Acne Scars vs. Post-Acne Marks: How to Tell What You Actually Have

A pimple heals, but something remains behind.

Sometimes it is red.

Sometimes it is brown or darker than the surrounding skin.

Sometimes the skin looks indented.

And sometimes patients describe all of these changes with the same words:

“I have acne scars.”

But not everything left behind after a breakout is actually a scar.

A flat red mark is different from a dark pigmented spot.

Both of those are different from a true acne scar that changes the texture or structure of the skin.

Knowing which one you have matters because these concerns do not always improve the same way and may require different treatment strategies.

At SAS Aesthetic Institute in Mokena, Dr. Michael Romberg, MD, evaluates whether a patient’s concern is active acne, post-acne redness, pigmentation, true scarring—or a combination of several problems.

What Is the Difference Between an Acne Scar and an Acne Mark?

An acne mark changes the color of the skin while leaving the surface relatively flat. An acne scar changes the actual texture or structure of the skin.

That is the simplest distinction.

If you run your finger over a red or dark area and the skin feels smooth, you may be looking at post-inflammatory discoloration rather than a true scar.

If the skin has a visible indentation, depression, uneven contour or raised area, structural scarring is more likely.

The difference can be summarized like this:

Patients can also have several of these at the same time.

For example, someone may have active acne on the jawline, red marks from recent breakouts and older indented scars on the cheeks.

Why Does Acne Leave Marks After It Heals?

Acne is an inflammatory process.

When a pimple becomes inflamed, the surrounding skin reacts.

Even after the active lesion resolves, that inflammatory response may leave visible changes behind.

The skin may remain:

• Red
• Pink
• Brown
• Gray
• Darker than the surrounding skin

These areas may remain visible much longer than the original pimple.

That does not necessarily mean the skin has been permanently scarred.

What Are Red Marks After Acne?

Flat red or pink marks that remain after a pimple heals are commonly related to persistent vascular and inflammatory changes.

You may notice them most clearly after:

• Inflamed papules
• Pustules
• Larger red breakouts
• Picking or squeezing
• Repeated inflammation in the same area

The active pimple may be gone, but the surrounding redness can remain.

This is one reason someone may believe their acne is still very active when much of what they are seeing is actually leftover redness.

Are Red Acne Marks Permanent?

Not necessarily.

Post-acne redness may gradually become less noticeable over time.

However, the timeline can vary considerably.

Some marks fade relatively quickly.

Others can remain noticeable for months.

Persistent redness may become especially frustrating when new acne continues forming while older marks are still present.

The result can make the skin appear continuously inflamed.

What Are Dark Spots After Acne?

Brown, gray or darker marks that remain after inflammation can represent post-inflammatory hyperpigmentation.

This means the inflammation has stimulated increased pigment production in the affected area.

The skin remains flat, but the color changes.

These marks can occur after many forms of skin inflammation, not only acne.

They may become especially noticeable after deeper or repeatedly manipulated breakouts.

Are Dark Acne Marks the Same as Scars?

No.

A flat area of pigmentation is not the same as a structural scar.

This is an important distinction.

A dark mark changes color.

A scar changes structure.

Someone may describe both as “acne scars,” but they should not automatically be treated the same way.

What Is a True Acne Scar?

A true acne scar develops when inflammation damages the deeper structure of the skin and the healing process changes the normal contour.

The scar may be depressed below the surrounding skin or, less commonly, raised above it.

This structural change is why true acne scars usually require a different approach from flat discoloration.

What Causes Acne Scars?

Acne scars are most strongly associated with deeper inflammatory acne.

When inflammation extends deeper into the skin, it can damage surrounding tissue.

The skin then attempts to repair the area.

If the healing process produces too little supporting tissue, an indentation may remain.

If excessive scar tissue develops, the area may become raised.

Several factors can increase the likelihood of lasting scars, including:

• Deep inflammatory acne
• Nodules
• Cystic lesions
• Repeated inflammation
• Picking
• Squeezing
• Delayed treatment of severe acne
• Individual tendency to scar

This is one reason controlling active acne matters even when the patient’s main concern is already-existing scars.

If new deep breakouts continue forming, new scars can continue developing.

What Are the Main Types of Depressed Acne Scars?

Not all indented scars look the same.

Ice Pick Scars

Ice pick scars are narrow, deep depressions.

They may look like tiny punctures extending into the skin.

Although the opening can be small, the scar may extend relatively deeply.

Boxcar Scars

Boxcar scars are broader depressions with more defined edges.

They may appear round or oval and can vary in depth.

