Do acne scars get worse over the years ?

I've had moderate acne scars for about 8-9 years now. I have ice pick scars and box scars. I was wondering if I leave them the way they are now would they get worse or bigger in the future ? I'm 25 years old. I'm a pale middle eastern female. Idk if this helps to determine that. I saw a doctor today and I'm unsure if the side effects and the recovery that come with total fx may be right for here. In fact, I'm terrified. I'm scared the total fx will cause more harm to me in the future

Doctor Answers 6

Acne scar treatments in Los Angeles

Acne scarring can complement normal aging and make some wrinkles appear prematurely. I would consider application of Melarase creams and Ematrix RF for the scars. 

Best, 
Dr. Karamanoukian 
Los Angeles


Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Best Laser Treatments for Acne Scars

Acne scars, both ice pick and box type become more prominent as we age as a direct result of loss of collagen and elastin. These types of acne scars respond really well to the TotalFX which is a fractional CO2 laser. While there are always risk factors associated with laser procedures, neither would cause more harm to the existing scars . I can understand why you would be terrified as the TotalFX procedure has discomfort associated with it and requires a significant amount of downtime. As an alternative, you could do the Fraxel laser which we find to work well for moderate acne scars and is safe in patients of your skin type and requires far less down time. However more than one treatment is necessary. It is very important that you have a thorough consultation which includes seeing before and after photos to full comprehend what to expect. Best of luck.

Karen Hammerman, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Acne Scarring -- Requires a Combination of Fractional Laser Resurfacing, Fillers Like Bellafill, Subcision and Eclipse Micropen

Acne scarring needs a combination of lasers, needling, fillers and often surgery and they can get worse with aging as the volume beneith them decreases and makes them look much worse.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

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Acne scars worsen with age

The reason that acne scars worsen with age is because your skin loses collagen and elasticity as you age. In other words, injecting collagen or volume into scars will make your scars look better.  That is why I use Sculptra on many patients who have acne scars to give added volume to their face and produce new collagen.  I much prefer the eMatrix for your type of skin color and acne scars.  You can go deeper than with the total FX and not have to worry about hyperpigmentation.  I treat so many patients with acne scars and it is a complex process to give the best cosmetic results.  Best, Dr. Green

Acne scars and worsening with age

Acne scars often do get worse as we age.  Most acne scars are atrophic with a loss of collagen.  This is an area of skin weakness and this becomes more apparent with age.  People tend to get wrinkle lines and creases in areas where the collagen is weak.  

It's not possible to give any specific recommendations without seeing you in person or seeing pictures but you might consider microneedling as a less invasive alternative to laser resurfacing.  In my practice, we are seeing good results with SkinPen microneedling for boxcar and rolling scars and there is little downtime.  We generally recommend a series of five treatment sessions to start with.  

I would recommend that you get an opinion from an expert in the treatment of acne scars who offers more than one type of treatment for acne scars.

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

Yes with volume loss

To answer your question- yes, with volume loss, but at the age of 25, you are at least a decade away from that. Total FX is a very good laser, it has a lot of power- for your skin type, power is fine, but treatment density should be low. 

For the best results, one should target the acne scar type with ideal treatments. For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgery.

The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars.

All the best,
Dr Davin Lim
Laser, surgical & aesthetic dermatologist
Brisbane, Australia

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 60 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.