ACNE & ACNE SCARRING
Acne is a medical condition, not a hygiene problem, a diet problem or something you will grow out of on schedule. It is also one of the most treatable things we see — provided the treatment matches what you actually have.
Treating acne is a course of action, not a single appointment.
ACNE & ACNE SCARRING - MOST PEOPLE ARE BEING TREATED FOR THE WRONG THING
Many patients who come to us asking about acne scarring have marks alongside the scarring, and indeed - in some cases, no actual 'scarring' at all — simply red or brown patches left behind after a spot has healed, which can look similar to a 'scar' in the mirror and behave completely differently under treatment. Marks tend to fade, and may - or may not, need treatment. Scars are structural and need something else entirely. Knowing which you have changes the treatment, the timescale, the cost and the outcome. It is the first thing we establish.
MARKS OR SCARS?
Not sure which you have?
Five questions, based on what you can see and feel. It takes a minute and it will tell you honestly — including if the answer is that you don't need treating.
Post-inflammatory erythema
The red marks. Flat, pink or red patches where a spot has been. These are dilated blood vessels left behind by inflammation, not damage to the skin's structure. They fade on their own, typically over three to twelve months, and treatment can speed that up considerably.
Post-inflammatory hyperpigmentation
The brown marks. Flat, brown or grey-brown patches, more common in deeper skin tones. This is excess melanin produced during inflammation. Also temporary, though slower — six months to two years untreated. Very responsive to the right treatment, and made dramatically worse by sun exposure.
True scarring.
A change in the structure of the skin. Either indented — icepick, boxcar or rolling — or, less commonly, raised. This does not fade. It is permanent unless actively treated.
How to tell the difference at home
Stretch the skin gently. If the mark disappears or flattens out, it is a mark or a shallow one. If a shadow or indentation persists when the skin is stretched, that is structural.
The other one that catches people out
If your "scarring" is still red and raised, and you are still breaking out, that is active inflammation. Treating it as scarring will not work, and some scar treatments make active acne worse. The acne comes first, always.
TREATING ACTIVE ACNE
Home care is not optional and it is not the bit you skip.
We will be direct about this. Roughly 80% of your result comes from what you do at home every day, and 20% from what we do in clinic. A clinic treatment on top of no routine is money wasted. If you only ever act on one thing from this page, make it that.
That is why an acne consultation here starts with what you are using, how you are using it and what has happened when you have tried things before — not with which treatment to book.
We prescribe topical treatments considerably stronger than anything available over the counter, tailored to what your skin is actually doing. This is often the single biggest change we make.
Getting the basics right.
Most people are either over-treating — stripping, scrubbing, layering actives until the barrier is destroyed and the skin is inflamed — or using products that are quietly making things worse. Correcting this alone improves a good number of people.
In-clinic treatments that support it
Our most-used peel for acne. A biphasic formulation combining TCA with salicylic and other acids, which reaches beneath the surface while the oil phase protects the top layer — meaning it works on congestion and post-acne marks without the visible peeling of a traditional peel. Usually a course of four to six, one to two weeks apart.
A superficial salicylic peel giving brightness and decongestion with light flaking over three to five days.
Jessner's peel.
A medium-depth peel for post-acne pigmentation and sun damage where a stronger approach is appropriate. This one does visibly peel and needs planning around.
LED light therapy.
Blue light targets the bacteria involved in acne; red light calms inflammation. Not a stand-alone answer, but a useful, gentle addition — particularly for inflamed skin that cannot yet tolerate anything stronger.
What we will not do
Treat over actively inflamed, pustular skin with abrasive or aggressive treatments. It spreads bacteria, worsens inflammation and increases the risk of the scarring you are trying to avoid. We settle the acne first.
WHEN YOU SHOULD SEE YOUR GP
We would rather tell you this than treat you around it.
If your acne is severe — deep, painful cysts or nodules, widespread inflammation, or acne that is already causing scarring — you should be seen by your GP and very likely referred to dermatology. Severe acne needs oral treatment, and treating it with facials while it scars is not in your interest.
Isotretinoin, sometimes known by brand names including Roaccutane, is the most effective treatment available for severe acne. In the UK it can only be prescribed by, or under the direct supervision of, a consultant dermatologist, with mandatory monitoring throughout. We do not prescribe it and no aesthetic clinic can. Any clinic offering it should be treated with real suspicion.
Antibiotics, hormonal treatment and the combined pill are also GP or dermatology routes. If your acne pattern suggests a hormonal driver — jawline and chin, flaring with your cycle, adult onset — that conversation is worth having with your GP alongside anything we do.
Where we fit.
We treat mild to moderate acne, congestion, and everything that comes afterwards — the marks, the pigmentation and the scarring. We also work well alongside medical treatment: many of our patients are on or have finished a GP or dermatology regime and come to us for what it left behind.
One important timing point
We cannot treat you with peels, microneedling or most in-clinic treatments until six months after finishing isotretinoin. The skin heals differently during and immediately after treatment, and the risk of scarring is genuinely increased. If you are on it or recently finished, tell us — we will plan around it rather than turn you away.
TREATING POST-ACNE MARKS
The red and brown marks that acne leaves behind are, in our experience, what upsets people most — and they are the most straightforward thing on this page to improve.
They will fade on their own. Nothing we do changes that fact; what treatment does is get you there considerably faster and more evenly.
Sun protection is the single most important thing. Daily SPF 50, without exception. UV drives pigmentation directly, and marks that would have faded in months can persist for years without it. Every treatment on this page works better with it and several are undermined without it.