Rolling Scars

Rolling scars create a wavy or uneven appearance across the skin.

Instead of one sharply defined pit, the surface may look as though it gently dips and rises.

A patient can have more than one scar type at the same time.

Can Acne Cause Raised Scars?

Yes.

Some patients develop raised scar tissue rather than depressions.

These scars occur when the healing response produces excessive tissue.

Raised scars are more common in certain areas of the body and in people who are more prone to abnormal scar formation.

This is another reason acne-scar treatment should be individualized.

A treatment intended for a depressed scar may not be appropriate for a raised scar.

How Can I Tell Whether I Have a Scar or a Mark?

Look at the skin in good natural light.

Then ask several questions.

Is the Area Flat?

If the skin is smooth and the main difference is color, it is more likely a post-acne mark.

Is There an Indentation?

A visible pit or depression suggests structural scarring.

Is the Area Raised?

Raised tissue suggests a different type of scar.

Is It Red or Pink?

Flat red or pink areas may represent persistent post-acne redness.

Is It Brown, Gray or Darker?

Flat darker areas may represent post-inflammatory pigmentation.

Does the Appearance Change With Lighting?

Shadows can make depressed scars much more noticeable.

Texture may appear deeper in side lighting because the uneven surface creates shadows.

That can help distinguish texture from simple discoloration.

Why Do Acne Scars Look Worse in Certain Lighting?

Indented acne scars create changes in the surface contour of the skin.

When light comes directly from the front, the surface can appear smoother.

When light hits the face from the side, depressions create shadows.

This can make scars appear deeper or more noticeable.

It also explains why someone may feel their skin looks different:

• In the bathroom mirror
• In direct sunlight
• Under overhead lighting
• In photographs
• On video calls

The scar itself did not suddenly become deeper.

The lighting changed how the texture was emphasized.

Can a Red Mark Also Have a Scar Underneath It?

Yes.

Color and texture can overlap.

A recently healed inflammatory lesion may leave:

• Redness
• Pigmentation
• An indentation

all in the same location.

The redness may improve with time while the underlying texture remains.

That can make it difficult to understand exactly how much permanent scarring is present until some of the post-inflammatory color settles.

Can You Have Active Acne, Marks and Scars at the Same Time?

Absolutely.

This is very common.

A patient may have:

Active acne
Current blackheads, whiteheads, pimples or deeper lesions.

Post-acne redness
Flat red or pink areas where previous pimples healed.

Post-inflammatory pigmentation
Flat brown or darker marks.

Acne scars
Indentations, pits or raised areas.

These four concerns should not simply be grouped together.

The treatment priorities may be different for each one.

For a broader explanation of acne itself, read our Complete Guide to Acne.

Why Is It Important to Control Active Acne Before Focusing Only on Scars?

Because every new deep inflammatory breakout creates another opportunity for scarring.

Imagine trying to repair a floor while damage continues happening in another part of the room.

The same idea applies to acne.

Improving old scars is useful, but if uncontrolled inflammatory acne continues producing new lesions, the patient may keep developing new marks and scars.

The treatment plan should therefore consider:

• Current breakouts
• Frequency of new acne
• Depth of lesions
• Scarring risk
• Existing scars
• Redness
• Pigmentation

This is why scar treatment and active acne treatment are connected but not identical.

Learn more about controlling active breakouts on our Acne Treatment in Mokena page.

Does Picking Acne Cause Scars?

It can increase the risk.

Picking and squeezing add additional trauma to already inflamed skin.

That can:

• Increase inflammation
• Damage surrounding tissue
• Prolong healing
• Increase redness
• Increase pigmentation
• Increase the chance of structural scarring

Deep lesions are especially poor candidates for squeezing because the inflammation extends beneath the surface.

Trying to force out a lesion that sits deep in the skin can create more tissue damage.

Does Every Pimple Cause a Scar?

No.

Many pimples heal without creating permanent structural changes.

The likelihood of scarring generally increases with deeper and more severe inflammation.

A small superficial blemish is much less likely to create the same type of damage as a large painful nodule.

However, repeated picking can turn a relatively minor lesion into a more significant inflammatory injury.

Why Do Some People Scar More Easily From Acne?

Scarring is individual.

Two people may experience similar acne but heal differently.

Factors can include:

• Depth of inflammation
• Duration of the breakout
• Genetic tendencies
• Picking or squeezing
• Location
• Healing response
• History of abnormal scars

This is why it is difficult to predict exactly which individual pimple will leave a lasting scar.

Do Acne Marks Fade on Their Own?

Some can.

Flat post-acne redness and pigmentation may gradually improve as the skin recovers.

