Choosing Acne-Scar Treatment According to Scar Type

The right acne-scar treatment depends on the anatomy of the scar, not simply on which device is available in the clinic. Rolling and tethered scars may require subcision, ice-pick scars may respond to TCA CROSS, boxcar scars may benefit from resurfacing, and selected depressed scars may benefit from conservative filler support. Most patients require a carefully planned combination approach.

Not all acne scars are the same. Before recommending acne-scar treatment in Jeddah, a dermatologist should determine whether the skin contains rolling scars, boxcar scars, ice-pick scars, tethered scars, post-inflammatory pigmentation, or raised scars.

This classification matters because each scar pattern forms differently and therefore responds to a different type of treatment.

The American Academy of Dermatology identifies distinct patterns of acne scarring and explains that classifying scars into different types helps dermatologists choose the most appropriate treatment for each type.

In my clinical practice in Jeddah, a treatment plan may include a carefully selected combination of subcision, fractional CO₂ laser, radiofrequency microneedling, TCA CROSS, conservative hyaluronic-acid support, or diluted calcium hydroxylapatite when appropriate. The aim is not to use every treatment available, but to match the treatment to the actual scar anatomy while minimizing unnecessary inflammation and the risk of pigmentation.

Medically reviewed by: Dr. Shazia Ali, MBBS, DDSc, MSc Dermatological Sciences UK-trained Dermatologist & Aesthetic Physician TrueMe Medical Center, Jeddah, Saudi Arabia Last medically reviewed: 25 July 2026

Quick Answer: Which Treatment Is Suitable for Each Type of Acne Scar?

Scar Type or Skin Concern	Typical Appearance	Treatments That May Be Considered	Main Limitations
Rolling scars	Broad, shallow depressions with a wavy appearance	Subcision, RF microneedling, fractional laser, selected fillers	Laser alone may not release deep tethering
Tethered scars	Depressions that remain pulled downward even when the skin is stretched	Subcision, sometimes followed by filler or resurfacing	Resurfacing without releasing the tether may give limited improvement
Boxcar scars	Round or oval depressions with well-defined edges	Fractional CO₂ laser, RF microneedling, punch elevation or excision in selected cases	Deep, sharp-edged scars may not flatten completely with laser alone
Ice-pick scars	Narrow openings extending deeply into the skin	TCA CROSS or punch excision in selected cases	Broad resurfacing may not adequately reach the deepest part of the scar
Superficial atrophic scars	Mild depressions and uneven texture	Fractional laser, microneedling or RF microneedling	Usually requires multiple sessions
Depressed scars with volume loss	Broader depressions with reduced underlying support	Conservative HA filler or selected diluted CaHA protocols	Filler does not replace subcision when tethering is strong
Red post-acne marks	Flat redness or pink discoloration	Vascular-targeted treatments, sun protection and time	These are not true depressed scars
Brown pigmentation	Flat brown or grey marks following inflammation	Pigment-directed skincare, sun protection and selected procedures	Aggressive treatment may worsen pigmentation
Raised scars	Elevated, firm hypertrophic or keloid scars	Intralesional injections, silicone, vascular treatments and other scar therapies	Subcision and filler are generally inappropriate

No table can replace an in-person examination. Many patients have several scar types in the same area, and the treatment plan should also consider skin tone, scar depth, active acne, previous procedures and the risk of post-inflammatory hyperpigmentation.

What Type of Acne Scars Do I Have?

Acne scars are broadly divided into atrophic scars, which lie below the level of the surrounding skin, and raised scars, which rise above it.

The main types of depressed acne scars include:

Rolling Scars

Rolling scars are broad, relatively shallow depressions that give the skin a wavy or undulating appearance. They often develop when fibrous bands beneath the skin pull the surface downward.

Some rolling scars become less visible when the skin is stretched, while others remain fixed because of stronger underlying tethering.

Rolling scars often respond only partially to resurfacing when the fibrous attachments beneath them have not first been released.

Boxcar Scars

Boxcar scars are round or oval depressions with more clearly defined edges. They may be shallow or deep.

Superficial boxcar scars may respond to fractional resurfacing or RF microneedling. Deep, sharp-edged boxcar scars may require more focused procedures such as punch elevation, punch excision or carefully selected combination treatment.

