Ella Rubin’s Cystic Acne and Minimal Routine: When Should Scar Treatment Begin?

If deep, painful cystic acne keeps appearing, treating the inflammation comes before scar procedures. Microneedling, radiofrequency microneedling, and fractional lasers are options for smoothing indented scars that have already formed; they do not treat the cause of new acne in their place. [1][2]

In a Vogue video from September 2026, actor Ella Rubin said she experienced deep, painful cystic acne during the actors’ strike and later pared back her routine to focus on soothing and moisturizing. She described microneedling and red light as helpful for managing scars based on her own experience, but this is a personal treatment history, not a clinical trial guaranteeing the same sequence for every skin type. [1]

How can cystic acne and indented scars be distinguished?

Cystic acne is an inflammatory lesion that feels painful and firm deep beneath the skin. An indented scar is a depression that forms when the dermal structure is reduced after inflammation has passed. Flat red or brown marks may look like scars but can instead be post-inflammatory erythema or hyperpigmentation.

If a spot is painful and swollen when pressed with a finger, it often has not yet reached the “scar stage.” Adding needles or intense heat energy at this point can increase the risk of pain, inflammation, and hyperpigmentation, so the first priority is to stop the cycle of new lesions.

What should a minimal routine keep, and what should it remove?

Keep a gentle cleanser, a non-comedogenic moisturizer, and sunscreen. “Non-comedogenic” means the product is designed to reduce the likelihood of clogging pores, but it is not a guarantee that comedones will not form for everyone.

Remove newly added acids, scrubs, heavily fragranced oils, and the habit of layering several spot products at once. The longer the routine, the harder it is to identify the cause when the skin stings. The key takeaway from Ella Rubin’s experience is not a specific product list, but the choice not to add steps to skin that was not calming down. [1]

What treatment should come first for active acne?

The 2024 American Academy of Dermatology guidelines strongly recommend topical benzoyl peroxide and topical retinoids, as well as combinations of the two. Benzoyl peroxide reduces acne-related bacteria, while retinoids regulate the processes that clog pores and contribute to inflammation. [2][3]

When large, deep nodules recur or scars are increasing quickly, topical products should not be tested alone for too long. Oral antibiotics should be used for a limited duration and combined with benzoyl peroxide to reduce the risk of resistance. For severe acne or cases that have not responded to standard treatment, isotretinoin may be considered. This choice requires medical care that takes pregnancy potential, testing, and current medications into account. [2]

When should scar treatment begin, and how should it be chosen?

Once new inflammation has stabilized and the skin is no longer stinging, the scar type can be assessed. Broad, gently sloping rolling scars, sharply defined boxcar scars, and narrow, deep ice-pick scars do not produce the same response with the same device.

Microneedling creates tiny channels in the skin to induce a healing response, and there is evidence that it can improve atrophic acne scars. However, the number of sessions, depth, and evaluation methods differed among studies, and there is no conclusion that it is always superior to other treatments. As a rule, it should not be performed over active inflammation. [4][5]

RF microneedling, or radiofrequency microneedling, delivers radiofrequency heat through the needle tips to promote dermal remodeling. Depending on skin tone, it may be an option for reducing epidermal damage, but it can involve pain, swelling, crusting, and temporary hyperpigmentation. Fractional lasers create microscopic treatment zones in the surface and dermis, while the depth and recovery period vary considerably by device and mode.

Does red light treat both acne and scars?

It cannot be stated that simply. Red light has been studied as an adjunctive method that regulates inflammatory and healing responses through photobiomodulation, but it does not replace standard treatment for cystic acne or structural correction of deep indented scars. Nor should Ella Rubin’s personal experience be generalized to the effectiveness of all LED masks. [1][2]

Frequently asked questions

Can I get microneedling if I have only one or two pimples?

If there are inflammatory lesions in the treatment area, it is safest to avoid that area. If the inflammation is widespread or involves many lesions, it is better to postpone scar treatment and first stabilize an acne treatment plan.

Do brown marks also require scar laser treatment?

Flat brown marks may be post-inflammatory hyperpigmentation rather than indented scars. Sun protection and topical treatment may take priority, and choosing an intense fractional procedure without a diagnosis can make the discoloration darker.

Recommendations from Dr. Kang Jung-ha

Priority 1 is to reduce the number of new breakouts over 8–12 weeks. In the morning, use a gentle cleanser, moisturizer, and sun protection; in the evening, introduce either a topical retinoid or a benzoyl peroxide combination according to the prescription, one at a time. If deep, painful lesions recur, first design a disease-treatment plan that may include oral medication. [2][3]

Priority 2 is to distinguish marks from scars. Take monthly photos under the same lighting, separating flat redness and brown discoloration, which are managed as pigmentation, from depressions, which are treated as scars. The most practical way to prevent scars is not to squeeze lesions or use a home roller.

Priority 3 is to choose only one or two procedures suited to the scar type after the inflammation has stabilized. For rolling scars and shallow boxcar scars, consider microneedling or RF microneedling; for surface texture and broad scars, consider a fractional laser. Ice-pick scars may respond better to focal chemical reconstruction or punch procedures. Common risks include redness, swelling, crusting, and hyperpigmentation; during recovery, sun protection and stopping irritating ingredients are necessary. [4][5]

The treatment sequence, rather than the procedure’s name, determines the outcome. “Stop the inflammation, classify the scars, then start with the single most suitable option” is the practical sequence for translating a minimal routine into a treatment plan.

Interesting Skin Stories for Healthy Skin

Drawing on 16 years of experience performing dermatological procedures at Seolleim Clinic Gangnam, Dr. Kang Jung-ha presents accessible, friendly stories about dermatology, using everyday skincare methods as well as celebrities, public figures, and television as subjects. Through professional knowledge and experience, the aim is to help your skin look healthier and more beautiful. We hope this series broadens your understanding of skin and helps you discover ways to care for yourself.

Dr. Kang Jung-ha, Medical Director (Seolleim Clinic Gangnam)