Can atrophic scars turn into hypertrophic scars?

No, these represent fundamentally different healing responses. An atrophic scar forms when the body produces insufficient collagen during healing, creating a depression. A hypertrophic scar develops when the body makes excess collagen, creating raised tissue. Once the scar has formed, it cannot transform into the opposite type because the initial healing response has completed.

Do hypertrophic acne scars go away on their own?

Hypertrophic scars may flatten slightly over several years as collagen remodels, but they rarely disappear completely without treatment. The excess collagen that creates the raised appearance remains in the dermis permanently. Early hypertrophic scars respond better to treatment than older, established scars, making timely intervention important.

Which type of acne scar is harder to treat?

Atrophic scars generally require more treatments to achieve significant improvement because they involve missing tissue that must be rebuilt or replaced. Icepick scars prove particularly challenging due to their depth and narrow shape. Hypertrophic scars often respond well to steroid injections and pressure therapy, though multiple sessions are typically needed.

Can vitamin C help prevent acne scars?

Vitamin C supports collagen synthesis and reduces inflammation, which may help skin heal more effectively after acne. However, it cannot prevent scars from severe inflammatory acne that penetrates deep into the dermis. Vitamin C works best as part of overall skin health rather than as a specific anti-scarring treatment.

Why do I only get acne scars on my cheeks?

Facial skin varies in thickness and oil gland density across different areas. Cheeks have thinner skin with less underlying fat support, making atrophic scarring more visible there. The temples and cheeks also experience more inflammatory acne due to higher sebaceous gland concentration, increasing scarring risk in these zones.

Are hypertrophic scars more common in certain skin tones?

Yes, people with darker skin tones have higher rates of hypertrophic scarring due to increased fibroblast activity and collagen production in response to injury. This represents an adaptive healing response, but it creates more raised scarring from acne. Lighter skin tones show higher rates of atrophic scarring.

How long after acne clears can scars still form?

Scars form during the healing process while acne lesions resolve, not after the skin has completely healed. However, post-inflammatory changes continue evolving for 12-18 months after active acne clears. What initially appears as temporary redness or discoloration may reveal permanent atrophic or hypertrophic changes as this remodeling period progresses.

Can retinoids prevent acne scars?

Retinoids reduce acne severity by normalizing skin cell turnover and decreasing inflammation, which indirectly lowers scarring risk. They also stimulate collagen production that may help fill shallow atrophic scars over time. However, retinoids cannot prevent scars from deep cystic acne or modify genetic tendencies toward hypertrophic scarring.

Atrophic vs Hypertrophic Acne Scars: Key Differences

Atrophic and hypertrophic acne scars represent opposite extremes of the skin's wound-healing response following severe inflammatory acne breakouts. Atrophic scars are sunken or pitted depressions caused by a loss of collagen and supporting tissue during healing. In contrast, hypertrophic scars are raised, thickened bumps on the skin’s surface caused by an overproduction of collagen.

Treating acne scars depends heavily on whether they are atrophic or hypertrophic. While atrophic scars require procedures to stimulate collagen and restore lost volume, hypertrophic scars need therapies designed to flatten the raised tissue and calm overactive collagen production.

What Causes Atrophic vs Hypertrophic Scars?

Atrophic and hypertrophic scars are typically caused by skin damage based on how the body manages collagen production during the healing process.

Here are common triggers that cause these scars (which are not limited to acne):

Atrophic Scars Causes	Hypertrophic Scars Causes
Severe cystic acne	Deep surgical incisions
Chickenpox infections	Thermal or chemical burns
Mole or cyst removals	Piercings or tattoos
Skin trauma with tissue loss	Infected or inflamed wounds
Genetic predisposition to poor wound healing	Wounds under high skin tension

Difference Between Atrophic and Hypertrophic Acne Scars

Atrophic and hypertrophic acne scars are textural scarring, and they represent opposite healing responses by your body. The key difference is that atrophic scars appear as indentations due to collagen loss, while hypertrophic scars appear as raised tissue due to excess collagen.

Here are some key differences between atrophic and hypertrophic acne scars:

Feature	Atrophic Scars	Hypertrophic Scars
Appearance	Sunken pits, craters, or depressions	Raised, firm bumps or thickened tissue
Collagen Level	Deficit (too little collagen produced)	Surplus (too much collagen produced)
Common Areas	Cheeks, temples, forehead, and nose	Jawline, chest, shoulders, and back
Main Goal	Build up skin volume and stimulate collagen	Flatten excess tissue and halt overproduction
Top Treatments	Microneedling, lasers, fillers, and TCA Cross	Steroid injections, silicone sheets, and cryotherapy

Atrophic Scars vs Hypertrophic Scars Treatment

Atrophic and hypertrophic scars are caused by different processes and therefore require entirely different treatment approaches.