Ice-Pick Scars

Ice-pick scars are narrow at the surface but extend deeply into the skin. They can resemble enlarged pores, although they are usually deeper and more sharply defined.

Because their opening is narrow and their track extends vertically into the skin, broad surface treatments may not reach their full depth. TCA CROSS or punch excision may therefore be considered.

Tethered Scars

The term “tethered scar” describes how a scar behaves, rather than simply how it looks.

A tethered scar is anchored downward by fibrous bands beneath the skin. During examination, the dermatologist may stretch or move the surrounding skin to determine whether the depression remains fixed.

These scars often require a release procedure such as subcision before resurfacing treatments or fillers can produce meaningful improvement.

Pigmented Post-Acne Marks

Brown, grey or red marks following acne are frequently described as “scars,” but many are actually flat changes in skin colour rather than structural scars.

These marks may include:

• Post-inflammatory hyperpigmentation
• Post-inflammatory erythema
• Persistent redness
• Mixed pigmentary changes

Pigmentation requires a different treatment strategy from depressed structural scars. Treating a pigment problem as though it were a deep structural scar may expose the skin to unnecessary procedural risks.

Raised Acne Scars

Raised scars occur when the skin produces excessive scar tissue. These include hypertrophic scars and keloids.

Raised acne scars are more commonly seen along the jawline, chest, shoulders and upper back. They may also be more common or clinically significant in patients with darker skin tones.

Raised scars should not be treated in the same way as depressed scars. Filler, aggressive deep needling or subcision are generally inappropriate and may worsen the problem.

Why Can't One Type of Laser Treat All Acne Scars?

Laser treatment can stimulate collagen remodelling and improve surface texture, but it cannot correct every component of every scar.

For example:

• Laser may soften the edges of a boxcar scar.
• It may improve superficial textural irregularity.
• It may stimulate collagen remodelling in some atrophic scars.
• It may not fully release a rolling scar that is genuinely tethered to deeper tissues.
• It may not adequately reach the narrow base of a deep ice-pick scar.
• The same settings cannot be used for a raised keloid scar and a depressed scar.

This is why a device-led approach can produce disappointing results. A treatment plan should begin with diagnosing the scar type, not with the name of a device.

Fractional CO₂ laser is an important tool, but it remains only one component of a broader acne-scar treatment strategy.

What Is the Difference Between Rolling, Boxcar and Ice-Pick Scars?

The main differences involve the width, depth and borders of the scar, as well as the degree of underlying tethering.

Scar Type	Width	Depth	Edges	Common Underlying Problem
Rolling	Broad	Usually superficial to moderate	Smooth and sloping	Subcutaneous fibrous tethering
Boxcar	Medium to broad	Superficial or deep	More vertical and defined	Localized tissue loss
Ice-pick	Very narrow	Deep	Sharp, defined opening	Deep vertical tract

A patient may have all three types simultaneously. A dermatologist may therefore divide the face into different treatment zones rather than use one setting or one technique across the entire face.

Is Subcision Better Than Fractional CO₂ Laser?

There is no single treatment that is universally better because each treatment targets a different anatomical problem.

Subcision is used to cut fibrous bands that pull a scar downward. It is particularly useful for rolling and tethered scars.

Fractional CO₂ laser, on the other hand, creates controlled microscopic columns of thermal injury within the skin, stimulating healing, collagen remodelling and improvement in surface texture.

Subcision may be more important when the main problem is deep tethering, while fractional CO₂ laser may be more useful when there is superficial-to-moderate textural irregularity, defined scar edges or a general need for resurfacing.

For some patients, the treatments complement one another:

1. Control active acne.
2. Release selected tethered scars.
3. Allow the skin adequate time to heal.
4. Improve residual texture using fractional CO₂ laser or RF microneedling.
5. Reassess any persistent focal depressions.
6. Consider focal treatment or conservative filler support if required.

Subcision also carries risks, including bruising, swelling, bleeding, temporary pain, haematoma, surface irregularity, infection and injury to deeper structures. It should therefore be performed by a physician who understands facial anatomy and scar depth.

When Is TCA CROSS Appropriate?

TCA CROSS stands for Chemical Reconstruction of Skin Scars using Trichloroacetic Acid.

A high-concentration acid is applied very precisely inside the scar itself rather than across the entire face. The controlled chemical injury stimulates tissue remodelling within the scar.

