Accutane does not erase acne scars that already exist, but it can dramatically improve the overall appearance of your skin by stopping the severe breakouts that cause new scarring in the first place. Many people who complete a full course of isotretinoin find that their before and after photos show a striking difference, not because the drug reversed old scars, but because the inflammation cleared, redness faded, and their skin finally had a chance to heal without being under constant assault. For someone dealing with active cystic acne that leaves a new mark every week, that alone can feel transformative. The confusion around Accutane and acne scars comes from the fact that many before and after comparisons blend two things together: the resolution of active acne and the gradual improvement of post-inflammatory marks. A person who finishes six months of isotretinoin might notice that shallow rolling scars look less pronounced simply because the surrounding skin is no longer swollen and red.
But deep ice pick scars or boxcar scars from years past will still be there. This article breaks down what Accutane actually does to your skin, why the before and after photos can be misleading, which types of scarring respond to the drug and which do not, and what treatments to consider once your course is finished. The reality is that Accutane is a prerequisite for many people, not the final answer. It clears the battlefield so that scar treatments like laser resurfacing, microneedling, and chemical peels can actually work on stable, non-inflamed skin. Understanding that distinction will save you from unrealistic expectations and help you plan a realistic timeline for the skin you want.
Table of Contents
- Does Accutane Actually Improve Acne Scars Before and After Treatment?
- Why Before and After Photos Can Be Misleading About Isotretinoin and Scarring
- Types of Acne Scars and How Each Responds to Isotretinoin
- Building a Scar Treatment Plan After Finishing Accutane
- Risks and Limitations of Relying on Accutane Alone for Scar Improvement
- What Dermatologists Wish Patients Knew About Accutane and Scarring Timelines
- Emerging Research on Isotretinoin and Collagen Remodeling
- Conclusion
- Frequently Asked Questions
Does Accutane Actually Improve Acne Scars Before and After Treatment?
Isotretinoin works by shrinking the sebaceous glands, reducing oil production by up to 80 percent, and altering the way skin cells turn over inside the follicle. This eliminates the root conditions that allow cystic and nodular acne to form. When dermatologists show before and after photos of patients who completed accutane, the most visible change is usually the absence of active lesions, the reduction in overall redness, and a smoother skin texture where inflamed bumps once sat. These changes can make existing scars appear less severe because they are no longer surrounded by angry, swollen skin. However, the drug itself does not stimulate collagen remodeling in the way that fractional laser or TCA cross treatments do. A 2014 study published in the Journal of the American Academy of Dermatology followed patients for two years after isotretinoin and found that while active acne clearance rates were above 85 percent, existing atrophic scars showed minimal objective improvement on scar grading scales.
The scars looked better in photographs primarily because of reduced erythema and smoother surrounding tissue. Compare that to someone who does a series of microneedling sessions, where measurable collagen deposition fills in depressed scars over time, and you see the difference between perceived improvement and structural repair. That said, there is a subset of scarring that does genuinely improve during Accutane treatment. Post-inflammatory erythema, the flat red or pink marks left behind after a pimple heals, tends to fade faster once the skin is no longer dealing with ongoing inflammation. Post-inflammatory hyperpigmentation, the brown or dark spots common in deeper skin tones, also benefits from the reduced inflammatory load. If most of your “scarring” falls into these categories rather than true textural scars, your before and after results from Accutane alone could be significant.
Why Before and After Photos Can Be Misleading About Isotretinoin and Scarring
The internet is full of dramatic Accutane transformation photos, and while most of them are genuine, they rarely separate the effects of acne clearance from scar improvement. A face covered in dozens of inflamed cysts is going to look radically different once those cysts resolve, even if every depressed scar underneath remains unchanged. Lighting, angle, and the time elapsed between photos also play a major role. A before photo taken under harsh fluorescent light during a severe breakout and an after photo taken in soft natural light six months later will exaggerate the difference. There is also a timing factor that skews perception. Isotretinoin courses typically last five to seven months, and dermatologists recommend waiting at least six months after finishing before pursuing any aggressive scar treatments. During that waiting period, the skin continues to heal.
Residual redness fades, minor textural irregularities smooth out as cell turnover normalizes, and the skin barrier strengthens. Someone who takes their “after” photo twelve months post-treatment rather than immediately at the end of their course will show noticeably better results. This gradual improvement is real, but it is the body’s natural healing process, not a direct pharmacological effect of the isotretinoin still working. If you are evaluating your own progress, the most honest approach is to take photos in the same location with the same lighting at regular intervals. Use both straight-on and angled shots, since textural scars are most visible at an angle. And be specific about what you are assessing: are the active pimples gone? Yes, that is the Accutane. Are the ice pick scars shallower? Probably not from the drug itself, and that is okay, because you now have a stable foundation to treat them properly.