For hypertrophic scars (raised and thickened), the goal shifts to inhibiting and restructuring excess collagen, not stimulating more of it. Treatments that encourage collagen to fill in indentations are necessary to treat atrophic scars, which are sunken or depressed.

At-home treatments cannot totally eradicate atrophic or hypertrophic scars. To some extent, discolouration may be softened and faded with natural therapies. Dermatologists perform effective clinical therapies to eliminate or physically restructure scar tissue.

Atrophic Scars Treatment

Atrophic scars form when the skin loses tissue during healing and cannot rebuild enough collagen to restore the surface, making professional dermatological intervention the most effective route to treat them.

Some of the most common treatments for atrophic scars are:

Laser Resurfacing

CO2 lasers remove the outer skin layers, triggering the body to produce new collagen and resurfacing the skin.

Subcision

A fine needle is inserted beneath the scar to sever the fibrous bands tethering the skin downward, allowing the depressed surface to gradually lift.

Dermal Fillers

Dermal fillers are injected to temporarily lift depressed areas and restore volume to sunken areas.

Collagen-Stimulating Therapies

Procedures such as microneedling stimulate the body's natural production of collagen.

TCA Cross (Chemical Reconstruction of Skin Scars)

A high-concentration trichloroacetic acid solution is applied directly into the base of ice pick or boxcar scars to stimulate collagen and gradually fill the pit.

Hypertrophic Scars Treatment

Hypertrophic scars form when the body produces too much collagen during healing. They appear as firm, raised bumps, most commonly on the chest, back, and jawline.

Some common treatments done for hypertrophic scars are:

Intralesional Steroid Injections

To flatten elevated scars, corticosteroids (such as triamcinolone) are injected directly into the scars to break down extra collagen and reduce inflammation.

Silicone Gel or Sheet

Medical-grade silicone helps hydrate the skin, soften scar tissue, and gradually flatten elevated areas. It is frequently advised for both prevention and treatment.

Lasers and Cryotherapy

Liquid nitrogen is used in cryotherapy to freeze and reduce scar tissue. Pulsed Dye Lasers (PDL) effectively reduce redness, itching, and the blood vessel activity (vascularity) that keeps scars raised and inflamed.

Cryotherapy is often combined with steroid injections for better outcomes.

5-Fluorouracil (5-FU)

5-Fluorouracil (5-FU) is injected alongside steroids to suppress the overactive cells (fibroblasts) producing excess collagen, helping prevent the scar from thickening again.

Clear Ritual’s Perspective on Atrophic vs Hypertrophic Acne Scars

Clear Ritual emphasises that identifying scar type accurately is the most critical step in acne scar treatment. The Clear Ritual Skin Test helps assess your skin concerns and provides personalised insights that support accurate scar identification and treatment planning.

Our framework categorises scars based on how the skin heals, dividing them by collagen volume produced during healing.

Dealing with acne scars starts with distinguishing between two opposite types:

Atrophic scars (depressed pits from collagen loss)
Hypertrophic scars (raised bumps from excess collagen)

We believe the right treatment involves stimulating collagen via microneedling or lasers for pitted scars, while focusing on flattening raised scars with calming, non-stimulating methods.

Frequently Asked Questions

Are acne scars atrophic or hypertrophic?

Acne scars can be both, but they are predominantly atrophic or depressed. The type of scar depends on your skin type and how much collagen it produces after severe inflammatory acne.

What do Koreans do for acne scars?

Korean treatment for acne scars follows a highly structured, dual approach: advanced dermatological procedures and gentle, barrier-restoring at-home skincare.

The Korean routine focuses heavily on separating scar revision into addressing either the texture of indented pits or pigmentation, usually dark or red spots.

Do atrophic acne scars go away?

No, atrophic acne scars do not go away entirely on their own, and they can even appear deeper as skin tends to lose collagen with age.

However, these scars are not permanent. Professional dermatological treatments can significantly stimulate collagen production and smooth the skin's texture.

What is the hardest acne scar to fix?

The hardest scars to treat are ice pick scars (a deep type of atrophic scar) and keloid scars, a severe form of raised scarring that extends beyond the original wound and tends to recur even after removal.

Do atrophic scars flatten over time?

Atrophic scars do not flatten or fill in on their own over time. Because they form when the skin loses tissue and collagen during healing, they are generally permanent and require cosmetic or dermatological intervention to improve their appearance.

How to treat an atrophic scar?

Flattening an atrophic scar with at-home skincare like retinoids can aid remodelling. Professional dermatological procedures, such as microneedling, fractional laser resurfacing, or dermal fillers, are the most effective methods for raising the indentation to the level of the surrounding skin.

Will a hypertrophic scar ever go away?

While a hypertrophic scar rarely disappears completely without intervention, it often flattens, softens, and fades significantly on its own within one to two years.

Because these scars stay within the boundaries of the original injury, they respond very well to dermatological treatments.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC2958495/

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