How can I improve the hyperpigmentation from acne scars? (Photos)

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. For post-acne hyperpigmentation, especially in Asian skin, the approach focuses on gentle yet effective pigment control and preventing further inflammation. Topical treatments such as niacinamide, azelaic acid, vitamin C, and hydroquinone (if tolerated) can gradually lighten dark spots, while retinoids help increase cell turnover, smooth texture, and prevent new acne. Chemical exfoliants like low-strength AHAs or BHAs can also aid in fading pigmentation over time. Sun protection is crucial, as UV exposure can worsen hyperpigmentation. In-office treatments like chemical peels, low-fluence laser therapy, or microneedling with PRP can accelerate results, but should be approached cautiously to avoid irritation or post-inflammatory hyperpigmentation. I hope this helps and best of luck!

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best,
Dr. Raffy Karamanoukian
Realself100 Surgeon

Thank you for sharing your concern — this is something I see often, especially among those with medium to deeper skin tones where the skin tends to produce more pigment after inflammation or breakouts. The dark marks you’re describing are known as post-inflammatory hyperpigmentation (PIH), and they often appear after acne lesions heal.
To improve this, a multi-step approach works best:

Treat active acne first – It’s important to calm ongoing breakouts to prevent new dark spots from forming. Gentle, consistent acne management helps tremendously.

Topical brighteners – Ingredients such as azelaic acid, niacinamide, kojic acid, and tranexamic acid can safely lighten hyperpigmentation over time. Prescription-strength options, such as hydroquinone or retinoids, may also be helpful under supervision.

Exfoliation – Incorporating a mild chemical exfoliant (like glycolic or lactic acid) 1–2 times per week can help fade pigmentation and smooth skin texture.


Sun protection – Daily sunscreen is absolutely essential, even indoors. UV exposure can darken existing spots and make them much harder to treat.

In-office treatments – Once your acne is stable, options like chemical peels, microneedling, or gentle laser treatments can speed up fading and improve skin tone overall.

Hyperpigmentation takes time to resolve — patience and consistency are key. With a tailored plan, it can improve significantly, revealing a much clearer and more even complexion.

Hi!
A great medical grade and prescription skincare routine to target your acne breakouts can help to prevent the scarring associated with acne. A series of chemical peels and proper skincare with appropriate ingredients that target dark spots can also be used to help with scarring. As a last line, CO2 laser would be used to help lighten the scarring. As always, sunscreen in your morning routine is a mainstay.
As always, an in person consultation is needed for proper assessment and goals.
Sincerely,Eleni Sgantzos, PA-C