The simple test
Stand in front of a mirror in good light and look at the marks from the side, at an angle, rather than straight on.
If the area is flat — a change in colour only, brown, red or purple, but level with the surrounding skin — that is a mark. In medical terms, post-inflammatory hyperpigmentation if brown, post-inflammatory erythema if red.
If you can see a dip, a shadow or a change in texture at an angle, that is a scar. The structure of the skin has changed, not just its colour.
You can have both, frequently in the same area, which is why the angled look matters. It is very easy to see a dark patch and assume the worst.
Marks: time and sun protection
Marks are the aftermath of inflammation. The spot has gone; the pigment or the dilated vessels remain. Given time, the body clears both.
How much time is the frustrating part — three to twelve months, sometimes longer in deeper skin tones. And there is one thing that reliably extends it: sun exposure. Ultraviolet light drives more pigment into a healing mark, which is why marks that would have faded in four months sit there for a year in someone who does not use sunscreen.
Treatment can accelerate the process with prescription topicals and graded peels. But no treatment outpaces daily sunscreen in importance for marks, and this is the single most common thing I have to persuade patients of. It is not glamorous advice and it works.
Scars: rebuilding structure
Scars need collagen remodelling, because tissue is actually missing or disorganised. They will not fade on their own and no cream will fill them.
Types matter, because they respond differently:
- Rolling scars — broad, shallow, wave-like depressions. Respond well to microneedling and RF microneedling.
- Boxcar scars — wider depressions with defined edges. Respond reasonably well to needling and resurfacing.
- Ice-pick scars — narrow, deep, like a pinprick. These respond least to needling and often need a focused technique.
- Raised or keloid scars — more common on the chest, shoulders and back. A completely different treatment approach.
Most people have a mix, and a plan that treats one type only will produce partial results.
Why sequence matters more than technique
There is an order to this, and skipping it wastes courses of treatment.
- Control the active acne first. Resurfacing skin that is still breaking out is treating a moving target, and needling through inflamed acne can spread bacteria and create new scarring.
- Wait for the skin to settle. A few months of calm skin. This is the step patients most want to skip and where the most money gets wasted.
- Let the marks fade. Once inflammation stops, marks start clearing on their own. Many patients discover at this point that what they were calling scarring was largely marks, and the remaining work is far smaller than they feared.
- Then treat what is genuinely left. Assess the true scars, identify the types, and plan a course.
What improvement realistically means
For true scarring, a full course of microneedling typically gives 40 to 70 per cent improvement. Read that carefully: improvement, not erasure. Skin that was scarred does not become skin that never scarred, and any clinic promising that is selling something.
Forty to seventy per cent is a lot in practice. It is the difference between scarring being the first thing you see in a photograph and it being something you have to look for. Patients who begin with that expectation are almost always pleased. Patients promised perfection are almost always disappointed by exactly the same result.
Written and medically reviewed by Dr. Bareera Usman, MBBS
Last reviewed: July 2026. This page is general information, not a diagnosis or a treatment plan for any individual.