TCA CROSS is most commonly used for:

• Ice-pick scars
• Narrow, deep boxcar scars
• Some enlarged pores with a scar-like morphology

It is not usually the first choice for broad rolling scars or scars caused primarily by deep tethering.

Several sessions are often required. Temporary frosting, crusting and redness are expected. In Middle Eastern or darker skin tones, treatment should be conservative because of the risk of post-inflammatory hyperpigmentation.

TCA CROSS should not be attempted at home. Incorrect application can cause burns, prolonged pigmentation, widening of the scar or permanent skin damage.

When Is RF Microneedling Appropriate for Acne Scars?

Radiofrequency microneedling delivers energy into the dermis through insulated or non-insulated needles, depending on the device.

It may be considered for:

• Mild-to-moderate rolling scars
• Superficial boxcar scars
• General textural irregularity
• Patients requiring a resurfacing option that does not rely on laser energy
• Some darker skin types when an appropriately conservative protocol is used

RF microneedling can stimulate dermal remodelling while reducing some of the superficial thermal exposure associated with ablative lasers. However, it is not risk-free.

Excessive needle depth, high energy or repeated passes can produce prolonged inflammation, post-inflammatory pigmentation, needle-track marks, burns, fat loss or worsening of texture.

It may improve some partially tethered scars, but obvious fibrous tethering may still require subcision.

When Is Fractional CO₂ Laser Appropriate?

Fractional CO₂ laser may be suitable for:

• Superficial boxcar scars
• Some rolling scars after underlying tethering has been addressed
• Rough or irregular texture
• Softening scar edges
• Some enlarged pores
• General resurfacing in carefully selected patients

The laser removes microscopic columns of tissue while leaving surrounding skin intact to support healing. This controlled injury stimulates collagen remodelling over the following months.

Fractional CO₂ laser settings should be customized according to:

• Skin phototype
• Scar depth
• Treatment density
• Energy level
• Pulse characteristics
• Number of passes
• Treatment area
• Previous pigmentary reactions
• Recent sun exposure or tanning
• Ability to comply with post-procedure care

More aggressive settings do not necessarily produce better results. In pigmentation-prone skin, excessive inflammation can create a new problem while attempting to improve the original scar.

Can Radiesse Help Depressed Acne Scars?

Radiesse is an injectable product containing calcium hydroxylapatite, or CaHA.

CaHA provides immediate structural support and can also stimulate collagen production. Published studies suggest that it may improve selected atrophic scars, including when used in diluted form or in combination with other treatments.

However, the scientific evidence supporting CaHA for acne scars is smaller than the evidence available for more established approaches such as fractional laser, microneedling, radiofrequency devices, TCA CROSS and subcision.

CaHA for acne scarring should therefore be presented as a selected or emerging application, rather than a first-line treatment suitable for everyone.

In my clinical practice, diluted CaHA may be considered in carefully selected patients after evaluating:

• Whether the scar is tethered
• Whether the tether should first be released
• Skin thickness
• Scar depth and distribution
• Previous filler treatments
• Risk of nodules or uneven product distribution
• Whether broader dermal support is likely to provide meaningful benefit

CaHA is not suitable for every scar, anatomical region or skin type. Dilution, injection plane, volume and distribution technique are all important.

Can Hyaluronic-Acid Filler Help Depressed Acne Scars?

Hyaluronic-acid filler may help selected depressed scars by restoring support beneath the depression.

It may be appropriate for:

• A limited number of persistent rolling or boxcar scars
• Scars that improve when manually elevated
• Residual depressions after subcision
• Localized tissue loss
• Patients who prefer a reversible filler option

Filler should not simply be placed beneath a scar without evaluating tethering. If a scar is firmly anchored, injecting filler without adequate release may produce swelling around the scar while leaving its centre pulled downward.

I prefer a conservative, anatomy-based approach. When appropriate, a soft or tissue-integrating HA product may be used in small amounts to support the area without creating visible fullness or an overfilled appearance.

HA filler carries important risks, including bruising, swelling, infection, nodules, vascular occlusion and, very rarely, severe vascular complications. Treatment should therefore be performed by an appropriately qualified physician.

Is Combining Subcision With Filler Better Than Subcision Alone?

Some depressed scars may reattach during healing after being released. A small amount of filler may help maintain separation beneath the released scar and provide structural support.

