Read about acne or, worse yet, experience it, and you’ll notice the militaristic terminology: Blackheads are a battle that must be won; we wage wars against whiteheads; treatment must be swift, aggressive, and unrelenting. So it follows that once the crusade concludes, former acne sufferers, like soldiers, can experience a bit of a skin identity crisis. Treating newly clear skin is a lot less time-consuming and emotionally exhausting than treating a complexion inflamed with pustules, and yet, the former acne sufferer also faces foreign challenges (scarring, dark marks, unevenness). In short, there’s no post-acne section on the dropdown menus of Sephora.com.
And then there’s the psychological component: After years ducking mirrors and hiding behind bangs, curtains of hair, turtlenecks, and scarves, what does it feel like to step away from going incognito? We asked our favourite dermatologists, aestheticians, and other skin experts to share their own stories, their patients’ tales, and their best tips for dealing with every aspect of life after acne.
You Sure That’s A Scar?
If your skin is fair and you had moderate acne, you’re likely left with some nasty red marks. If your complexion is darker, the marks will be a deeper hue. “People think these pigmentations are scars,” says New York City dermatologist Joshua Zeichner, MD. “They’re actually just stains that likely fade in a few months.” To speed the process, Stalina Glot, an aesthetician at Haven Spa in NYC, suggests weekly acid peels or glycolic exfoliants, noting that avoiding the sun after treatment is key. If acids don’t help, Dr. Zeichner says in-office lasers, like the VBeam for red spots and the Fraxel for brown ones, can be effective. Another at-home option? Brightening creams like SkinMedica Lytera or those with kojic acid or hydroquinone.
Identify Your Scar
Not all acne is created equal, nor do the leftover scars fit a single profile. But they do fall in three main categories, as outlined below.
Crater Or Rolling Scars
These types of depressions are probably what you most readily associate with acne scars. “They’re wide and deep with gently sloping borders,” explains NYC dermatologist Neal Schultz, MD, who likes injecting both temporary and permanent fillers beneath the skin to lift the bottom of the scar and flatten the zone. Diane Berson, MD, an associate clinical professor of dermatology at Cornell University's Weill Medical College, likes the two-pronged approach of Bellafill for this purpose. “It contains collagen to immediately lift the skin, and an ingredient to stimulate future collagen production,” she explains. Of course, not every crater scar requires fillers: Topical retinoids can also help fade discolouration and restore subtle changes in surface texture.
Hypertrophic Scars
These scars are red and raised — most of us have at least one on our knees from childhood spills. Dr. Berson says a pulse-dye vascular laser is your best bet; depending on the severity of your scars, multiple treatments may be necessary.
Ice-Pick Scars
These scars are deep, angular, and look — you guessed it — like an ice pick pierced the skin. (Yeesh.) And while they are treatable, it’s a more serious proposition. “There is no topical treatment for ice-pick scars,” says Dr. Schultz. “The only way to really get rid of them is by cutting them out. It’s an easy procedure.” The surgery is officially called a punch graft, and involves removing the affected area, then replacing it with a section of skin from behind the ear. It’s local anaesthesia, minimal downtime, and patients are usually thrilled with the results.
Oil, Oil Everywhere
Dr. Schultz says some of his patients do experience an excess of oil, even after their complexions have cleared. “Usually, it’s managed at home with gentle cleansers, toners, and blotting papers,” he says. If that routine doesn’t cut it, low-dose Accutane is another option. To this end, NYC dermatologist Francesca Fusco, MD, mentions that she has had some patients who've become obsessive about their hygiene routines. “Even if they know it’s not true, some patients think their acne was the result of poor hygiene and they’ll stay fearful of moisturisers and insistent on twice-daily scrubbing even after their faces have cleared,” she says. “There’s a risk of over-exfoliating and leaving the skin raw.”
Your Mental Wellbeing
Dr. Berson has been treating acne for nearly three decades. Yes, she’s thrilled when she sees flare-ups make way for calm and clear complexions. But she’s most moved by the inevitable psychological transformations. “It’s so gratifying, because patients become different people. The guys who were wearing bangs are suddenly pushing their hair back. The girls whose hair hung long on the sides are now in ponytails. They’re happier, more outgoing, more self-assured. They just feel wonderful about themselves,” she says.
Of course, sometimes, the damage is more than skin-deep. “My father was a psychologist so I have that background. If I treat someone’s acne and they still seem down or depressed, I encourage them to consult a professional,” Dr. Berson says. Dr. Fusco, who suffered from acne herself as a child, says she still won’t wear bangs. “I thought that was what caused the bumps and whiteheads on my forehead,” she says.
Happily, not all post-acne mental changes are negative. In fact, people who once had the worst skin are likely to have the best skin as they age. “They’re more likely to wear sunscreen, to cleanse, and to address the signs of ageing,” says Dr. Berson. “Acne sufferers are accustomed to following a regimen. Like it or not, but they’re more tuned in to their faces — and that makes a big difference.”
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