Ask five people which treatment is best for acne scars and you'll be handed five confident answers, each of them a single treatment name. They can't all be right, and the reason they disagree is worth having before you book anything: the word scar is covering four rather different things, and the four don't answer to the same treatment.
The four marks that get called acne scars
Nearly everything people bring us under that name is one of four things, and working out which of the four you have does most of the deciding.
Rolling scars are the shallow, wide ones. Their sides slope inwards rather than dropping, so what you notice isn't a hole in any one place; it's a whole cheek looking gently uneven.
Boxcar scars are more defined. The sides go down more steeply and the base is flat, so the mark has a border rather than a slope, and you could point straight at it. They come shallow and they come deep, and the depth matters a great deal more than the name does.
Ice-pick scars are the narrow, deep ones: small at the surface, dropping further down than their width would suggest.
Flat marks that are only a change of colour are the fourth, and strictly speaking they aren't scars at all. A brown patch, or a redness that lingers long after the spot itself has gone, is pigment and blood supply rather than any change in the level of your skin. They belong on the list because they get counted as scarring constantly and answer to a completely different set of treatments. If you're not sure which you have, why acne scars sit below the surface gives you a way of telling at home, with no equipment at all.
Very few people have only one of the four. A face usually carries a mixture of them, in different places and different amounts, and that on its own is the first reason a single treatment name was never the whole answer.
Why "best" is a question about the mark rather than the treatment
Ask in a hardware shop for the best glue and you'll get a question back before you get a product: what are you mending? Wood takes one thing, china takes another, the sole of a shoe takes another again, and the assistant isn't being awkward. Best belongs to the break rather than to the glue. The strongest tube on the shelf is the wrong answer as often as not, because a glue that suits the wrong material stays wrong however strong it is.
Choosing a treatment for a scar works the same way, which is why our scar treatment page opens by saying that scars come from accidents, operations, acne, chicken-pox and burns, and that no single treatment suits them all: we keep a suite of treatments and match the method to the individual scar. It's a page that declines to name a favourite, because a favourite is precisely the thing nobody can honestly have.
Colour marks: peels, elōs and time
Start here, because it's the most cheerful corner of the map. Colour left behind by a spot often fades on its own: slowly, sometimes over many months, but it does move, which is more than a dip in your skin will ever do unaided.
Where you'd rather not wait it out, colour is the kind of thing a chemical peel is built for. A peel removes the damaged outer layers of your skin, and that colour is very often sitting in exactly those layers, which is the same reason peels are used for sun damage and pigmentation generally. We use the Obagi Blue Peel RADIANCE. It works on all skin types, and the depth of yours is agreed at your consultation rather than settled in advance. What a chemical peel actually does has the mechanism.
Red marks are a separate job again. Our elōs skin rejuvenation carries dedicated settings for pigmentation and separate ones for vascular blemishes, so a brown mark and a red one are treated as the two different things they are.
Rolling and shallower boxcar scars: microneedling
This is where microneedling belongs, and acne scars are one of the concerns it improves most significantly.
The short of it is that a dip is missing structure rather than something lying on top, so the work has to come from underneath. Thousands of controlled micro-columns prompt your skin to regenerate: new collagen forms, the structure of the dermis strengthens, and the floor of the scar rises nearer to the level of its surroundings. Visible improvement typically begins around six weeks as that new collagen matures, and carries on over the months that follow.
Why these particular scars suit it so well, and why an old scar is still worth bringing, is the subject of microneedling for acne scars. What matters here is that the wide, sloping, shallower scars do best out of it. A broad, gently dished scar gives the new collagen somewhere to build, and the shallower the dip, the less building there is to do. The deeper a scar goes, whatever its name, the more it asks of the same process.
Ice-pick scars: the hardest of the four
This is the corner of the map where we have to be plainest, and hearing it from us now beats discovering it for yourself six months in.
A scar that is narrow and steep leaves new collagen almost nothing to work with, so the approach that serves rolling scars so well does noticeably less here. That isn't a reason to leave them at home. It's the reason we look first: the marks on one face won't all be matched to the same method, some will improve less than their neighbours in the same cheek, and now and then a single mark simply won't shift much. We tell you what improvement to expect before anything begins, and where ice-pick scarring is concerned, that is worth a great deal more than a promise.
Where microdermabrasion honestly sits
Microdermabrasion, our thirty-minute exfoliating facial, comes up in scar conversations often enough to be worth placing properly. Fine crystals lift the dead cells off the surface, taking the dullness, the clogged pores and the light sun damage with them, painless and with no downtime.
What it doesn't do is reach a scar. Its whole work happens at the surface, while a scar sits at its own level underneath, and taking the top layer off leaves that level exactly where it was: a good thing to have alongside a scar plan, and a poor one to have instead of it. What that half hour takes off is the fuller picture if it's your skin's texture rather than its shape bothering you.
Scars that never came from acne
Everything above applies just as squarely to scars from elsewhere, which is much of what we see: accident and injury scars, surgical scars, chicken-pox and burn scars, self-harm scars and tribal marks. The method is matched to the scar we're looking at rather than to the history behind it, because how a scar came about tells us less than the scar itself does, and reading yours is where your consultation begins.
If your acne hasn't finished yet
There's a difference between tidying up after a party and tidying up during one. Both are real work, and only one of them stays done, because in the second, more keeps turning up behind you while you carry it out.
Acne marks follow the same rule: while spots are still arriving, new marks are still being made behind the ones being treated. That isn't a reason to put the conversation off. It does mean the order is worth settling with somebody who can see your skin, so it's the first thing to raise when you come in. Acne itself sits on the list of what peels treat and what elōs treats, so this is a question about sequence rather than about being sent elsewhere.
What a course of treatment honestly changes
Improvement over time rather than erasure. Our scar treatment page puts it plainly: it may not be possible to remove a scar completely, and what treatment can do is make a scar significantly less visible and less prominent. In practice that means softer edges, shallower dips, colour that sits closer to what's beside it, and skin that stops pulling your eye every time you pass a mirror. What isn't on the table is a face that never had acne, and we'd rather say so now than have you booking against a picture of one.
It also arrives in instalments. Improvement of this kind is built up over a course rather than handed over in one appointment, and how many appointments, how far apart, and in which order are all decisions about your particular skin. They get settled with you at the consultation, and not before it.
Bring the marks and we'll tell you which ones you have
All of this comes down to one appointment, and it opens with identification: we look at your scarring, name the kinds you have, recommend the method matched to them, and say what to expect before anything begins. If something wouldn't serve you, we say so rather than book it. What happens at a consultation describes that appointment in full, should you want the shape of it beforehand.
Arrange your consultation and bring the marks themselves; a few minutes of looking at your own skin settles what no article can. Every treatment at Broadway Retreat is delivered by experienced medical professionals at our CQC-registered clinic on Broadway in Manchester, and nothing goes ahead until you've decided it should.
There is a best treatment for your acne scars. It simply isn't the same one as the best treatment for somebody else's, and finding out which is yours takes a conversation rather than a commitment.