However, not every scar treated with subcision requires filler.

The decision depends on:

• Number and depth of scars
• Extent of tissue release
• Skin thickness
• Associated volume loss
• Likelihood of re-tethering
• Whether the planned filler is temporary, reversible or biostimulatory
• The patient's tolerance for risk, swelling and cost

Conservative HA support may be useful when reversibility is important. Diluted CaHA may be considered in selected patients when broader dermal support or collagen stimulation is desirable, recognizing that this is a more specialized use with a smaller evidence base.

Can Acne Scars Be Removed Completely?

Acne scars can usually be improved, but complete removal cannot be guaranteed.

A realistic goal is to make scars:

• Shallower
• Softer at the edges
• Less noticeable under direct or overhead lighting
• More even in colour
• Less tethered to deeper tissues
• Less visible in photographs and during facial movement

The final degree of improvement depends on:

• Scar type
• Scar depth
• How long the scar has been present
• Skin tone
• Presence of active acne
• Individual collagen response
• Previous procedures
• Treatment selection
• Healing response
• Sun exposure
• Willingness to complete a staged treatment plan

Claims promising “100% removal,” “glass skin after one session,” or permanent elimination of deep scars should be approached with caution.

How Many Sessions Will I Need for Acne-Scar Treatment?

Most patients require a series of treatments rather than a single session.

Approximate treatment courses may include:

Treatment	Common Treatment Course
Subcision	Often 1–3 sessions for selected tethered scars
Fractional CO₂ laser	Often 2–4 sessions
RF microneedling	Often 3–5 sessions
TCA CROSS	Often 3–6 focal sessions
Traditional microneedling	Often 3–6 sessions
HA filler	May provide immediate structural support; maintenance varies according to product and area
Diluted CaHA	Often 1–3 sessions in selected protocols
Punch procedures	May be performed once or staged for individual scars

These are general estimates, not guarantees.

Sessions are usually separated by several weeks or months to allow inflammation to settle and collagen remodelling to develop. Performing treatments too close together may increase irritation and pigmentation without improving the final outcome.

Is Fractional CO₂ Laser Safe for Middle Eastern or Darker Skin?

Fractional CO₂ laser can be used in selected Middle Eastern or darker skin types, but careful patient selection, conservative settings and strict aftercare are important.

Many Saudi patients have Fitzpatrick skin phototypes III, IV or V. These skin types can heal well, but they are more susceptible to post-inflammatory hyperpigmentation following excessive heat, inflammation or sun exposure.

Factors that may help reduce the risk include:

• Controlling active acne and skin irritation first
• Avoiding treatment on recently tanned skin
• Customizing energy and density
• Avoiding unnecessary overlap between passes
• Preparing pigmentation-prone skin when appropriate
• Regular use of broad-spectrum sunscreen
• Avoiding direct sun and excessive heat after treatment
• Starting post-procedure pigmentation treatment only when medically appropriate
• Allowing adequate healing time between sessions

Jeddah's climate adds important practical considerations. Strong ultraviolet exposure, heat, sweating and outdoor activity can make post-treatment care more challenging.

Fractional CO₂ laser should therefore not automatically be considered the best first treatment for every darker-skinned patient. In some cases, RF microneedling, non-ablative fractional laser, subcision, focal techniques or a staged combination plan may provide a better balance between benefit and risk.

What Is the Risk of Post-Inflammatory Hyperpigmentation?

Post-inflammatory hyperpigmentation, or PIH, is darkening of the skin that develops after inflammation or injury.

It is more common in medium-to-dark skin tones and may occur after:

• Active acne
• Picking or squeezing spots
• Laser treatment
• RF microneedling
• Chemical reconstruction of scars
• Aggressive chemical peels
• Burns
• Infection
• Excessive sun exposure following a procedure

PIH may be temporary, but it can persist for several months. In some patients, it can become more troublesome than the original scar texture.

The risk cannot be reduced to zero, but it may be minimized through:

• Correct diagnosis
• Conservative treatment settings
• Appropriate pre-treatment skincare
• Daily broad-spectrum sunscreen
• Visible-light protection when pigmentation is present
• Gentle barrier-supportive post-procedure skincare
• Early recognition of excessive inflammation
• Avoiding unnecessary treatment combinations
• Careful follow-up

Patients with active melasma, recent tanning or a history of prolonged pigmentation may require a modified treatment plan.

