Acne Scars: What Actually Works for Each Type
Quick Summary: Not all acne scars are the same, and not all treatments work on every type. Post-inflammatory marks (flat dark or red spots) often fade with sun protection, topical care and time. Raised acne scars may respond to medical-grade silicone gel. Pitted or indented scars (ice pick, boxcar, rolling) involve structural skin damage that topical products alone generally cannot correct. This guide breaks down each type honestly and explains where silicone gel fits, and where it does not.
Why Most Acne Scar Advice Gets It Wrong
If you have searched for acne scar treatments, you have probably encountered products promising to fade, smooth or remove your scars. The problem is that "acne scars" is an umbrella term covering at least three very different conditions, each requiring a different approach. Treating all of them the same way wastes time and money.
Before choosing any treatment, you need to identify what type of mark you are actually dealing with. That single step will save you more frustration than any product recommendation.
The Three Types of Acne Scars (and Why the Difference Matters)
Post-inflammatory hyperpigmentation (PIH). These are flat, dark brown or black marks left behind after a breakout heals. They are not true scars. They are caused by excess melanin production triggered by inflammation. PIH is more common and more persistent in darker skin tones. With sun protection and time, most PIH fades within 3 to 24 months.
Post-inflammatory erythema (PIE). These are flat, red or pink marks caused by dilated blood vessels near the skin surface. More common in lighter skin tones, PIE can persist for months. It is not a pigmentation issue; it is a vascular one, which is why treatments targeting melanin (like vitamin C) may not help much.
Atrophic (pitted) scars. These are true structural scars: ice-pick scars (narrow, deep holes), boxcar scars (wider depressions with sharp edges), and rolling scars (broad, wave-like undulations). They form when inflammation destroys collagen deep in the dermis, leaving permanent indentations. These scars do not fade on their own and generally require professional treatment.
Raised (hypertrophic) acne scars. Less common on the face but sometimes seen on the chest, shoulders and back. These form when the body overproduces collagen during healing, creating a raised, firm scar that stays within the boundaries of the original breakout.
What Works for Post-Inflammatory Marks (PIH and PIE)
Sun protection (essential). UV exposure is the single biggest factor in prolonging both PIH and PIE. Melanin production increases with sun exposure, darkening existing marks. Apply broad-spectrum SPF 30+ daily, even on overcast days. In Australian conditions, this is non-negotiable if you want marks to fade.
Time. Most PIH and PIE will fade on their own, but timelines vary. Mild marks may clear in 3 to 6 months. Deeper pigmentation can take 12 to 24 months. Patience is part of the treatment.
Topical ingredients that may help. Vitamin C (ascorbic acid) can support melanin regulation and may help fade PIH over time. Niacinamide (vitamin B3) has some evidence for reducing pigmentation and supporting skin barrier repair. Retinoids (prescription or over-the-counter retinol) encourage cell turnover, which can help marks fade faster. Azelaic acid may help with both pigmentation and residual inflammation.
Silicone gel. While silicone is not a first-line treatment for flat post-acne marks, it may support the healing environment by maintaining hydration and creating a protective barrier. It is most useful if your post-acne marks are accompanied by any raised texture or if you want to protect healing skin from environmental irritants.
What Works for Raised (Hypertrophic) Acne Scars
This is where silicone therapy has the strongest evidence in the context of acne scarring. A review in Advances in Wound Care (2015) confirmed that medical-grade silicone helps regulate collagen production and maintain scar hydration, both of which are directly relevant to reducing the thickness and firmness of raised scars.
If you have raised acne scars, particularly on the chest, shoulders or back, silicone gel applied twice daily for 8 to 12 weeks may help soften, flatten and reduce redness. One option is Genova Silicone Scar Gel, which combines medical-grade silicone with VANISTRYL (a peptide that supports skin elasticity) and Ecoskin Probiotic. It dries clear and can be worn under clothing or sunscreen.
For more persistent raised scars, professional treatments, including steroid injections or laser therapy, may be needed. Silicone gel can be used alongside these as part of a broader scar management plan.
What Works for Pitted (Atrophic) Acne Scars: An Honest Assessment
This is where we need to be straightforward. Topical products, including silicone gel, are generally not effective for true atrophic acne scars. These scars involve structural loss of collagen and tissue beneath the skin surface. No cream, gel or serum can rebuild that lost architecture from the outside.
