What type of treatment should I look for to improve my acne scars? (photos)

Question

Is it possible to get rid of them completely and how long would that take?

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. Karamanoukian
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

Based on your photos, your scars appear to be predominantly atrophic (depressed) acne scars, which are among the most common types of acne scarring. The good news is that these scars can often be improved significantly, but it's important to set realistic expectations: complete removal is uncommon, even with the best treatments. Most patients can achieve a meaningful improvement in skin texture and appearance, often in the range of 50–90%, depending on the type and severity of the scars.

The best treatment depends on the specific scar pattern. Many people have a combination of:

Ice pick scars (narrow and deep)
Boxcar scars (wider with defined edges)
Rolling scars (soft, wave-like depressions)

Because different scars respond to different treatments, the most effective approach is usually a combination of procedures rather than relying on a single treatment.

Some of the most effective options include:

Fractional laser resurfacing (CO₂ or Er:YAG): Excellent for improving overall skin texture and stimulating new collagen production.
Microneedling or radiofrequency microneedling: Helps remodel collagen gradually with less downtime and is particularly useful for mild to moderate scarring.
Subcision: Especially effective for rolling scars that are tethered beneath the skin. This procedure releases the fibrous bands pulling the scar downward.
TCA CROSS: Often the treatment of choice for deep ice pick scars.
Dermal fillers: Can provide immediate improvement for selected depressed scars, although the effect may be temporary depending on the filler used.

Treatment is a gradual process. Most patients require 3–6 treatment sessions, sometimes more for deeper scars, with procedures spaced several weeks apart. Visible improvement often begins after the first few sessions, but collagen remodeling continues for several months, so the final results develop over time.

If you still experience active acne, controlling new breakouts is equally important. Continuing to form new scars while treating existing ones can make it difficult to achieve the best outcome.

Overall, while no treatment can guarantee perfectly smooth skin, today's combination therapies can produce dramatic improvements that leave the skin looking smoother, healthier, and much less noticeable than before. Patience and a personalized treatment plan usually provide the best long-term results.

Chet Mays, MD · Answer

Thank you for your inquiry! Lasers such as Microneedling can be performed to minimize appearance of scars. We would love to see you in person or virtually to discuss treatment options or schedule a consult with a licensed aesthetician to make a plan for you!

Nelson Lee Novick, MD · Answer

At least from the photos provided, it would appear that you might profit from a Field Subcision to improve the generalized facial acne atrophy related to the loss of the collagen and elastic fibers. Individual subcisions can then be performed to elevate and smooth boxcar and rolling scars, and TCA CROSS may be used to improve ice pick scars and dilated pores. Finally, manual, professionally performed microneedling (no need for the added expense and risks of RF microneedling) to better blend in both texture and color, the aforementioned treated areas with the surrounding normal skin. I have personally been performing each of these procedures for more than twenty-five years in all skin types with gratifying results. 
In general about three or four treatment sessions on average are required to achieve a 60-80% overall improvement in appearance for all scars that are over twelve weeks old (so-called "mature" scars). 
No doubt you will be barraged with offers for all kinds of expensive "bells and whistles" fraxel laser and RF gizmo treatments. But, you should be aware that the hard science to support the use of these supposedly "next big thing" devices lags woefully behind the heavy marketing hype and social media buzz to promote them. As for the use of ablative lasers, these are much like old-style aggressive dermabrasion insofar as they go deep, have prolonged downtime, and run the risk of infection and scarring and an unnatural-looking glossy, orange peel appearance. So, buyer beware when considering these. Hope this helps and best of luck.

Jeff Rapaport, MD · Answer

Combination Therapy and Follow-Up
   - Combination therapy involving TCA-CROSS, PRP, microneedle radiofrequency, subscision and fractionated CO2 laser can maximize outcomes for your acne scar treatment.
   - Regular follow-up visits are crucial to monitor progress, adjust treatment as needed, and optimize long-term results.
   - Patient compliance with post-treatment care instructions and maintenance treatments, such as occasional fractional CO2 laser sessions, subscision or microneedling, can help sustain improvements in acne scars over time.

This comprehensive treatment plan addresses various types of acne scars and utilizes a combination of advanced techniques to attempt to achieve improvement in skin texture, contour and appearance. However, the specific approach may vary based on individual patient factors and perfection is not possible . Find a scar expert.
Jeff Rapaport MD FAAD 
Realself Hall of Fame
Castle Connolly Top Doctor

Laura A. Katz, MD · Answer

My first question would be are you having any current issues with acne or are these just old skin changes?  any breakouts now?  Successful treatment would depend on the stability of the skin.  If theses are old scars only, Morpheus8 radiofrequency treatment followed up by a radiofrequency resurfacing would be a great option that is office based and minimally invasive.  The average time for the treatment marks post treatment to resolve is anywhere from 24 to 48 hours.  Visible change can occur in as soon as a month.  Here are some helpful links.

What type of treatment should I look for to improve my acne scars? (photos)

Answers (6)

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