However, fading can be slow.

It can also be difficult to appreciate improvement when new breakouts keep creating new marks.

Sun exposure can make certain pigmentation concerns more noticeable or persistent, which is one reason consistent sun protection is useful for acne-prone skin.

Do True Acne Scars Go Away on Their Own?

True structural scars generally do not behave like temporary discoloration.

The color around them may fade, which can make them less noticeable.

But an indentation represents a change in the structure of the skin.

That is why patients sometimes say:

“My scars faded a little but never completely disappeared.”

Often, what improved was the redness or pigmentation surrounding the scar while the texture remained.

Can Skin Care Remove Acne Scars?

Skin care can improve the overall appearance and condition of the skin, but significant structural scars usually require more than topical products alone.

A cream cannot simply fill in a deep depression.

However, skin care can still be valuable for:

• Supporting the skin barrier
• Managing active acne
• Improving pigmentation
• Protecting against sun exposure
• Preparing the skin for other treatment
• Maintaining results

The treatment plan depends on whether the main problem is color, texture or both.

How Is Post-Acne Redness Treated?

Treatment depends on the cause and severity of the redness.

Some redness gradually improves without procedural treatment.

Persistent redness may be addressed with technologies designed to target vascular or inflammatory components of the skin.

At SAS Aesthetic Institute, ADVATx is one technology available for selected patients with acne-related redness and other acne concerns.

The decision depends on what is actually producing the visible redness.

How Does ADVATx Help With Acne-Related Concerns?

ADVATx is a dual-wavelength laser platform available at SAS Aesthetic Institute.

It uses 589 nm and 1319 nm wavelengths, which can be selected differently depending on the treatment goal.

This is useful in acne-prone skin because a patient may have more than one concern.

For example:

• Active inflammatory acne
• Persistent post-acne redness
• Uneven texture
• Acne scars
• A combination of active and healed lesions

The treatment does not simply target “acne scars” as one broad category.

The wavelength and treatment approach depend on whether the goal involves active inflammation, redness, texture or another acne-related concern.

Learn more about the ADVATx technology used at SAS Aesthetic Institute.

Can ADVATx Help Active Acne and Marks at the Same Time?

In selected patients, treatment planning may address more than one acne-related concern over the same overall treatment period.

For example, a patient may still have active inflammatory lesions while older lesions have left persistent redness.

That does not mean every concern receives exactly the same treatment.

It means the plan can account for both ongoing acne and the changes left behind by previous breakouts.

For more information on treating acne while it is still active, read Can Laser Treatment Help Active Acne?.

Can ADVATx Help Acne Scars?

ADVATx may be incorporated into treatment planning for selected acne-scar and texture concerns.

The appropriate approach depends on factors such as:

• Type of scar
• Scar depth
• Amount of active acne
• Redness
• Skin characteristics
• Previous treatments
• Overall treatment goals

Not every acne scar responds the same way.

A shallow rolling scar is different from a narrow deep ice pick scar.

That is why scar classification matters before treatment begins.

For more specific information about scar treatment, visit our Acne Scar Treatment in Mokena page.

Can Laser Treatment Make Acne Scars Completely Disappear?

No procedure should be presented as a guarantee that every scar will disappear completely.

The more realistic goal is improvement.

Depending on the scar, treatment may help:

• Soften irregular texture
• Reduce the appearance of certain depressions
• Improve associated redness
• Improve the overall appearance of the skin

The degree of improvement varies based on the type, depth and age of the scars as well as the treatment being used.

Are New Acne Scars Easier to Treat Than Old Scars?

The age of a scar is only one factor.

What often matters more is:

• Scar type
• Depth
• Skin characteristics
• Associated redness
• Active acne
• Previous treatment

A newer scar may still be deep.

An older scar may be relatively shallow.

Treatment should therefore be based on the actual scar rather than age alone.

Can Dark Acne Marks Be Treated the Same Way as Red Marks?

Not necessarily.

Redness and pigmentation represent different processes.

A red mark may have a stronger vascular component.

A brown or darker mark involves pigment.

A patient may have both.

The treatment approach should reflect the actual color change rather than grouping everything under the word “discoloration.”

Why Does Sunscreen Matter for Post-Acne Marks?

Sun exposure can make post-inflammatory pigmentation more noticeable.

Protecting the skin from ultraviolet exposure can help prevent additional darkening while the skin recovers.

For acne-prone skin, sunscreen should generally be selected with the skin type in mind.

Look for products that are:

• Broad-spectrum
• SPF 30 or higher
• Non-comedogenic
• Comfortable enough to use consistently

A sunscreen that someone refuses to wear because it feels too heavy is not very useful.

