Mild atrophic scarring - what is the best treatment option subcision, RF microneedling, or light CO2? (Photos)

Hello! I’m Lauren, the aesthetic provider here at Colorado Plastic Surgery Center. For mild atrophic scarring, a combination approach often gives the best results. RF microneedling improves skin texture and stimulates collagen. Light CO2 laser can refine the surface, especially for shallow boxcar scars.

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.


Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hello and thank you for your question. This is a very common and often frustrating problem for so many of our patients. If you’re dealing with mild atrophic acne scars, especially rolling scars with a few shallow boxcar scars, one of the most effective treatment options is full ablative laser resurfacing with CO₂ or Erbium. These lasers penetrate deeper into the skin and stimulate strong collagen remodeling, which can dramatically improve texture and smooth out scars in a single treatment. Fractional CO₂ or Erbium can also help, but usually requires multiple sessions to achieve similar results.
Another option that’s becoming increasingly popular is radiofrequency microneedling (RF-MNRF). This treatment also encourages collagen production and improves overall skin texture, with the benefit of less downtime and a lower risk of pigment changes. For most patients with shallow rolling or boxcar scars, subcision isn’t necessary at this stage — it’s typically reserved for deeper, tethered scars like icepick scars.
Pairing any of these treatments with a high-quality skincare routine, including retinoids, brightening agents, and daily sun protection, can help your skin heal faster and maintain results long-term. For anyone searching for the best acne scar treatments, full ablative laser resurfacing remains a top choice for improving both rolling and shallow boxcar scars, while RF microneedling offers a gentler alternative with excellent results. I hope this answers your question.
Best, Justin Buro, M.D.