Next steps for acne scarring: keep going or give up? (Photo)

Question

Hi, I have acne scarring and have.had numerous procedures with little result (maybe 20%): 1) Punch excision (had horrible red marks that eventually became white) 2) full ablative C02 laser x1 3) 3x Morpheus8 and 2 halos 4) Subscision/TC cross/filler/erbium one month ago. Doc that performed #4 told me today that another subscision won't help further but he will keep doing trio. Says my best hope at this point is filler. Should I give up and resign to filler/tc cross/yag? What would you do?

Anna Chacon, MD, FAAD · Answer

First, I want to acknowledge how exhausting this journey must feel. You've invested a tremendous amount of time, money, and recovery into treating your acne scars, and it's understandable to wonder if you've reached the point of diminishing returns.

Looking at your history, you've already undergone many of the treatments we commonly use:

Punch excision
Fully ablative CO₂ laser
Morpheus8
Halo laser
Subcision
TCA CROSS
Filler
Erbium laser

The important question now isn't "What procedure haven't I tried?" It's "Which scar types remain, and which treatment best matches those specific scars?"

One reason patients plateau is that acne scarring is rarely just one type. Rolling scars, boxcar scars, ice-pick scars, tethered scars, and volume loss often coexist. Once the tethering has been adequately released, repeating subcision over and over may provide very little additional benefit—which is likely why your physician feels another subcision is unlikely to help.

From your description, I agree that filler can be a very reasonable next step, especially if the remaining scars are primarily due to volume loss or broad depressions rather than tethering. Hyaluronic acid fillers or longer-lasting biostimulatory fillers can soften the appearance of rolling scars remarkably well in carefully selected patients.

That said, I would not necessarily abandon treatment altogether.

If I were evaluating you, I would first determine:

Are there still any scars that remain tethered?
Are the remaining defects mostly atrophic because of lost volume?
Are the ice-pick scars still the most noticeable?
Is skin texture or scar depth now the biggest issue?

The answers would guide the next step.

In many patients who have already had extensive treatment, the goal shifts from trying to achieve 100% correction to refining the remaining 10–20% with targeted therapies. That may include:

Strategic filler for persistent volume deficits.
Additional TCA CROSS only for true ice-pick scars.
Fractional ablative laser for texture if the skin has recovered sufficiently.
Biostimulatory treatments to gradually improve collagen production over time.

One thing I would avoid is continuing to repeat the same procedure simply because it helped initially. Once improvement plateaus, repeating identical treatments often yields progressively smaller returns.

I also think it's worth recognizing that you've already achieved approximately 20% improvement despite having difficult scars. While that may not feel like enough, it suggests your skin is capable of remodeling—it just may require a different strategy now than it did at the beginning.

My biggest piece of advice is don't measure success by whether every scar disappears. Mature acne scars often require maintenance and refinement rather than a single "final" treatment. If filler provides the greatest improvement in the scars that bother you most, that doesn't mean you've failed—it means you've reached the stage where camouflage and structural support may offer more benefit than continued aggressive resurfacing.

I wouldn't say it's time to give up. I would say it's time to become more selective, focusing only on the treatments that specifically address the scars that remain rather than continuing broad treatments with diminishing returns.

Raffy Karamanoukian, MD, FACS · Answer

Acne scar treatments require precision and attention to detail. There are several types of acne scars, including atrophic, hypertrophic, PIH hyperpigmented, and hypopigmented scars. Depending on the types of scars you have, our office can recommend a Hidef treatment protocol that can recontour existing scars and reduce complexion irregularities. The results are simply life-changing. As a general rule, we recommend fillers, subcision, acne surgery, RF ablation, and laser ablation to help with atrophic scars. Hypertrophic and keloid acne scars require pulsed dye laser and IIT SC. PIH scars require chemical peels, Melarase creams (AM and PM) and laser.If you have ice-pick scars, we recommend RF ablation and TCA Cross.Best,Dr. KaramanoukianRealself100 Surgeon

Laura A. Katz, MD · Answer

As long as these are old scarring changes and there is not active acne still occurring, morpheus 8 radiofrequency microneedling would be a great option.  The morpheus 8 will transmit energy into the tissue to stimulate remodeling, plumping of collagen, skin tightening and muscle contraction.  It is also a scar reducer.  It is a simple in office treatment with minimal down time and you can often see results within the month.  Depending on the extensivity and depth of the scaring, a follow up radiofrequency resurfacing could also be done.  Here are some helpful links.

Next steps for acne scarring: keep going or give up? (Photo)

Answers (3)

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