The only thing worse than an acne breakout is the scarring it can leave behind.

We're all guilty of picking at our acne — sometimes rather aggressively — and the visual outcomes are almost always a reminder of why we should resist the urge next time.

But, even when you do find the strength to leave your acne alone, sometimes you still scar.

Annie Christenson, medical aesthetician at Houston Methodist who practices with our ENT specialists, is here to explain why.

When and why does acne scar?

While acne often makes its presence very known above the skin, the reason it leaves scarring behind actually has to do with what's happening underneath the skin.

"During a breakout, inflammation is happening underneath your skin. This inflammation causes trauma to skin tissue — leading to scarring," says Christenson. "Whether there's scarring and how exactly it presents depends on your skin type and the extent of damage."

The two main types of acne scarring are:

• Discoloration scarring – hyperpigmentation that causes the affected skin to remain darker after the blemish has healed
• Indentation scarring – more common with severe acne, occurs when the top layer of skin doesn't fully heal and regenerate — leaving an indentation in the skin
  
  

"In most cases, acne scarring mirrors how your skin generally scars. Some people's skin discolors easier than others, for instance. I have a Hispanic background and my skin hyperpigments fairly easily, so I myself am prone to discoloration scarring after a breakout," adds Christenson.

So...scarring can happen whether you pick at your acne or not, but here's why you should still avoid the urge to pop.

"Inflammation-related acne scarring aside, aggressively pinching or squeezing a pimple or whitehead just makes the underlying inflammation worse. This, in turn, makes scarring even more likely. Plus, if your hands aren't clean, picking at your acne can lead to a small, localized infection or your acne spreading to other areas of skin," explains Christenson.

Are acne scars permanent?

Now time for some good news. Christenson says there are definitely things you can do to reduce acne scarring once you have it.

"The best course of treatment depends on the type of scarring you have, with indentation scarring often requiring more advanced treatment," says Christenson.

For discoloration acne scarring, start by trying the at-home retail topicals aimed at counteracting hyperpigmentation, such as brightening serums or retinol-containing products.

"The one watch-out about using retinol is that it can make your skin more sun-sensitive. It's always important to use sunscreen to protect your skin, but be even more diligent about applying sunscreen while using a retinol product," warns Christenson.

For hyperpigmentation that doesn't respond to retail products, and for the deeper indentation scarring, Christenson recommends the more advanced treatment options a medical aesthetician can provide, including:

• Chemical peels
• Microneedling
• Prescription brightening products
  
  

"Chemical peels are great for both discoloration and indentation scarring, and these peels can also help with what's called ice pick scarring — very deep indentations that form due to severe acne lesions," explains Christenson. "Microneedling, which uses tiny needles to stimulate your skin's healing process, works incredibly well to reduce indentation scarring and make your skin look smoother."

Lastly, for discoloration scarring, a skin-brightening product containing 4% hydroquinone typically offers the best results. However, it must be purchased in a medical office.

5 tips for preventing acne scars

While there are treatments for acne scarring, you might also consider the following tips for preventing scarring in the first place.

1. Avoid the urge to pop a pimple

As mentioned, serious squeezing, pinching and scraping of pimples causes more harm than help, making it more likely for you to scar. In addition, popping a pimple may result in a small, local infection or result in you inadvertently spreading acne elsewhere on your skin — again, more chance for scarring.

2. Know the different types of acne

You see the whiteheads, blackheads and pimples, but have you ever wondered about those acne bumps that never actually seem to surface. They're hard, red bumps that can really hurt, but, unlike other types of acne, they remain under the surface of your skin.

"Cystic acne is a type of acne characterized by inflammation underneath the skin with no pore to the surface. Since there's nowhere for the fluid to actually come out, you really want to avoid trying to apply pressure to cystic acne. Attempting to pinch or pop this type of acne will just lead to the inflammation spreading underneath the skin, creating a larger area of damage and, ultimately, a larger area of discoloration scarring," explains Christenson.

For cystic acne, Christenson recommends applying ice to help relieve the inflammation — and leaving it at that.

3. If you really want to handle a whitehead or blackhead, don't overdo it

Whiteheads and blackheads are unsightly, so — naturally — you want them gone.

If you want to take action on a whitehead, Christenson recommends following these steps:

1. Wash your hands
2. Gently apply light pressure to remove the whitehead
3. Wipe the area with alcohol
4. Apple an acne serum
5. Wash your hands again
   
   

"If removing the whitehead takes anything more than gentle pressure, stop what you're doing and try again the next day," recommends Christenson.

And while blackhead removers can help clear your pores, Christenson adds that you should only use these devices if (and only if) you know how to do so correctly.

"It's very easy to get carried away while using a blackhead extractor, especially if you have a heavy hand. These devices can be dangerous if not used correctly," warns Christenson.

4. Start acne treatment ahead of time

If you break out once a month or in a predictable cycle, start treating your skin early.

The type of acne treatment that works best varies from person to person, but consider applying your acne serum, retinol product or antibacterial topical before the breakout even begins.

"In addition to these topicals, wearing sunscreen can help prevent any hyperpigmentation that may occur as a result of acne," adds Christenson. "Just be sure to choose a sunscreen that's appropriate for your skin. A sunscreen that clogs your pores can make your acne worse, causing more chance for scarring."

5. See a skin care specialist

If you feel like you're using all the right at-home preventive measures but still can't control your acne or acne scarring, consider seeing a medical aesthetician.

"In our medical spa, we offer many advanced, effective treatments for acne and acne scarring, including chemical peels, microneedling, hydrafacials and prescription skin products," adds Christenson. "We can also help you understand your skin and recommend the retail topical products we trust."

In particular, Christenson recommends visiting a medical aesthetician for help with treatments and choosing the correct products for your skin if you're prone to acne and/or acne scarring.

"Having monthly maintenance skin care retreatments, including facials, can be very helpful. It can also help with anti-aging in the long run!" adds Christenson.