Any Hope for Severe Acne Scars? (photo)

From my research I've learned that acne scars are difficult to treat, is there anything that can improve this type of scarring?. I have ice picks, rolling, and box scars. thanks.

Doctor Answers 9

Treating Severe Acne Scars

Your acne scars can definitely be improved.  I hate to blatantly disagree with another physician, but lasers are a waste of your time and money.  You have many broad-based, depressed scars which will do beautifully with injectable filler. In our practice we use liquid injectable silicone for these acne scars as it is very precise and permanent, giving you the opportunity to have long-lasting results.  The scars that are more pitted or ice-pick in nature need to be treated with different techniques such as electrosurgery and/or punch excision. Click on the link below to view before and after photos of some of our acne scar patients. 

New York Dermatologist
4.1 out of 5 stars 8 reviews

Yes, acne scars can ALWAYS be improved.

You do exhibit a variety of scar types including atrophic, tethered, rolling and ice pick scars. A few things to remember- scars can be improved, but not totally fixed. Namely a combination of treatments will improve things, but you may still be able to see the odd scar. 

1. Always treat the scar type. Ice pick= TCA CROSS or punch excision

2. You will benefit from subscision to treat teathered scars and anchored scars. These are visible if you smile or grin, and your skin puckers. Several treatments are needed

3. Fractional CO2 is probably best. Once again several treatments. 

4. Dermal fillers- I would layer your filler, depending on your age, and how you respond to laser. You will probably need say Volbella or Voluma for the deeper atrophic scars. 

This combination will make a significant difference, though scars will still be visible. 

You are indeed correct, you do have difficult scars to treat, but still treatable. 

All the best in your quest. 

Dr Davin Lim
Cosmetic and Laser Dermatologist

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 75 reviews

Any hope for severe acne scars

Yes.  Of course there is hope.  I agree with Dr. Barnett that subcision with filler and punch excisions are extremely important here.  I do think facial resurfacing has a role here, but not by itself.  Unfortunately, most doctors want to introduce a desperate patient like yourself immediately to their favorite laser as this is the most expensive treatment option.  I think you find a doctor who will use a multimodality approach and who will work with you to achieve the best results.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 131 reviews

Severe Acne Scars - respond to a combination of treatments.


A combination of treatments - subcision/ Lasers/ TCA CROSS/ punch excision - would be your option. You would also require these treatments to be repeated once every 3-6 months, depending on your response. Fillers would also be required to replace the cheek volume lost due to the scarring process.

Good luck!

Renita (Lourdhurajan) Rajan, MD, DNB
India Dermatologist
4.9 out of 5 stars 16 reviews

Hope for Severe Scarring?

Leon, as you see from the varied opinions already expressed, there are different approaches to your problem. You absolutely can achieve significant improvement but it is going to take a combination of procedures over 2 years or so. I hope that you can be patient. From the photos, it appears that you have a combination of multiple scar types. Many of them are "box-car type" - sharply demarcated and relatively shallow. These respond to CO2 laser resurfacing but you will need more than one treatment. A reasonable number of ice pick scars could be punch excised prior to CO2 laser. If you can stretch your skin and make the rolling-type scars go away, then deep fillers such as Sculptra will help. Also effective would be a skin only face lift to put tension on the scars to smooth them. I believe that you actually have fat atrophy related to the severity of your acne and the Sculptra would work for this also. Don't give up. Just be patient and be clear about what each of the procedures has to offer.

William M. Ramsdell, MD
Austin Dermatologic Surgeon
4.7 out of 5 stars 3 reviews

Severe acne scars treatment

No one has mentioned Scuptra.  From the photos, it looks like the cheek is hollowed out due to scarring.  I would treat both from the inside and out.  Sculptra to restore the natural contour of the face and help build collagen formation, Fraxel or other laser to help with the scarring and collagen formation, and probably some hyaluronic acid fillers.  It will be a multifactorial approach over a year or so of multiple treatments, but I think the results would be great. 

Rebecca Baxt, MD
Paramus Dermatologic Surgeon
4.8 out of 5 stars 27 reviews

Acne Scarring

If you were my patient, I would make sure that you would be happy with significant improvement.  This type of scarring will never be completely improve.  Getting rid of the scars may mean having hypo pigmented (very light) skin after a laser treatment.  CO2 lasers are the gold standard here, but also have the highest risk of scarring and causing hypo pigmentation.  I have used fillers such as Restylane and Juvederm to improve the scarring, but this has to be maintained.  Most patients do well with yearly touch-up.  My suggestion is to stick with a board-certified dermatologist in your area for the best results.  


Jay S. Gottlieb, DO
Fort Lauderdale Dermatologist
5.0 out of 5 stars 5 reviews


Hello, Acne scars are hard to treat but not impossible. There's lasers that can help, Profractional,micro laser peels. You can do one treatment or a combination of lasers for the best results. You should see a plastic surgeon so you can get ask about your options.

Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon
3.3 out of 5 stars 9 reviews

Acne Severe Scarring any hope

Of course there is hope. I would consider volumizing and then also some resurfacing. Acne scarring is challenging but it can totally be improved. You could benefit from a combination of TCA CROSS, fillers, fat injections, and resurfacing. There is a progression that I like to do in terms of treatment.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.