Pearls for management

• Treat active acne before procedures for acne scars are initiated

• Allow red/purple macular discoloration to resolve before full evaluation and treatment of atrophic scars

• Set appropriate expectations. Emphasize that improvement is unpredictable, often multiple procedures are required. The goal should be improvement in acne scars and not total cure.

• Consider excisional techniques for fibrotic, deep, or markedly hypopigmented lesions (acne excoriee)

• In older patients with lax skin or soft tissue atrophy, consider volumizing fillers (calcium hydroxylapetite or poly-L-lactic acid) or referral for facelift

• Globally evaluate patient's appearance (there may be more “slam dunk” procedures, such as removal of facial moles or botulinum toxin, that may have more dramatic improvement)