What If My Acne Marks Are Getting Worse Even Though I Have Fewer Pimples?

This can happen.

Acne lesions may be decreasing while the marks from previous inflammation remain visible.

Because the color lasts longer than the breakout, the skin may still look covered with acne even though active disease is improving.

Take a closer look.

Are the areas:

• Raised?
• Inflamed?
• Tender?
• Flat?
• Red?
• Brown?

If most are flat, you may be seeing the aftermath of previous acne rather than dozens of new breakouts.

Why Do I Keep Getting New Marks?

The most common reason is that new inflammatory acne is still forming.

Every new inflamed lesion creates another opportunity for persistent redness or pigmentation.

That is why treating only the marks while ignoring active acne can become frustrating.

A complete plan should address both:

what acne has already left behind
and
what is creating new lesions now.

If new breakouts continue returning, read Why Does Acne Keep Coming Back?.

When Should Acne Scars or Marks Be Evaluated?

Consider having the skin evaluated when:

• You cannot tell whether the concern is a scar or discoloration
• Acne continues creating new marks
• Indentations are becoming noticeable
• Deep acne is still active
• Redness remains for long periods
• Pigmentation is persistent
• Picking has caused visible damage
• Previous treatments have not helped
• Several different scar types are present
• You are interested in treatment but do not know which concern should be addressed first

The more clearly the concern is identified, the more focused the treatment plan can be.

Frequently Asked Questions About Acne Scars and Post-Acne Marks

Are red marks after acne scars?

Not necessarily. If the skin remains flat and only the color has changed, the concern may be post-acne redness rather than a true structural scar.

Are dark spots after pimples scars?

Usually not if the skin is flat. Dark post-acne spots may represent post-inflammatory pigmentation.

How do I know if I have an acne scar?

A true acne scar changes the texture or contour of the skin. You may see an indentation, pit, rolling depression or raised area.

Can acne scars fade?

The redness or pigmentation around a scar may fade, making it less noticeable, but structural scars usually do not behave like temporary marks.

Can acne marks disappear naturally?

Some post-acne redness and pigmentation gradually improve with time, although the timeline varies.

Why are my acne scars more visible in certain lighting?

Indented scars cast shadows. Side or overhead lighting can emphasize uneven texture and make depressions appear deeper.

Can one pimple leave both a dark mark and a scar?

Yes. The same inflammatory lesion can leave discoloration and a structural change in the skin.

Does picking acne cause scars?

Picking and squeezing can increase inflammation and tissue damage, which may increase the risk of discoloration and scarring.

Should active acne be treated before acne scars?

Active acne should be part of the treatment plan because ongoing deep breakouts can continue creating new scars. The exact order depends on the individual patient.

Can ADVATx help post-acne redness?

ADVATx may be considered for selected patients with persistent acne-related redness. The appropriate treatment depends on the cause of the redness and the overall condition of the skin.

Can ADVATx help active acne too?

In selected patients, ADVATx may be incorporated into an acne treatment plan for active inflammatory acne and related redness.

Can ADVATx treat acne scars?

ADVATx may be considered for selected acne-scar and texture concerns. Scar type, depth, active acne and other skin characteristics influence treatment planning.

Are acne scars permanent?

True scars represent structural changes in the skin. They can remain long term, although treatments may improve their appearance.

Should I treat redness, dark spots or scars first?

That depends on which concerns are most significant and whether active acne is still creating new lesions. An evaluation can help establish the right priority.

Before Treating an “Acne Scar,” Identify What It Actually Is

The term acne scar gets used for almost everything that remains after a breakout.

But there are several different possibilities.

A flat red mark is not the same as an indentation.

A brown spot is not the same as a raised scar.

Active inflammatory acne is not the same as post-acne redness.

And a patient can have all of them at once.

Understanding those differences is the first step toward choosing treatment appropriately.

At SAS Aesthetic Institute, Dr. Michael Romberg, MD, evaluates active acne, post-acne redness, pigmentation and structural scarring to determine what is actually present and which concerns should be addressed first.

If new breakouts are still occurring, learn more about Acne Treatment in Mokena and read our Complete Guide to Acne.

For patients dealing with persistent redness, active acne or scar-related concerns, ADVATx may be one of the technologies considered as part of an individualized treatment plan.

Patients primarily concerned with permanent texture changes can also learn more about Acne Scar Treatment in Mokena.

SAS Aesthetic Institute
19657 South La Grange Road, Mokena, IL 60448
(708) 476-8205