Understanding Acne Scarring
Advanced Acne Solutions at Illustria Medical Aesthetics
Acne scars can linger long after breakouts have cleared, affecting skin texture and confidence. At Illustria Medical Aesthetics in Milton, Ontario, Dr. Leonora Ogbeide, MD, CCFP, a member of the Canadian Board of Aesthetic Medicine (CBAM), provides physician-performed treatments tailored to your scar type and skin tone.
Acne scars form when inflamed breakouts damage collagen in the deeper layers of skin. Common types include:
- Ice-pick scars: Narrow, deep pits
- Boxcar scars: Wider, sharply defined depressions
- Rolling scars: Broad, wave-like unevenness
Skin of colour (Fitzpatrick types IV–VI) is more prone to post-inflammatory hyperpigmentation and requires careful technique to avoid worsening pigment issues.
How Acne Scars Form and Why They Persist
Acne scars form when inflamed breakouts damage collagen in the deeper layers of skin. Common types include:
- Ice-pick scars: Narrow, deep pits
- Boxcar scars: Wider, sharply defined depressions
- Rolling scars: Broad, wave-like unevenness
Skin of colour (Fitzpatrick types IV–VI) is more prone to post-inflammatory hyperpigmentation and requires careful technique to avoid worsening pigment issues.
How Acne Scars Form and Why They Persist
Acne scars form when inflamed breakouts damage collagen in the deeper layers of skin. Common types include:
- Ice-pick scars: Narrow, deep pits
- Boxcar scars: Wider, sharply defined depressions
- Rolling scars: Broad, wave-like unevenness
Skin of colour (Fitzpatrick types IV–VI) is more prone to post-inflammatory hyperpigmentation and requires careful technique to avoid worsening pigment issues.
The Formation Process
Acne begins when pores become clogged with oil (sebum), dead skin cells, and bacteria (Cutibacterium acnes). In mild cases the inflammation stays near the surface. In more severe or prolonged breakouts—especially cystic or nodular acne—the inflammation spreads into the dermis, the layer rich in collagen and elastin that gives skin its firmness and smoothness.
This deeper inflammation destroys or weakens the collagen framework. As the body tries to heal the wound:
- It may produce too little collagen, leaving a depression (atrophic scar).
- It may produce too much collagen, creating a raised scar (hypertrophic or keloid).
- Fibrous bands can form that tether the skin downward, producing the rolling or wave-like appearance common in atrophic scarring.
The type of scar that develops depends on the depth of damage, the intensity of the inflammatory response, individual genetics, and whether the lesion was picked or squeezed.
Why Acne Scars Stay
Once the collagen architecture is altered, the change is largely permanent without intervention. Here’s why scars persist:
- Limited natural remodeling – After the acute healing phase ends (usually weeks to a few months), the skin’s ability to rebuild significant amounts of new, organized collagen slows dramatically. Everyday turnover of skin cells affects only the outermost layer and does not correct deeper dermal defects.
- Structural loss or excess – Atrophic scars represent actual missing tissue volume and disrupted collagen scaffolding. The body does not spontaneously fill these voids. Raised scars contain excess, disorganized collagen that remains stable over time.
- Tethering and fibrosis – In many rolling and some boxcar scars, fibrous strands anchor the skin to deeper tissue. These bands keep the surface depressed even if some new collagen forms around them.
- Secondary pigment changes – Especially in darker skin tones, inflammation can also trigger excess melanin production. While pigment may fade slowly, the textural scar itself does not.
- Aging and further collagen decline – As natural collagen production decreases with age, existing scars can become more noticeable because the surrounding skin loses firmness and the contrast increases.
In short, acne scars are the result of incomplete or abnormal wound healing in the dermis. Because the structural change is locked in after the initial repair phase, the scars remain visible for years unless treated with methods that stimulate new collagen, release tethered tissue, or resurface the skin.
Why Choose Illustria for Acne Scarring?
- All treatments performed exclusively by Dr. Leonora Ogbeide
- Expertise in treating diverse skin tones with techniques proven safe for melanin-rich skin
- Customized combination protocols rather than one-size-fits-all approaches
- Focus on realistic expectations and long-term skin health
