Is it acne scarring or just texture?
The question that matters is whether the surface is uneven because the dermis has lost volume, which constitutes scarring, or because of irregularity, enlarged pores and superficial roughness. Textural change can be caused by acne and acne scarring. Many patients have both.
A helpful test is to stretch the skin gently between two fingers. Enlarged pores and surface roughness flatten out and largely disappear, whereas a true atrophic scar persists. The second test is light. Scarring casts a shadow under directional light from above because it has depth, whereas texture and pores scatter light rather than casting a discrete shadow. This is also why lighting has such a marked effect upon how bad scarring appears.
Pore size is influenced by sebaceous gland activity, by ageing and by sun damage, and enlarged pores across the cheeks and nose can closely resemble fine scarring in a mirror. They are not scars, they have not lost dermal volume, and they will not respond well to laser treatments.
Textural changes can respond to topical retinoids used consistently over months, and there may be some benefit to resurfacing with non-ablative or fractional ablative laser. Scarring requires the contour to be addressed first, with subcision for tethered scars, TCA CROSS for ice pick scars and punch excision for a small number of deep ones.
Generally it is worth having this assessed properly rather than guessing from photographs, since the two problems appear similar in a mirror and are treated entirely differently. In person it is usually possible to establish whether scars are tethered, which cannot be assessed alone and which alters the whole plan.
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