Treating Acne Scars and Pigmentation: Which Comes First?

When acne marks and pigmentation appear together, the usual approach is to calm any active breakouts first, settle the brown discoloration next, and treat depressed scarring last with collagen-stimulating procedures. Scar treatments generate heat and inflammation that can darken pigment that is already there, which is why sequence matters. Scar depth and how a patient's skin actually responds can still shift that order, so diagnosis comes before any plan.

Hello, I'm Dr. Yeonjin Kim, director of UH CELL Clinic's Gangnam location. In consultations, patients often use the word "marks" to describe three things that are not the same problem at all. Before I suggest an order, I separate them.

Three Different Kinds of "Marks"

The American Academy of Dermatology explains that in medium to deep skin tones, a dark spot can appear where a pimple has healed, a pattern it calls post-inflammatory hyperpigmentation. The same source adds that lighter skin tones can be left with a reddish mark instead, and that either kind of mark can last for months. Depressed scarring is a structural issue rather than a color issue, so it calls for a different approach.

The Three-Step Order and the Evidence Behind It

Step 1: stabilize active acne. A 2023 Delphi consensus study published in the Journal of the American Academy of Dermatology reported agreement that most patients who have both acne and acne-related pigmentation should start effective acne treatment early, using topical retinoids and benzoyl peroxide. New inflammation keeps producing new pigment in the same spots, so this step comes first.

Step 2: settle the pigmentation. Mayo Clinic notes that laser resurfacing carries a higher risk of side effects in darker skin, and that chemical peels can also cause changes in skin color when applied deeply, particularly in darker skin. Running an aggressive scar procedure on top of active pigmentation risks layering new discoloration over the old. Letting the pigment response settle first reduces that burden before moving on.

Step 3: address depressed scarring. The same Mayo Clinic source states that microneedling tends to carry a comparatively lower risk of causing changes in skin color. Even at this stage, I weigh the type and intensity of a scar treatment against how likely it is to trigger another pigment reaction.

When the Order Can Change

If pigmentation is mild and depressed scarring is the main concern, the scar-focused step can move earlier, or run at a lower intensity alongside pigment management rather than strictly after it. Because our Gangnam location designs each treatment plan around an individual skin diagnosis, I ask a few questions before deciding: whether new acne is still appearing, whether a mark has darkened after a previous treatment, and whether the patient has significant sun exposure planned in the near term. Readers comparing regenerative options for scarring and texture may also find our guide on Rejuran versus standard hyaluronic acid skin boosters useful for understanding how collagen-stimulating treatments differ from hydration-focused ones.

FAQ

Do acne scars fade on their own over time?

The American Academy of Dermatology notes that acne scars can fade somewhat, but they rarely disappear completely without treatment. If depressed scarring is present, a consultation to assess the actual condition is more useful than waiting and watching.

Why does sunscreen matter during treatment?

Mayo Clinic advises that sunscreen can help reduce the contrast between a scar and the surrounding skin. That makes it a baseline habit through both the pigmentation stage and the scar-treatment stage.

Is one scar treatment session enough?

Mayo Clinic explains that results from radiofrequency, light-based treatments, and microneedling tend to appear gradually and that repeat sessions may be needed. The number of sessions and the interval between them are set based on scar depth and how quickly the skin recovers.

※ Individual skin response and recovery time vary. Please consult with a physician for an accurate diagnosis and treatment plan.