Chemical peels accelerate turnover and lift pigment. BioRePeel and Obagi Blue Peel Radiance for most people; Jessner's where a stronger approach is warranted.
Prescription topicals — including tyrosinase inhibitors and retinoids — work on pigment production directly and are usually the backbone of treating brown marks.
Medical microneedling improves overall tone and texture and is particularly useful where marks and early textural change occur together.
Timescale: meaningful improvement over two to four months with a proper course and consistent home care. Faster for red marks than brown.
TREATING ACNE SCARRING
True scarring is permanent unless treated, and it needs treatment matched to the scar type. This is where most clinics get it wrong, offering one treatment for everything.
Rolling scars
Broad, shallow depressions with sloping edges, giving skin an undulating look. Caused by fibrous bands tethering the scar base to the tissue beneath. These respond best to subcision, which physically releases the tethering, usually combined with microneedling.
Boxcar scars
Sharply defined, with steep edges, like a small crater. Tethered boxcar scars respond to subcision; shallower ones respond to medical microneedling at depth, usually over a course.
Icepick scars
Narrow, deep, like a puncture mark. The most difficult type. Microneedling and subcision do not reach the base. These generally need a different approach and sometimes a dermatology or surgical opinion, and we will tell you if that is the case rather than sell you a course that will not work.
Raised and keloid scarring
Less common after acne but it occurs, particularly on the chest, back and jawline. Needs a different approach entirely, and most treatments on this page are contraindicated.
How we usually treat scarring
Rarely with one thing. Subcision addresses tethering, microneedling addresses texture and stimulates collagen, peels address surface quality and pigmentation, and PRP, Sculptra, Profhilo or polynucleotides support the healing response. A realistic scarring plan runs over months and combines several of these — and we will tell you at the outset roughly how long and how much.
What is realistic.
Significant improvement, yes. Complete removal, no. Anyone promising you smooth skin from a course of anything is selling. We aim to make scarring considerably less noticeable and we will show you what that looks like.
WHAT TO EXPECT FROM US
Your consultation. Face to face in clinic. We assess your skin, establish what you actually have, go through what you have already tried, and build a plan in a sensible order — because treating scarring while you are still breaking out does not work.
A plan, not a purchase. You will leave knowing what to do at home, what to do in clinic, roughly what it will cost and roughly how long it will take. Some of that plan will be things you can buy anywhere.
We may tell you to go elsewhere first. If your acne needs GP or dermatology input, we will say so plainly and explain why.
We will not sell you scarring treatment while you have active acne. It does not work in that order and it risks making things worse.
The acne consultation fee is £50 and is not redeemable against treatment, unlike our other consultations. This is because the consultation itself is the treatment — the assessment, the plan and the home care advice are the substance of it, whether or not you book anything afterwards.
FAQ
How do I know if I have acne scars or just marks?
Stretch the skin gently. If the mark flattens or disappears, it is pigmentation or redness and it will fade. If an indentation or shadow persists, that is structural scarring. Flat red or brown patches are marks, however permanent they look.
Will my acne marks go away on their own?
Yes. Red marks typically fade over three to twelve months, brown marks over six months to two years. Treatment speeds this up considerably and makes it more even. Sun protection is the difference between the fast end of those ranges and the slow end.
Can you prescribe Roaccutane?
No, and neither can any aesthetic clinic. Isotretinoin can only be prescribed by or under the supervision of a consultant dermatologist, with monitoring throughout. If your acne is severe enough to need it, see your GP for a referral.
I have just finished Roaccutane — can I have treatment?
Not for six months afterwards. Skin heals differently during and immediately after isotretinoin and the risk of scarring is increased. Tell us your dates and we will plan around them.
Can acne scarring be completely removed?
No. Significant improvement is realistic; complete removal is not, and anyone telling you otherwise is selling. Most patients achieve a marked reduction in how noticeable their scarring is.
How many treatments will I need?
For marks, usually a course of four to six over two to four months. For true scarring, expect a programme running over six to twelve months combining several treatments. We will give you a realistic estimate at consultation rather than an optimistic one.
Will treatment make me break out at first?
Sometimes. A purge in the first few weeks of starting a retinoid or a course of peels is common as congestion clears. It settles. We will warn you before it happens rather than after.
Do I really need to buy skincare as well?
Yes. Roughly 80% of your result comes from home care and 20% from clinic treatments. A course of peels on top of no routine is money wasted, and we would rather tell you that than take the booking.
Does diet cause acne?
The evidence is mixed and considerably weaker than the internet suggests. There is some association with high-glycaemic diets and, in some people, skimmed milk. It is not the main driver for most people, and cutting out food groups on the strength of a social media post is more likely to make you miserable than clear.
Is acne caused by poor hygiene?
No, and over-washing makes it worse. Acne is driven by hormones, oil production, follicular blockage and bacteria — not by how often you wash your face.
Can I have treatment while on antibiotics or the pill for acne?
Usually yes, and it often works well together. Tell us what you are taking so we can plan properly — some antibiotics increase sun sensitivity, which affects what we can safely do.
Do you treat back and chest acne?
Yes. Both respond well, though they can be slower than facial acne. BioRePeel Body is often the treatment of choice.
Do you treat under-18s?
No. All treatments at Sebastian Rose are for adults only, without exception. If you are under 18 and struggling with acne, please see your GP — they can treat you, and effectively.
BOOK YOUR CONSULTATION
A consultation with someone who will tell you what you actually have, what will work, what will not, and in what order. If your skin needs your GP rather than us, we will tell you that too.
0800 772 0137 · 39 Charles Street, Cardiff, CF10 2GB