Why Should Active Acne Be Controlled Before Scar Treatment?

Treating scars while new inflammatory acne is continuing to develop is similar to repairing a wall while damage is still occurring.

Active acne should usually be controlled first because:

• New spots may create new scars.
• Procedures can worsen inflammation or infection in existing lesions.
• Active inflammation increases the risk of pigmentation.
• The true scar pattern is easier to evaluate once acne has settled.
• Treatment time and cost may be wasted if new scarring continues.
• Some procedures may need to be delayed during or after certain acne medications.

Acne control may include topical treatments, oral medication, hormonal assessment or isotretinoin when appropriate.

The timing of scar procedures during or after isotretinoin should be individualized. Modern evidence does not support one universal waiting period for all procedures, although fully ablative resurfacing and extensive surgery require particular caution. The procedure type, isotretinoin dose, healing history and skin characteristics should all be considered.

Should Pigmentation Be Treated Before Scar Texture?

Sometimes, but not always.

When a patient has significant active pigmentation, irritation or melasma, stabilizing pigment activity first may make procedures safer.

However, some patients have pigmentation and structural scars simultaneously, and both can be managed within a coordinated sequence.

A staged plan may include:

1. Control active acne.
2. Stabilize the skin barrier.
3. Begin pigmentation treatment and sun protection.
4. Identify tethered, ice-pick, boxcar and rolling scars.
5. Treat the deeper structural problem first.
6. Reassess before adding resurfacing.
7. Continue pigmentation-prevention measures throughout recovery.

The sequence should be determined by clinical examination rather than by a fixed treatment package.

Is Traditional Microneedling the Same as RF Microneedling?

No.

Traditional microneedling creates microscopic mechanical channels using fine needles, while RF microneedling adds thermal energy at a selected depth.

Traditional microneedling may help mild scars and general textural improvement. RF microneedling can provide more targeted thermal remodelling within the dermis.

However, RF microneedling is not automatically better. Results depend on:

• Needle depth
• Energy
• Number of passes
• Device design
• Scar type
• Skin thickness
• Interval between sessions
• Practitioner experience

For deep ice-pick scars or severely tethered rolling scars, neither technique may be sufficient as a stand-alone treatment.

Do Acne-Scar Creams Work?

Creams cannot release a genuinely tethered scar or replace substantial deep tissue loss.

However, topical products may help by:

• Controlling active acne
• Supporting collagen renewal
• Improving mild textural irregularity
• Reducing pigmentation
• Improving the skin barrier
• Preparing the skin for procedures
• Supporting recovery after treatment

Prescription retinoids may gradually improve acne, pigmentation and superficial texture. Sunscreen is also essential to prevent scars and dark marks from becoming more noticeable.

Creams should be viewed as supportive treatment rather than a substitute for procedures when structural scars are present.

Why Do Combination Treatments Often Produce Better Results?

Most patients do not have only one type of acne scar.

A patient may have:

• Tethered rolling scars on the cheeks
• Ice-pick scars near the temples
• Boxcar scars on the lower cheeks
• Post-inflammatory pigmentation along the jawline
• Active acne in the same area

Using fractional CO₂ laser over the entire face may improve some regions while leaving others relatively unchanged. A scar-specific plan may therefore include:

• Subcision for tethered scars
• TCA CROSS for ice-pick scars
• Fractional CO₂ laser or RF microneedling for general texture
• Conservative HA support for selected persistent depressions
• Diluted CaHA in selected cases requiring broader dermal support
• Pigment-directed treatment and sun protection
• Continued acne control

Combination treatment does not mean performing every procedure on the same day. Staging treatments allows the physician to assess the response and reduce unnecessary inflammation.

Established Treatments Versus Emerging Treatments

Patients should understand the difference between treatments supported by a broader body of clinical evidence and promising treatments that are still supported mainly by smaller studies.

