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True Mohammed
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Hey Everyone
So I'm 16 and have been dealing with moderate acne since I was 14. I have grade 2 atrophic scarring that easily disappears when stretched and am eager to begin treatment once I'm done Accutane.
But that's not the point of this thread, I wanted to educate you all on the mechanism of scarring, how it occurs and the myth-laden claim that popping causes scars.
So I'm 16 and have been dealing with moderate acne since I was 14. I have grade 2 atrophic scarring that easily disappears when stretched and am eager to begin treatment once I'm done Accutane.
But that's not the point of this thread, I wanted to educate you all on the mechanism of scarring, how it occurs and the myth-laden claim that popping causes scars.
1. How does scarring really occur?
To understand the mechanism of scarring, we must understand the layers of skin (heavily abridged)
The skin is divided into three main layers
Thickness: ~0.05–1.5 mm depending on location.
Composition: Mostly keratinocytes, melanocytes, Langerhans cells.
Thickness: ~0.3–3 mm.
Composition: Fibroblasts, collagen (types I & III), elastin, blood vessels, nerves, hair follicles, sebaceous glands.
Composition: Fat, connective tissue, larger blood vessels, lymphatics.
-Atrophic acne scarring occurs when inflammation caused by any form of acne destroys fibroblasts and collagen reserves within the dermis. It is permanent in the sense that it will always be 'scar tissue' (regardless of improvement).
-Macular/Pigmentary acne scarring occurs at the epidermis, and is oftentimes a temporary change.
Layers of the Skin
Classifying the severity of scars:
Acne scars are often classified into 4 grades:
1- Pigmentation only, no true atrophy.
2- Shallow depressions, visible on close inspection, flatten with stretching.
3- More distinct depressions that don’t flatten with stretching; visible at conversational distance.
4- Deep, extensive scarring or disfigurement; may involve rolling, boxcar, or ice-pick scars with contour distortion.
Goodman and Baron scale
For example:
Grade 4 atrophic acne scars
Grade 3 acne scars (left) improving to grade 2 (right)
To understand the mechanism of scarring, we must understand the layers of skin (heavily abridged)
The skin is divided into three main layers
- The Epidermis(Outermost layer)
- The Dermis (Inner/Mid Layer)
- Subcutaneous (Lowest layer of the skin, fat, blood vessels , whatnot)
Thickness: ~0.05–1.5 mm depending on location.
Composition: Mostly keratinocytes, melanocytes, Langerhans cells.
- Role in scarring:
- Macular / pigmentary changes occur here.
- Damage usually heals without true collagen loss.
- Temporary redness (erythema) or hyperpigmentation happens because of local inflammation and vascular changes.
Thickness: ~0.3–3 mm.
Composition: Fibroblasts, collagen (types I & III), elastin, blood vessels, nerves, hair follicles, sebaceous glands.
- Role in scarring:
- Atrophic scars originate here.
- Inflammatory acne destroys fibroblasts and collagen, causing volume loss.
- Tethering occurs when scar tissue adheres to underlying dermis.
- True scarring = collagen remodeled but weaker and less elastic.
Composition: Fat, connective tissue, larger blood vessels, lymphatics.
- Role in scarring:
- Usually not involved in acne scars, unless severe nodulocystic lesions cause deep tissue inflammation.
- Damage here can lead to contour deformities beyond superficial atrophy.
-Atrophic acne scarring occurs when inflammation caused by any form of acne destroys fibroblasts and collagen reserves within the dermis. It is permanent in the sense that it will always be 'scar tissue' (regardless of improvement).
-Macular/Pigmentary acne scarring occurs at the epidermis, and is oftentimes a temporary change.
Layers of the SkinClassifying the severity of scars:
Acne scars are often classified into 4 grades:
1- Pigmentation only, no true atrophy.
2- Shallow depressions, visible on close inspection, flatten with stretching.
3- More distinct depressions that don’t flatten with stretching; visible at conversational distance.
4- Deep, extensive scarring or disfigurement; may involve rolling, boxcar, or ice-pick scars with contour distortion.
Goodman and Baron scaleFor example:
Grade 4 atrophic acne scars
Grade 3 acne scars (left) improving to grade 2 (right)2. Popping pimples, and its relation to the formation of acne scars.
Would you be surprised to learn that all research on this topic is PURELY anecdotal? (yes, ALL of it)
There is no peer-reviewed scientific proof that popping does in fact, cause acne scars.
"But the pimple I popped a month ago left a crater, How?"
Simple answer, you did it wrong.
Popping MAY actually mitigate the risk of scarring when done PROPERLY.
Indications of a poor job at extracting a comedone involve:
-No sterile technique
-Significant/Noticeable bleeding
-Bruising, swelling or prolonged redness
-No extraction of a true keratin plug/follicle
In these cases, what you have simply done is pushed the pimple/breakout deeper into the skin (Remember those layers we discussed) and destroyed collagen reserves.
To pop a pimple 'properly', envoy the following techniques:
Pop on a pimple patch overnight and make sure to remove it in the morning
If done right, a plug should come out. When it does, wash your face and put on another patch to promote adequate healing.
2. See a derm or an Esthetician
Self explanatory. They will extract for you.
3. 'Hands on' method (NOT RECCOMENDED UNLESS YOU ARE EXPERIENCED)
Would you be surprised to learn that all research on this topic is PURELY anecdotal? (yes, ALL of it)
There is no peer-reviewed scientific proof that popping does in fact, cause acne scars.
"But the pimple I popped a month ago left a crater, How?"
Simple answer, you did it wrong.
Popping MAY actually mitigate the risk of scarring when done PROPERLY.
Indications of a poor job at extracting a comedone involve:
-No sterile technique
-Significant/Noticeable bleeding
-Bruising, swelling or prolonged redness
-No extraction of a true keratin plug/follicle
In these cases, what you have simply done is pushed the pimple/breakout deeper into the skin (Remember those layers we discussed) and destroyed collagen reserves.
To pop a pimple 'properly', envoy the following techniques:
- Lance and drain
Pop on a pimple patch overnight and make sure to remove it in the morning
If done right, a plug should come out. When it does, wash your face and put on another patch to promote adequate healing.
2. See a derm or an Esthetician
Self explanatory. They will extract for you.
3. 'Hands on' method (NOT RECCOMENDED UNLESS YOU ARE EXPERIENCED)
- Locate your pimple, it MUST have come to a head and there should be a noticeable plug
- Gently squeeze all around, do NOT poke hard
- Once you've extracted the comedone, do the previously mentioned aftercare techniques
- and absolutely DO NOT continue if you see blood. (although a little may be fine)
