Papular Scar: What It Is and How It Differs from Keloid

What is Papular Scar?

A papular scar is the soft-white or skin-coloured bump that stays raised where an acne lesion once sat. Most of them appear on the nose, the sides of the nose and around the jaw — areas where the sebaceous glands are large and the skin is thick. Pressed with a finger they feel firm rather than squashy, and they usually sit there for years with no redness, no itch and almost no change in size.

Even though both are called acne scars, this is the opposite direction from the depressed scars most people picture. An atrophic scar is what is left when tissue is lost; a papular scar is what is left when fibrous tissue bunches up and hardens in a healing wound. That is why the methods used on depressed scars do not do much here.

It is also the kind of scar that is barely visible to others and still bothers you for years. Because it is not red, it hardly shows in photographs — but light coming from the side throws a shadow off it and makeup will not sit flat over it, so it is the sort of unevenness you notice every time you look in the mirror.

The Other’s Distinctive Technique — CO2 Pinhole Technique

The core of treating a papular scar is not shaving off the raised tissue, but making fine channels through hardened, fibrosed tissue so that it becomes pliable.

Shaving the bump down looks like the obvious answer, but it suits this scar poorly. What the scar actually is, is not a lump of flesh sitting on the surface but fibrous tissue that has hardened deeper in the skin. Tidy up only the surface and the hardened tissue underneath stays where it is, pushing back up over time — and if the depth removed goes even slightly too far, what is left this time is a depressed mark instead.

The pinhole technique comes at it from the other direction. Rather than removing the hardened tissue, it opens paths inside it. Through those fine channels the tissue gets room to breathe and rearrange, and the skin is guided into healing towards a flatter surface on its own. That is also why the change is gradual across a series of sessions rather than dramatic after one.

Aftercare

Very small crusts form over the scar right after the session. These crusts act as a cover while new tissue settles in, so they should not be forced off — leave them until they come away on their own. Picking them early can leave pigment behind, or leave the mark visible for much longer.

While the crusts are there you can wash your face as usual, but without rubbing, and you need to be especially careful with sunlight. Healing skin takes on pigment easily, and it is common for the scar itself to improve while that exact spot stays darker than the skin around it. Using sunscreen even indoors is the safer habit.

Makeup is safe from the point the crusts have fallen away on their own. Covering them before that can drag them off and leave a mark. On the day of the session, keep to a light cleanse; from the next day you can go back to your usual skincare as long as you avoid rubbing.

Exfoliating products, retinol and high-strength vitamin C and anything else irritating should wait until the crusts are fully gone and the redness has settled. Moisturising, by contrast, is worth doing generously — it helps the recovery.

Saunas, heated bathhouses and exercise that makes you sweat heavily should be avoided for a few days, since heat and irritation get in the way of healing. Alcohol adds to the swelling.

If during recovery you have pain that is unlike the usual soreness, any discharge, or redness that is spreading, please contact us rather than waiting for your next appointment.

How it differs from other acne scars

Acne scars divide broadly into the ones that sink and the ones that rise. What people usually mean by an acne scar is the sunken kind; a papular scar is the raised kind. The direction is opposite, so the treatment approaches it from the opposite side too.

Depressed scars come from tissue that is missing, so they are filled or induced to regenerate. Papular scars come from tissue that has bunched together, so they are loosened. It is common to have both kinds on one face, which can mean different methods for different areas.

When the skin is neither raised nor depressed and only the mark is left, red or brown, that is not a scar but a pigment or vascular issue. Those can fade with time, and the laser approach to them is different again.

Frequently asked questions

This page is general information about a treatment and is not a diagnosis or a recommendation. The right choice differs by skin condition, so treatment is decided after an in-person examination. Individual results vary.