More Established Options

Depending on the scar type, established or widely accepted approaches include:

• Subcision for tethered rolling scars
• Ablative and non-ablative fractional lasers
• RF microneedling
• Traditional microneedling
• TCA CROSS for selected ice-pick scars
• Punch excision or punch elevation
• Selected fillers
• Intralesional treatment for raised scars
• Combination treatment

Selected or Emerging Applications

These options may have some supporting evidence but generally require additional high-quality comparative studies:

• Diluted CaHA for broader atrophic scarring
• Hybrid filler approaches
• Biostimulatory injectables for scar remodelling
• Combining energy-based devices with biostimulators
• Regenerative products marketed as exosomes
• Polynucleotides or PDRN as stand-alone scar treatments
• Platelet-derived products combined with resurfacing procedures

The term “emerging” does not mean that a treatment is ineffective. It means that the quality, quantity or consistency of evidence has not yet reached the level available for more established treatments.

Claims that exosomes, stem-cell products or injectable regenerative treatments can completely regenerate scarred skin should be approached cautiously.

What Happens During an Acne-Scar Consultation?

A proper consultation should involve more than simply looking at the skin under one type of light.

The assessment may include:

• History of active acne
• Previous isotretinoin use
• Previous laser or scar treatments
• Skin tendency toward pigmentation
• History of keloid scarring
• Current skincare routine and medications
• Examination under direct and oblique lighting
• Skin-stretch testing to identify tethered scars
• Assessment of skin thickness and laxity
• Medical photography
• Classification of individual scar types
• Discussion of downtime and risks
• Development of a staged treatment plan

Lighting is particularly important. Some scars may appear mild under flat frontal lighting but become much more noticeable under overhead or side lighting.

Standardized photographs should therefore be taken using the same lighting, distance, facial position and camera settings.

How Do I Choose a Clinic for Acne-Scar Treatment in Jeddah?

Instead of asking only which device a clinic has, consider asking:

• Who will diagnose my scar types?
• Do I have tethered scars?
• Is the treatment selected according to my scar pattern, or am I being offered a fixed package?
• What is the pigmentation risk for my skin tone?
• What is a realistic result?
• Which scars may respond poorly?
• Do different areas of my face require different treatments?
• What are the possible complications?
• Who will manage complications if they occur?
• How will my progress be photographed and assessed?

A reliable treatment plan should explain not only what will be done, but also why the treatment has been selected and what it cannot achieve.

A Practical Framework for Matching Treatment to Scar Type

A simplified clinical framework may look like this:

Step One: Control Active Acne

Prevent the formation of new scars and reduce inflammation.

Step Two: Distinguish Pigmentation From Structural Scarring

Determine whether the primary concern is colour, texture or both.

Step Three: Identify Deep Tethering

Rolling scars that remain fixed during a skin-stretch test may require subcision.

Step Four: Treat Deep Focal Scars

Ice-pick scars and deep boxcar scars may require TCA CROSS or punch techniques.

Step Five: Improve General Texture

Fractional CO₂ laser, non-ablative fractional laser, microneedling or RF microneedling may be used depending on skin type and scar pattern.

Step Six: Reassess Residual Depressions

Selected scars may benefit from conservative HA support or, in carefully selected cases, diluted CaHA.

Step Seven: Maintain Acne and Pigmentation Control

Daily sunscreen, appropriate skincare and early treatment of new acne remain essential.

Conclusion

The most important question is not:

“What is the best device for acne scars?”

A more accurate question is:

“What structural problem is creating each scar, and which treatment can address it with the lowest reasonable level of risk?”

Rolling, boxcar, ice-pick, tethered, pigmented and raised scars behave differently. A single type of laser cannot treat all of them equally effectively.

For many patients, the best acne-scar treatment in Jeddah is a staged combination plan that controls active acne, releases deep tethering, treats focal deep scars, improves general texture and uses filler only when the anatomy genuinely requires it.

The realistic goal is improvement of acne scars, not a promise that they will disappear completely.

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Frequently Asked Questions About Acne-Scar Treatment

What Is the Best Treatment for Rolling Acne Scars?

Rolling scars often contain fibrous attachments beneath the skin. Subcision may be necessary to release these attachments. RF microneedling, fractional laser or conservative filler support may then be considered to improve residual texture or depression.

Is Subcision Better Than CO₂ Laser for Acne Scars?

Subcision is generally more suitable for tethered rolling scars, while fractional CO₂ laser is used for surface remodelling and improvement of some boxcar scars or textural irregularity. Many patients benefit from a staged combination plan rather than choosing only one treatment.

Is TCA CROSS Suitable for All Acne Scars?

