"If you occupy the area [under the skin] with a cyst, it destroys fat around it. Once the cyst goes away, the loss causes indentation," Dr. Karolak explains. A boxcar scar is a depression that has hidden scar tissue, which acts like an accordion pulling the scar downward. Subsicion is one solution for these deeper scars. Subsicion uses a sharp needle to go under the surface and break up that scar tissue. Then, you can fill it in with fillers made specifically for acne scars like Bellafill. Or you can do a fat transfer. "One of my favorite treatments for volume loss is fat transfer, which allows me to take inject a patient's own body fat instead of synthetic filler," says Dr. Karolak. Another treatment for boxcar scars is punch excision where the indented area of the scar is removed and the edges are pulled together with a suture. These treatments are often followed up with a collagen-boosting laser treatment.
Acne scar treatment: “Rolling scars can be treated with microfat injections followed by microneedling with platelet-rich plasma (PRP),” says Dr. Imber. Microneedling creates tiny wounds or pinpricks in the skin. The body’s natural, controlled healing process then kicks in to boost internal collagen production. Microneedling is also a great acne scar treatment because it opens up channels within the skin that give PRP—the healing factors in your own blood—and skin care products direct access to deeper layers of the skin where they’re needed most. PRP is created by taking some of your blood, isolating the platelet-rich plasma, which contains proteins and other growth factors, and injecting it back into the scar. “The objective is to build up the collagen layer under the depression in order to raise it to the level of the surrounding skin,” Dr. Imber says. You’ll likely need multiple treatments, but the results are worth it. This approach is backed up by a new study in the January 2017 issue of Aesthetic Plastic Surgery, which found that fat plus PRP improve depressed scars alone and in combination with laser skin resurfacing. What’s more, the treatment improved the social life and relationships of people with scarring, the study showed. These are the innocent habits that practically guarantee your acne will scar.
The best way to fix them: You have a few options with these. The first would be to visit an aesthetician or a dermatologist for a deep-cleaning in a sterile environment. The second? Use an exfoliator. That could be a face scrub, retinol—which boosts skin cell turnover—or even facial cleansing brushes. If you go this route, just pick one. "You just don’t want to combine all them, since that’ll make skin sensitive," adds Dr. Hale.
Retinoids: Retin-A (tretinoin) has been in use for years, and preparations have become milder and gentler while still maintaining its effectiveness. Newer retinoids include adapalene (Differin) and tazarotene (Tazorac). These medications are especially helpful for unclogging pores. Side effects may include irritation and a mild increase in sensitivity to the sun. Adapalene 0.1% is now available without a prescription. With proper sun protection, however, they can be used even during sunny periods. The combination medication known as Epiduo gel -- which contains the retinoid, adapalene, along with the antibacterial, benzoyl peroxide -- is applied once a day.
Both Avram and Tzu recommend looking for products with mark-fading hydroquinone. Ambi Fade Cream includes 2 percent hydroquinone, the highest concentration allowed without a prescription. “It also contains soy, which is well known for treating pigmentation issues, and vitamin E which helps with scarring,” says Tzu. While the FDA considers hydroquinone safe, it is banned in Europe and can potentially cause irritation or further discoloration, so remember to patch-test and check with a dermatologist whether it’s right for you.
Rosacea skin tends to be sensitive and may easily flare with self-treatment or common acne therapies. Approach any home treatment or attempts for natural remedies with some caution. As with any rosacea therapy, some people may experience sensitivity or irritation with treatment. Several possible natural remedies, including dilute vinegar cleansing and green tea applications, may be useful in rosacea.
Exfoliate dead skin cells that can clog pores and lead to breakouts with the power of salicyclic acid. Mario Badescu's Acne Facial Cleanser was specially formulated to effectly target acne-prone or acne-erupted skin. A soothing blend of botanical extracts including aloe, chamomile, and thyme help to improve the look and feel of troubled skin, while leaving skin thoroughly refreshed.
The best way to fix them: This is where the classic zit treatments come into play. "Topical medications are the best way to treat a lesion like this," says Jennifer Chwalek, M.D., a dermatologist at Union Square Laser Dermatology in NYC. "Benzoyl peroxide-, salicylic acid-, or sulfur-based products can help to dry it up." She prefers salicylic acid over benzoyl peroxide for these, since the latter can cause irritation, dryness, and even post-inflammatory hyperpigmentation (a.k.a. dark spots) in those with darker skin tones. Retinol works well for these, too.
Sometimes even though they wash properly and try lotions and oil-free makeup, people get acne anyway — and this is totally normal. In fact, some girls who normally have a handle on their acne may find that it comes out a few days before they get their period. This is called premenstrual acne, and about 7 out of 10 women get it from changes in hormones in the body.
Many over-the-counter lotions and creams containing salicylic acid or benzoyl peroxide are available to help prevent acne and clear it up at the same time. You can experiment with these to see which helps. Be sure to follow the instructions exactly — don't use more than you're supposed to at one time (your skin may get too dried out and feel and look worse) and follow any label directions about allergy testing.
Originally Exposed Acne Treatment was only available to private dermatologist facilities for severe acne sufferers. It wasn’t until 2012, Exposed Acne Treatment was finally made available to the general public due to its effectiveness and positive testimonies. Many users reported a diminished in acne, skin irritation, skin oiliness, and acne brown spots in less than one month.
Sunscreen: "Sun exposure during an active breakout can lead to darkening of inflammatory lesions, prolonging their appearance on your skin and making them harder to fade over time," says Dr. Shereene Idriss from Union Square Dermatology, which means it's important to lather on the sunscreen daily — even when it's cloudy. And don't worry about breaking out from a pore-clogging sunscreen; the latest formulas are more innovative and acne-friendly than ever. Elta MD UV Clear Broad-Spectrum SPF 46 is a top derm-approved favorite. It contains niacinamide, which is an anti-inflammatory that helps reduce redness.
A benzoyl peroxide cream (2.5 percent strength) is a good choice for adolescents experiencing red or inflamed breakouts that aren't getting better with medicated cleansers. Benzoyl peroxide is a very common and inexpensive acne treatment cream that can be found over-the-counter in the skin care aisle. Benzoyl peroxide kills the bacteria that cause pimples and is highly successful in treating mild cases of acne.
While over-the-counter products don’t treat the hormonal component of acne, salicylic acid—a.k.a. willow bark, a.k.a. what aspirin is made of—addresses all other aspects involved in a breakout. “It works,” says Anolik, who recommends using salicylic acid-based products in conjunction with benzoyl peroxide preparations that target acne bacteria with greater strength. Benzoyl peroxide can definitely cause dryness and irritation; if you decide not to use it, know that you’ve got to be even more vigilant about the bacteria on your skin, so cleanse and treat more often. Tea-tree oil preparations like Tammy Fender’s Clarifying Dermagel ($72, goop.com) help. Burt’s Bees Natural Solutions Acne Spot Treatment ($10, burtsbees.com) combines tea tree and salicylic acid for powerful (yet easy on skin) results.
Photodynamic therapy is a new acne treatment. It begins with light microdermabrasion. This is used to remove dead skin cells on the face's surface. Then, an acid is put on the skin for 30 to 60 minutes. After this period, the acid is taken off. Lastly, the skin is treated with a laser. This treatment is still being researched, but seems to give positive long-term results.
Oral contraceptives: Oral contraceptives (birth control pills), which are low in estrogen to promote safety, have little effect on acne one way or the other. Some contraceptive pills have been shown to have modest effectiveness in treating acne. Those that have been U.S. FDA approved for treating acne are Estrostep, Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary care physicians or gynecologists when recommending these medications.