That hole where your pimple used to be is a type of atrophic scar, and it formed because inflammation destroyed the structural protein (collagen) that keeps your skin smooth and firm. The deeper and more inflamed the breakout, the more collagen gets lost, and your skin can’t always rebuild it perfectly. The good news: depending on the scar’s depth and type, there are effective ways to improve it.
How a Pimple Destroys Skin Structure
When a pimple becomes inflamed, your immune system sends white blood cells to fight the bacteria trapped inside the pore. That immune response is necessary, but it comes with collateral damage. Inflammatory signals activate enzymes that chew through collagen, the protein fibers that give your skin its structure and volume. In inflamed acne lesions, the activity of these collagen-degrading enzymes spikes dramatically. Research published in The American Journal of Pathology found that the primary collagen-cutting enzyme was elevated 506-fold in acne lesions compared to normal surrounding skin, while another enzyme rose 829-fold.
These enzymes slice collagen fibers into fragments, and additional enzymes break those fragments down further. The result is a measurable loss of structural material. In that same study, inflamed skin showed 2.6 times more degraded, fragmented collagen than uninvolved skin nearby. Once the breakout clears, your body tries to patch things up by producing new collagen. But the repair is rarely perfect, especially when the damage runs deep. If the new collagen doesn’t fully replace what was lost, the skin sinks inward and you’re left with a visible indentation.
Picking and Popping Make It Worse
Squeezing a pimple dramatically increases the risk of scarring. When you apply pressure, the contents don’t always come out through the surface. Often, the pimple ruptures inward, pushing bacteria, oil, and dead skin cells deeper into the surrounding tissue. This triggers a second, more intense wave of inflammation in an area that wasn’t originally involved. Dermatologist Dr. Tsippora Shainhouse explains that squeezing creates a tear in the skin that then has to heal on its own, frequently leaving a scar. Even if the pimple does pop outward, the physical tearing of the skin surface adds injury on top of the inflammation already happening below.
Types of Pitted Scars
Not all acne holes look the same, and the shape of your scar tells you something about where the damage occurred and how it will respond to treatment.
- Ice pick scars are narrow, deep holes that look like the skin was punctured with a sharp point. They extend deep into the dermis and are the hardest type to treat because of their depth relative to their small opening.
- Boxcar scars have wider, flat bases with sharply defined vertical edges, almost like a crater. They can be shallow or deep.
- Rolling scars create a wave-like, undulating texture across the skin. They form when fibrous bands pull the surface downward from beneath, and they tend to respond best to treatment.
How Long Your Skin Keeps Remodeling
Your skin doesn’t stop repairing itself the moment a pimple heals over. Collagen remodeling continues for months afterward. New collagen deposits slowly, and the full extent of natural improvement can take 8 to 12 months. Some dermatologists recommend waiting up to 18 months before deciding a scar is truly permanent, since the skin may still be filling in during that window. A scar that looks deep at the three-month mark may soften and become shallower by the one-year mark, though it’s unlikely to disappear completely on its own if significant collagen was lost.
Topical Ingredients That Support Repair
While no cream will erase a deep pit, certain topical ingredients can nudge the healing process in the right direction, especially for newer or shallow scars. Retinoids (vitamin A derivatives available over the counter as retinol or by prescription as tretinoin) work on two fronts: they stimulate skin cells called fibroblasts to produce more collagen, and they reduce the activity of the same collagen-degrading enzymes responsible for the damage in the first place. Over time, retinoids can improve skin firmness and dermal structure.
Vitamin C is another ingredient with evidence behind it. It plays a direct role in collagen production and supports wound healing through multiple pathways. Neither ingredient will fill in a deep scar overnight, but consistent use over months can improve shallow indentations and help prevent new breakouts from scarring as severely.
Professional Treatment Options
For scars that don’t improve enough on their own, several professional treatments can make a meaningful difference. The right choice depends on the type and depth of your scars.
Microneedling
This procedure uses a device covered in tiny needles to puncture the skin in a controlled pattern. The micro-injuries trigger your body’s wound-healing response, prompting new collagen production in the scarred area. Healthy tissue between the puncture points provides a reservoir of cells that speed up healing. A study of 33 patients found that two sessions of microneedling improved scar depth by up to 25 percent. Multiple sessions are typically needed, spaced several weeks apart.
Subcision
For rolling scars that are tethered down by fibrous bands beneath the surface, a doctor can insert a needle under the scar and move it back and forth to release those attachments. This frees the skin so it can rise back to its normal level. The bleeding that occurs underneath also creates a space where new collagen can form. In a study of 40 patients with rolling scars, both patients and doctors rated the improvement at roughly 50 to 60 percent.
Fractional Lasers
Fractional laser treatments create tiny columns of controlled injury in the skin while leaving healthy tissue intact between them. This stimulates collagen remodeling without destroying the entire surface, which means faster healing and fewer side effects than older laser techniques. Multiple sessions can produce results comparable to more aggressive resurfacing, with less downtime.
Dermal Fillers
For scars that simply lack volume underneath, injectable fillers made from hyaluronic acid (a substance your skin naturally contains) can physically raise the depressed area back to the level of surrounding skin. A two-year clinical trial found that filler significantly reduced both the severity and number of rolling atrophic scars, and the improvement held steady from four months all the way through the end of the study at two years, with no side effects. One useful test: if you press on the sides of a scar and it flattens out, it’s a good candidate for filler. If pressing creates a dimple from deeper attachments pulling it down, the scar likely needs subcision first.
Why Some People Scar More Than Others
Scarring from acne is extremely common. Up to 95 percent of people with acne develop some degree of scarring, though most cases are mild. Your individual risk depends on several factors: the severity and duration of your breakouts, how deep the inflammation reaches, your genetics (which influence how efficiently your body produces collagen), and whether you pick at or squeeze your lesions. Inflammatory acne, the kind that produces red, swollen, painful bumps rather than simple blackheads, carries the highest scarring risk because the immune response is more intense and prolonged.
Treating active acne early and effectively is the single best way to prevent new scars from forming. Every inflamed breakout is a roll of the dice for your collagen, and the fewer severe breakouts your skin endures, the less cumulative damage it sustains.