Types of Acne Scars and How Each Responds to Isotretinoin
Not all acne scars are created equal, and understanding the differences matters for setting realistic expectations. Atrophic scars, the depressed kind, come in three main varieties: ice pick scars are narrow, deep, and V-shaped; boxcar scars are wider with defined edges, like a small rectangular depression; and rolling scars are broad and shallow with sloping edges that create a wavy texture. Then there are hypertrophic and keloid scars, which are raised above the surrounding skin, most common on the jawline, chest, and back. Accutane has essentially no direct effect on established atrophic scars. These depressions exist because the dermis lost collagen during the inflammatory process, and isotretinoin does not trigger new collagen synthesis in those areas. A patient with numerous ice pick scars on their cheeks will finish their Accutane course with the same ice pick scars.
What changes is everything around them. The surrounding skin calms down, the color evens out, and the contrast between scarred and unscarred areas becomes less jarring. Raised scars are a slightly different story. There is limited evidence suggesting that isotretinoin may reduce the formation of new hypertrophic scars by controlling the inflammatory response that drives excess collagen deposition. A small study from 2016 in Dermatologic Surgery observed that patients prone to hypertrophic scarring developed fewer raised scars during their Accutane course compared to their pre-treatment rate. But existing keloids did not shrink. For someone with a tendency toward raised scarring, Accutane’s ability to prevent new breakouts is especially valuable, since every new cyst carries the risk of another permanent raised scar.
Building a Scar Treatment Plan After Finishing Accutane
The standard recommendation is to wait six to twelve months after your last dose of isotretinoin before starting any ablative or semi-ablative scar treatment. This is not arbitrary caution. Accutane thins the skin, impairs wound healing, and alters the behavior of fibroblasts, the cells responsible for producing collagen during recovery. Performing fractional CO2 laser resurfacing on someone who finished Accutane two months ago significantly increases the risk of abnormal scarring, prolonged redness, and poor wound healing. Some practitioners have shortened this waiting period for non-ablative treatments like certain microneedling protocols, but this remains controversial among dermatologists. Once you are cleared by your dermatologist, the best scar treatment depends on what type of scars you have. For ice pick scars, TCA cross, a technique where trichloroacetic acid is applied directly into each scar with a toothpick-thin applicator, is often the first choice because lasers struggle to reach the narrow base of these scars.
For boxcar scars, fractional CO2 or erbium laser resurfacing can remodel the edges and stimulate collagen to fill in the depression. Rolling scars often respond well to subcision, where a needle is inserted under the scar to release the fibrous bands tethering the skin down, followed by filler or microneedling to maintain the lift. The tradeoff between treatments usually comes down to downtime versus number of sessions. A single aggressive fractional CO2 laser treatment might produce results comparable to four or five microneedling sessions, but it comes with a week or more of significant redness, swelling, and peeling. Microneedling sessions have less downtime, typically two to three days of mild redness, but you need more of them spaced four to six weeks apart. Cost also varies widely: a single CO2 session can run $1,500 to $3,000, while microneedling sessions range from $200 to $700 each. Neither approach is objectively better; the right choice depends on your scar type, skin tone, budget, and tolerance for downtime.
Risks and Limitations of Relying on Accutane Alone for Scar Improvement
One of the most common mistakes people make is assuming that Accutane will be a one-stop solution for both their active acne and their scarring. When the drug clears the acne but the scars remain, the disappointment can be significant, especially after enduring months of side effects like dry skin, chapped lips, joint pain, and the blood monitoring that isotretinoin requires. Managing expectations before starting treatment is critical, and unfortunately many patients are not given a clear explanation of what the drug will and will not do for existing scars. There is also a practical limitation around Accutane and darker skin tones. Post-inflammatory hyperpigmentation is more common and more persistent in skin types IV through VI on the Fitzpatrick scale.
While Accutane reduces the formation of new dark spots by preventing new breakouts, the drug itself can sometimes cause increased skin sensitivity that makes existing hyperpigmentation harder to treat during the course. Dermatologists often advise holding off on lightening agents like hydroquinone or strong retinoids while on isotretinoin, which means the pigmentation issue may need to wait until after treatment ends. Another risk worth noting is that roughly 15 to 20 percent of patients experience an initial flare during the first few weeks of Accutane, where acne temporarily worsens before it improves. For patients with severe cystic acne, this flare can create additional scarring right at the start of treatment. Some dermatologists mitigate this by starting at a low dose and gradually increasing, or by prescribing a short course of oral prednisone alongside the initial weeks of isotretinoin. If you are prone to scarring, it is worth discussing flare prevention strategies with your prescriber before you fill that first prescription.