Professional treatments with evidence for atrophic scars include: Microneedling (stimulates collagen production through controlled micro-injuries). Laser resurfacing, both ablative (CO2, erbium) and non-ablative fractional lasers. Subcision (a needle breaks the fibrous bands pulling the skin down in rolling scars). Chemical peels (TCA, phenol) for shallower boxcar scars. Dermal fillers for individual deep scars. Radiofrequency microneedling for deeper remodelling.
Most dermatologists use a combination of these techniques, tailored to the specific scar types present. Results are cumulative and typically require multiple sessions spaced weeks apart.
If you have pitted acne scars that bother you, the most productive step is a consultation with a dermatologist who specialises in scar revision. They can assess your scar types, map a treatment plan, and set realistic expectations for improvement.
A Decision Framework: Matching Treatment to Scar Type
Flat dark marks (PIH): Sun protection + time + vitamin C or niacinamide. Silicone gel optional for barrier support.
Flat red marks (PIE): Sun protection + time. Vascular laser if persistent. Silicone gel optional.
Raised scars (hypertrophic): Medical-grade silicone gel (first-line topical). Steroid injections or laser if silicone alone is insufficient.
Pitted scars (atrophic): Professional treatment required. Topical products alone are unlikely to produce meaningful improvement. See a dermatologist.
Realistic Expectations for Acne Scars
Acne scars are one of the areas where the gap between marketing promises and biological reality is widest. Managing expectations honestly is the most useful thing any guide can do.
Post-inflammatory marks will usually fade significantly with patience and sun protection, though some residual unevenness in skin tone is normal. Raised scars can be meaningfully improved with consistent silicone therapy and, if needed, professional treatment. Pitted scars can be improved but rarely eliminated completely, even with professional procedures. Most patients see 50 to 70% improvement over a series of treatments.
For a broader context on scar healing timelines across all scar types, see our guide to how long scars take to fade. If your scars itch persistently, our guide to why scars itch explains the biology behind this.
FAQ: Acne Scars
Does silicone gel work on acne scars?
Silicone gel works best on raised (hypertrophic) acne scars by regulating collagen production. It may provide some barrier support for healing post-acne marks, but it is not effective for pitted or indented scars, which require professional treatment.
How long do post-acne marks take to fade?
Post-inflammatory hyperpigmentation (dark marks) can take 3 to 24 months to fade naturally with sun protection. Post-inflammatory erythema (red marks) may take a similar timeframe. Consistent SPF use is the most important factor.
Can I treat acne scars at home?
Flat marks (PIH, PIE) and raised scars can be managed at home with sun protection, appropriate topical ingredients and silicone gel. True pitted scars require professional treatment for meaningful improvement.
When should I see a dermatologist for acne scars?
If you have pitted or indented scars, raised scars that are not responding to topical care after 12 weeks, or scars that are affecting your confidence or quality of life. Early intervention generally produces better outcomes.
Will my acne scars get worse with age?
Pitted scars can become more noticeable as skin loses elasticity with age, particularly during perimenopause and menopause when estrogen-driven collagen production declines. This is another reason to address them earlier if they concern you.
Can I use silicone gel while I still have active acne?
Silicone gel should be applied to healed skin, not active breakouts or open lesions. Wait until the blemish has fully healed before applying. If you have active acne, treating the acne itself is the priority to prevent further scarring.
Is there anything that prevents acne scars from forming?
The best prevention is early, effective treatment of active acne to reduce inflammation. Avoid picking or squeezing breakouts, protect healing skin from the sun, and consider seeing a GP or dermatologist if over-the-counter treatments are not controlling your acne.
References
- Mustoe, T.A. et al. (2015). 'The Use of Silicone Adhesives for Scar Reduction.' Advances in Wound Care, 4(7), pp. 422-430. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4486716/
- Kazemeini, S. et al. (2025). 'Evidence-Based Topical Therapy for Facial Scars in Diverse Skin Types.' Cureus, 17(6), e86343. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12275165/
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Results from any scar treatment vary between individuals. If you have concerns about acne scarring, consult your healthcare provider or a dermatologist for personalised advice.
