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 12

Treating Severe Acne Scars

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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. 

Boca Raton Dermatologist
4.1 out of 5 stars 8 reviews

Yes, acne scars can ALWAYS be improved.

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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

Any hope for severe acne scars

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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 140 reviews

Acne scars

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Yes, acne scars can be difficult to treat. The good news is that there are many different options available to help. Excision, laser skin resurfacing, dermabrasion, fillers, peels, and others can be helpful depending on the skin type and scar type. Many times, a combination of these is needed to achieve the best results.

A consultation with a physician specializing in facial aesthetics is recommended.

All the best,

Matthew Richardson, MD
Frisco Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews


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Dear leon,

Thank you for your question. 

Acne scars are common, but with advancement in technology, thankfully it is not something you have to live with.

Acne scars are the result of the breakdown of collagen and elastin in your dermis. They frequently occur at sites which were acne prone in the past, namely your temples, cheeks etc.

Acne scars are 3 dimensional, hence submitting a photo will not do justice to your scar. It requires real time examination (touch and animation), combined with lighting from various angles. That is why you may notice your scars differently in the bathroom mirror and in the dressing table mirror.

Dr Daniel Chang’s 3 STEP ACNE SCAR Treatment Formula: 

1- Control acne

2- Treatment – Fractional laser + skinboosters ( to promote collagen growth)

3- Maintainence with lasers ( to optimise collagen stimulation)

STEP 1: CONTROL YOUR ACNE. (Refer to this page on acne for more information)

Achieving good control of your acne is the important principle towards helping your acne prone skin. This prevents new scars from forming, which is a big step forward. Dont be too worried about your existing acne scars. Focus on prevention first.

STEP 2: Treatment based on scar type. Below are the 4 main types.of atrophic scars.

Ice pick scars =>    can be treated with TCA CROSS, Fractional and Microneedling

Rolling and box scars scars => are best treated with a combination of  RF Microneedling, PRP, fractional lasers and subcision

Hypertrophic scars can be treated with

  •  Microbotox
  • Intralesional steroid

Atrophic scars -> A combination approach is what I would recommend to improve the appearance of such scars.

  • Laser Resurfacing +/- RF microneedling 
  • Subcision
  • Dermal fillers – Skinboosters – Please refer to my Page on Skinboosters 
  • Intralesional saline – ( Latest evidence from Journal of Dermatology Sept 2016)

Fractional C02 used to be the industry gold standard for treatment of acne scars. Current studies point towards combination therapy, as I have outlined above. In addition, As collagen takes 3 months to grow, multicentre studies show one would require at least 4 sessions to see results. 1 session is unfortunately not enough.

New technology includes air dissection. Being a new treatment, I do not know of any randomised controlled trials regarding its safety and efficacy at present. Most studies are anecdotal. So time will tell.

As you rightfully pointed out, you have severe atrophic scars, so the combination approach above would help you.

I hope you find this helpful.

Daniel Chang, MBBS
Singapore Physician

Acne scars

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The deeper the scars, the more invasive the treatment to resurface the skin. You can start with deeper TCA or phenol peels at plastic surgeon or dermatologist office. If they remain then C02 laser or dermabrasion may be needed. You can use a thinner filler such as Volbella or juvederm for a large area. I would not recommend liquid silicone as it can cause problems hardening and granuloma reactions down the road.

Leslie G. Branch, MD
Winston Salem Physician

Severe Acne Scars - respond to a combination of treatments.

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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!

Hope for Severe Scarring?

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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

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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 29 reviews

Acne Scarring

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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

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.