Looking for opinions on acne scar removal - what would be the best options? (Photos)

Question

Hi I am looking for opinions on the best treatment plan for my acne scarring. I have had multiple microneedling facials that have had minimal results and I am looking for a better outcome. I have had a consultation with a dermatologist who recommended Fraxel laser treatment but looking to see if there any additional suggestions. Thank you for your time!

Anil R. Shah, MD · Answer

Acne scars can be really stubborn, especially boxcar scarring - but the good news is there are some amazing treatments out there that can make a big difference in both the texture and overall appearance of your skin. The Fraxel laser is a great option. This type of laser helps smooth out scarring, even out skin tone and boost collagen production.

Other lasers such as CO2 (an ablative laser for smoothing skin texture) and Pico4 (to even skin tone) is a great pairing together. Other options include chemical peels and/or TCA Cross - helps with discoloration and shallow scars. Fillers such as subcision can lift and smooth the skin.

At our practice, we also always recommend a good home routine with things like retinoids, vitamin C, and of course, daily SPF to protect your results and prevent further pigmentation.

Nick Slenkovich, MD · Answer

Hello! I’m Lauren, the aesthetic provider here at Colorado Plastic Surgery Center.  If microneedling hasn’t given you the results you want, CO2 laser is definitely worth considering. It’s one of the most effective treatments for acne scarring because it goes deeper than microneedling, removing damaged skin and stimulating strong collagen production. It can help smooth out deeper scars and improve overall texture. Downtime is a bit longer, but many people see noticeable improvement after just one session.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Amelia Damse, DO · Answer

The best treatments for acne scarring are using lasers. In your case I would recommend a fully ablative laser to pare down the skin a little, almost like sanding down the elevated portions, combined with fractionated laser to stimulate collagen production where the scars are indented. Usually a series of 2-3 treatments are needed, but you will see improvement with each treatment.

Justin Buro, MD · Answer

Hello and thank you for your question. This is a very common question given how prevalent severe childhood and adult acne. Both fractional CO₂ laser (i.e. Fraxel) and fractional Erbium (i.e. Halo) resurfacing can improve acne scars, but they differ quite a bit in terms of strength and results. Fraxel is a non-ablative fractional laser, meaning it works more gently, requires little downtime, and typically needs a series of treatments to see noticeable change. It’s a good option for patients with milder scars or those who can’t afford a long recovery. 
On the other hand, a full ablative CO₂ or Erbium laser is considered the gold standard for more significant acne scarring. It penetrates deeper into the skin, stimulates stronger collagen remodeling, and usually achieves more dramatic results in fewer treatments. The trade-off is longer downtime and a bit more aftercare, but for many patients with boxcar, rolling, or mixed scars, it’s the most effective choice. 
Regardless of which laser is used, pairing treatment with a high-quality skincare routine (such as retinoids, pigment control products, and daily sun protection) will enhance healing and help maintain long-term results. 
In my experience, if your goal is the most meaningful improvement in acne scarring, a full-face ablation laser offers the best outcome, while fractionated options are a reasonable option for those seeking a gentler approach with less recovery time, just know that repeated treatments will be required. I hope that answers your question. 
Best, Justin Buro, M.D.

Glenn Murray, MBBS · Answer

Hi, 
Fraxel and C02 ablative would definitely be most recommended. You could also try Morpheus 8 resurfacing (at least 3 treatments 6 weeks apart).

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