Most of us will have to deal with facial marks at some point in our life — whether they be a result of acne or more intense surgical or traumatic scars. Facial markings are an annoyance, for sure. For some, though, they are debilitating. “Some of my patients are battling acne scarring from their adolescent years until their middle age,” says Santa Monica-based dermatologist Dr. Soheil Simzar. “It can affect their daily self-esteem — depending on the severity, some are very cognizant of avoiding certain types of overhead lighting that makes scarring more noticeable.
Thankfully, it’s all treatable once you play detective and know which type of marking you are dealing with. Here’s how to fix it:
You know the ones. Even when you don’t pick at or pop it, the aftermath of a great honking whitehead on your face leaves a red mark in its place — for months. Contrary to what you might thing, these marks aren’t scars. They're the hyperpigmentation that occurs when your skin’s natural defenses send a horde of melanin (the substance that gives your skin color) to the area to protect it. “It’s what we call post-inflammatory hyperpigmentation,” says dermatologist Jennifer Chwalek, who practices in New York City. “It does fade, but it can be very cosmetically distressing to people, especially on darker skin tones because they contain more melanin naturally.”
Since these marks will eventually fade naturally, no heavy-duty treatment is needed. However, you can treat this type of mark with a variety of topical skin lightening treatments:
1. “It depends on the severity, but hydroquinone really is the gold standard for skin lightening creams,” Dr. Chwalek explains. Some stronger formulations (4 percent) of this ingredient do require a prescription, but a lighter 2 percent over the counter option is available.
She points to a few other common skincare ingredients as tools for lightening post-acne dark spots:
2. “Glycolic acid or alpha hydroxyl acid can help,” she says. “Vitamin C and kojic acid are also beneficial.” They each work in a different way though, she explains, "either by targeting the pigment and breaking it up or actually improving the turnover of cells so the pigment fades faster.” Try folding these ingredients into your regular skincare routine products to create a cocktail of mark-fighting ingredients for a quicker result.
Occasionally, you have some acne marks that run deeper into the skin’s surface, or your skin has been lowered or indented by surgical or traumatic scarring — this is known as a depressed scar. These types of marks don’t respond to topical creams and need to be addressed using more intense methods.
3-4. “Laser treatments nearly always work better than anything topical" in these situations, says Simzar. “Chemical peels can work as well, but they only address what’s on the surface of our skin, whereas laser goes into deeper issues.” Plastic surgeon Anthony Youn M.D., who practices in Michigan, agrees. “In general, the more aggressive the treatment, the more dramatic the result," he says.
He breaks it down: “Lasers function in two capacities. The heat generated by the laser causes the collagen in the skin to break down and then reform into tighter bundles, resulting in smoother, tighter skin. Ablative (stronger) lasers also remove the upper layer of the skin, causing the body to heal in a smoother fashion.”
If you're having an ablative laser treatment, you'll need to budget time for recovery. “They can be painful and necessitate sedation or general anesthesia. Downtime on a treatment can vary from two days to two weeks,” says Youn. However, non-ablative lasers (“which leave the upper layer of skin intact,” he explains) result in very little pain, and there's no recovery time required. Of course, he notes that the results tend to be more modest than those resulting from an ablative treatment.
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