No. It is mainly used for narrow ice-pick scars and some deep boxcar scars. It is not generally suitable for broad rolling scars or raised scars.

Can RF Microneedling Remove Deep Acne Scars?

RF microneedling can improve mild-to-moderate atrophic scars and general texture, but it may not fully correct severely tethered rolling scars or deep ice-pick scars without additional targeted treatment.

Can Filler Permanently Remove Acne Scars?

No. Hyaluronic-acid filler provides temporary structural support. Some biostimulatory fillers may produce longer-lasting changes in collagen, but they do not guarantee permanent scar removal. Filler is most useful for carefully selected depressed scars.

Is Radiesse Specifically Approved for Acne-Scar Treatment?

CaHA products such as Radiesse have been studied for atrophic scars, but their use for acne scars may be considered off-label depending on the country and the specific approved indication. The evidence is promising but remains smaller than the evidence available for some established treatments.

How Long Does It Take to See Results From Acne-Scar Treatment?

Filler support may be visible immediately, although swelling can affect the early appearance. Treatments that depend on collagen remodelling, including subcision, fractional laser, RF microneedling and CaHA, develop progressively over weeks to months.

Can Acne Scars Come Back After Treatment?

A successfully improved scar does not usually return completely to its original state. However, new active acne may create new scars, while ageing and natural volume loss may make some depressions more visible over time.

Is Fractional CO₂ Laser Safe for Brown Skin?

It can be used in some patients with brown or Middle Eastern skin when settings and aftercare are individualized. However, the risk of post-inflammatory hyperpigmentation is higher, making conservative settings and strict sun protection particularly important.

How Many Acne-Scar Treatment Sessions Are Usually Required?

Most patients require multiple sessions. The number depends on scar type, depth, skin tone, healing response and treatment method. A staged plan involving three or more treatment visits is common.

Can Acne Scars Be Treated While I Still Have Active Acne?

It is generally preferable to control obvious inflammatory acne first. Otherwise, new scars may continue to form, and procedures may increase inflammation or pigmentation.

What Is the Difference Between Acne Scars and Acne Marks?

Acne scars involve a structural change in the skin, such as a depression or elevation. Acne marks are flat red, brown or grey areas of discoloration caused by inflammation. Each requires a different treatment strategy.

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Which acne-scar treatment is most suitable for you?
Let Dr. Shazia Ali explain a personalized treatment plan after assessing your rolling, boxcar, ice-pick and tethered scars.
Which treatment may be most appropriate for you: subcision, fractional CO₂ laser, RF microneedling, TCA CROSS or filler?

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Medical References

1. American Academy of Dermatology. Acne scars: Signs and symptoms.

2. American Academy of Dermatology. Scars: Signs and symptoms.

3. American Academy of Dermatology. Acne scars: Overview.

4. Gupta A, et al. Evidence-based Surgical Management of Post-acne Scarring in Skin of Color. Journal of Cutaneous and Aesthetic Surgery. 2020.

5. Salameh F, et al. Energy-based devices for acne scar treatment: International consensus recommendations. Lasers in Surgery and Medicine. 2022.

6. Ziebart RL, et al. Laser and Energy Treatments for Acne Scarring. Journal of Cosmetic Dermatology. 2024.

7. Zhang DD, et al. Efficacy of fractional CO₂ laser in the treatment of acne scars: A meta-analysis. Dermatologic Therapy. 2021.

8. Ghazzawi R, et al. A systematic review evaluating the efficacy of fractional laser treatment for acne scars. Journal of Cosmetic and Laser Therapy. 2021.

9. Chilicka K, et al. Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review. Journal of Clinical Medicine. 2022.

10. Casabona G, et al. Combined use of focused ultrasound and diluted CaHA for treatment of atrophic acne scars. Journal of Cosmetic Dermatology. 2018.

11. Koren A, et al. Diluted calcium hydroxylapatite combined with an energy-based device for facial atrophic acne scars. Clinical and Experimental Dermatology. 2019.

12. Antonino A, et al. Calcium hydroxylapatite compared with calcium hydroxylapatite combined with focused ultrasound for acne scars. Journal of Cosmetic Dermatology. 2021.

13. Mehrabi JN, et al. Comparison of two hyaluronic acid-based fillers for the treatment of acne scars. Aesthetic Surgery Journal. 2023.