How can I get rid of this deep single acne scar between my eyebrows? (Photos)

Question

In spite of botox, I have a permanent pit scar between my eyebrows. What are my best options to get rid of it permanently? My budget is up to 3k. Things I have tried: 1. 5 rounds of microneedling (at dermatologist office) 2. botox I'm hoping for a permanent solution, not filler. Thank you so, so much.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Yes, I would recommend CO2 resurfacing laser to help reduce or even eliminate a deep acne scar between your eyebrows. This laser works by delivering precise, high-energy light to the skin’s surface, targeting the scar tissue and stimulating collagen production in the deeper layers of the skin. The treatment helps to resurface the skin, smoothing out the texture and improving the appearance of deep scars. CO2 lasers are particularly effective for more significant, stubborn scars like the one you have, as they penetrate deeply enough to promote healing and remodeling of the skin. While multiple sessions may be required for optimal results, CO2 resurfacing can significantly improve the look of acne scars, leaving you with smoother, more even skin.

Nelson Lee Novick, MD · Answer

Sorry you have been having such disappointment with your prior treatments. However, I am hardly surprised. Botox treats problems related to movement of the muscles of facial expression. So, while its use might help to diminish the muscular movement of the glabella (which can temporarily make the scar look worse when the muscle is contracted), it really does little to actually treat the scar. 
Likewise, microneedling, which I have been performing for twenty-five years, is best reserved for blending the superficial surface color and texture of a scar with the surrounding normal skin, but typically does little for addressing the depth of the scar. 
TCA CROSS, which I have been performing for a quarter of a century, has a proven track record of safety and efficacy for permanently treating ice pick scars and dilated pores. The place of Botox within the context of the proper TCA treatment would be to temporarily calm muscular movement in this area in order to allow optimal improvement from the TCA CROSS treatment. Total treatment time should be about fifteen minutes and well, well within your budget.
You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist acne scar and injector expert.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concern — scars in the glabella (between the eyebrows) can be especially frustrating because the area moves a lot and tends to develop deeper textural changes over time.

Given that you've already tried microneedling and Botox, it makes sense to explore more targeted treatments that can address a deep, permanent pit scar.

Here are the options that tend to work best for this specific type of scar:

1. Subcision

If the scar is tethered (meaning it’s being pulled down by fibrous bands), subcision can release those bands and allow the skin to lift.
This is often one of the most effective first steps for deep, isolated scars.

2. Fractional Laser Resurfacing (CO₂ or Erbium)

A high-precision resurfacing laser can help smooth the texture and stimulate deep collagen remodeling.
For a single deep scar, one to two sessions can make a meaningful difference.

3. Chemical Reconstruction (TCA CROSS)

For sharply edged, deep, narrow scars, TCA CROSS can help build collagen right at the base of the scar.
It’s inexpensive compared to laser and works well even for stubborn depressions.

4. Punch Techniques (Punch Excision or Punch Elevation)

If the scar is very deep and well-circumscribed, a punch excision or elevation can physically remove or lift the scar.
This is one of the most definitive options and often provides a “permanent” improvement.

Budget Considerations

With a budget up to $3k, you have room to combine treatments — which is often the most effective approach.
For example: subcision + laser or TCA CROSS + fractional resurfacing.

A realistic expectation

Completely erasing a deep scar can be difficult, but with the right combination of procedures, most patients see a very noticeable and long-lasting improvement.

I hope this gives you a clear and hopeful roadmap — you’ve already tried the basics, and there are still excellent options available for deeper correction.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

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