with severe acne and problem skin. In 1968 she moved from Israel to the U.S. and studied with Christine Valmy at the European Esthetic Skincare Institute. In 1975, she opened the Rena Levi Skin Care Salon in New York City. In 1980, she moved to Albuquerque, NM, where she managed the skin care center for Eleganza Salon and further developed and refined her practice. It was there that she became well known for her ability to treat what many considered impossible skin, while also teaching budding estheticians and skin practitioners at the same time, including the then-president of the New Mexico Board of Cosmetology. Here, Levi shares with us one of her most popular facial protocol treatments for treating clients with moderate to severe acne.
However, if you have a scar, you’re dealing with permanent skin damage that needs treatment in order to disappear. An acne scar changes the texture of the skin. If acne has left indentations, or raised spots, the damage has occurred at a deeper level in the skin. This “cobblestoning” effect indicates scarring that needs more than a surface-level treatment.
Other concerns include inflammatory bowel disease and the risk of depression and suicide in patients taking isotretinoin. Recent evidence seems to indicate that these problems are exceedingly rare. Government oversight has resulted in a highly publicized and very burdensome national registration system for those taking the drug. This has reinforced concerns in many patients and their families have that isotretinoin is dangerous. In fact, large-scale studies so far have shown no convincing evidence of increased risk for those taking isotretinoin compared with the general population. It is important for those taking this drug to report changes in mood or bowel habits (or any other symptoms) to their doctors. Even patients who are being treated for depression are not barred from taking isotretinoin, whose striking success often improves the mood and outlook of patients with severe disease.
Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes sometimes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid). Most cases of acne, however, are not drug related.
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