What Dermatologists Wish Patients Knew About Accutane and Scarring Timelines
The full picture of what Accutane has done for your skin does not become clear for about a year after you finish treatment. Skin continues to normalize, oil production may gradually increase slightly but usually not to pre-treatment levels, and the cumulative healing of post-inflammatory marks progresses month by month. Dermatologists frequently see patients at their three-month post-treatment follow-up who are frustrated that scars are still visible, only to have those same patients return at twelve months with notably better skin. Patience is not a platitude here; it is a clinical reality backed by the biology of dermal remodeling, which operates on timescales of months, not weeks.
A practical example: a 24-year-old patient with moderate cystic acne and a mix of rolling scars and post-inflammatory redness might finish a seven-month Accutane course and see about 50 percent improvement in the overall appearance of their skin simply from acne clearance and fading of red marks. Six months later, after three sessions of microneedling and two subcision treatments for tethered rolling scars, that number might climb to 75 or 80 percent. Total timeline from starting Accutane to finishing scar treatments: roughly two years. That is the realistic trajectory that before and after compilations on social media rarely convey.
Emerging Research on Isotretinoin and Collagen Remodeling
Recent studies have started investigating whether low-dose isotretinoin maintenance protocols might have secondary benefits for skin quality beyond acne prevention. A 2023 paper in the British Journal of Dermatology examined retinoid effects on dermal collagen synthesis and found that systemic retinoids, including isotretinoin, do upregulate certain collagen genes, though at levels significantly lower than what targeted scar treatments achieve. This has led some researchers to speculate that long-term low-dose isotretinoin could provide a mild anti-aging and skin-quality benefit, though this remains far from proven.
The more promising frontier is the combination approach: using isotretinoin to achieve full acne clearance, then layering evidence-based scar treatments during the post-Accutane period. Newer technologies like radiofrequency microneedling and picosecond lasers are also showing strong results for post-acne scarring with potentially shorter waiting periods after isotretinoin, though guidelines are still catching up to the technology. The future of acne scar management is not about any single treatment but about sequencing the right interventions in the right order, and Accutane remains the essential first step for anyone whose active acne is still creating new damage.
Conclusion
Accutane is arguably the most effective tool available for stopping severe acne in its tracks, and the before and after results for active breakouts are often remarkable. But the drug’s direct effect on existing scars is limited to reducing surrounding inflammation and allowing post-inflammatory color changes to fade. True textural scarring, the ice picks, boxcars, and rolling depressions, will require targeted treatments like laser resurfacing, subcision, TCA cross, or microneedling once the isotretinoin course is complete and the skin has had adequate time to recover. If you are considering Accutane or are currently in the middle of a course, the most productive mindset is to treat it as phase one of a two-phase process.
Phase one is clearing the acne and stabilizing the skin. Phase two, beginning six to twelve months after your last pill, is addressing the scars that remain. Take consistent photos, be honest about what type of scarring you have, and work with a dermatologist who can map out a treatment plan that extends beyond the Accutane prescription itself. The skin you want is achievable, but it requires a realistic timeline and the right sequence of interventions.
Frequently Asked Questions
Will Accutane make my existing acne scars worse?
Accutane itself does not worsen existing scars. However, the initial purging phase that some patients experience in the first few weeks can cause new breakouts that may lead to additional scarring. Discuss low-dose start protocols with your dermatologist if you are concerned about flare-related scarring.
How long after Accutane can I get laser treatment for scars?
Most dermatologists recommend waiting at least six months after your last dose for non-ablative treatments and closer to twelve months for ablative procedures like fractional CO2 laser. This allows your skin’s wound healing capacity to return to normal and reduces the risk of complications.
Can I use topical retinoids for scars while on Accutane?
No. Using topical retinoids like tretinoin or adapalene while taking oral isotretinoin is not recommended because the combined retinoid load can cause severe irritation, excessive dryness, and increased skin fragility. Wait until you have finished your course and your dermatologist clears you to resume topical retinoids.
Do Accutane before and after results last permanently?
For most patients, yes. Studies show that about 80 percent of people who complete a full course at an adequate cumulative dose remain clear long-term. However, roughly 15 to 20 percent may experience a relapse, particularly if they were younger when treated or had very severe acne. A second course is effective for most relapse cases.
Is microneedling safe after Accutane?
Microneedling is generally considered safe after the recommended waiting period, which most dermatologists set at six months post-treatment. Some practitioners are comfortable with shorter waits for shallow microneedling depths, but deeper treatments should follow the full waiting period to avoid abnormal healing responses.
Will Accutane help with back and chest acne scars?
Accutane is highly effective at clearing body acne, and the before and after improvements on the back and chest can be dramatic because these areas tend to have more inflammatory and cystic lesions. However, the trunk is also more prone to hypertrophic and keloid scarring, and those raised scars will not flatten from Accutane alone. Post-treatment options for body scars include steroid injections, silicone sheeting, and laser therapy.
