What results can I expect from scar removal and which procedure would work best for me? (photo)

Thank you for your thoughtful questions. I understand how frustrating facial scars, especially from old acne lesions, can be, and it’s great that you’re exploring options.

1. What results can you expect from scar removal?
While it’s unlikely we can completely erase scars, significant improvement is often achievable. Depending on the type and depth of your scars, you can expect:

A smoother skin texture

Reduced discoloration or redness

Less visible indents or raised areas

A more even, refined overall complexion

Most patients see progressive improvements rather than a dramatic "overnight" transformation, especially with older scars.

2. Can you achieve excellent results with older scars?
Yes, older scars can still respond very well to treatment, though they may require more sessions. The key is selecting the right modality (or combination) tailored to your skin type and scar pattern—whether they’re rolling, boxcar, ice pick, or post-inflammatory hyperpigmentation. Even if your scar is several years old, collagen remodeling is still possible.

3. What method or treatment would be best?
This depends on your skin tone, scar type, and sensitivity, but some highly effective options include:

Microneedling with PRP: Stimulates collagen regeneration and improves texture over time.

Fractional Laser (e.g., Halo or CO₂ Resurfacing): Excellent for deeper or mixed-type scars.

Subcision: Releases tethered scars (especially rolling scars).

TCA CROSS: Works well for ice pick scars by stimulating collagen within the scar pit.

Chemical Peels: Improve superficial scars and pigmentation.

Topicals (Retinoids, Silicone gels, Vitamin C): Best for maintenance and prevention of new scarring.

A combination approach usually yields the best results. I’d be happy to assess your skin either in person or virtually to recommend a custom treatment plan that suits your needs and goals.

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your inquiry! Scar creams can be used on scars to minimize appearance as well as silicone scar sheets. Lasers such as Microneedling can also be performed to minimize appearance as well. We would love to see you in person or virtually to discuss treatment options or schedule a consult with a licensed aesthetician.

The ideal window of time for treating scars from any cause is between the end of week four (when the area is healed enough to withstand treatment) to the end of week twelve (after which the scar is defined as a "mature" scar). If treated during that eight week window there is a chance for very significant improvement in appearance. If treated afterward between a 60-80% improvement is the most that typically can be expected.
When it comes to surgical scar revisions, particularly in areas subject to muscular tension or movement, the there is a significant risk for the subsequent development of stretch scars and even tram track stitch marks.
Subcision, which requires no cutting on the surface of the skin may be used to elevate and smooth the scars and professionally performed manual microneedling (no need for the added expense and risks of RF microneedling) may be used to better blend any residual surface, superficial color and texture irregularities with the surrounding normal skin.
You would be wise to consult with a board certified cosmetic dermatologist scar specialist and be wary if hawked this or that supposedly "next big thing," expensive fraxel laser, RF or ultrasound devices, as the hard science to support the use of these gizmos lags well behind the heavy marketing hype and social media buzz to promote them. Hope this helps and best of luck.

I appreciate your concerns, however you must realize that scars cannot be completely erased, but can be camouflaged and improved so they are not obvious. In person examination would be needed, but it appears that your photo may demonstrate an acne scar amenable to scar revision, which would be excising the scar, and closing the wound carefully to minimize the new scar formation. This can be performed in the office under local anesthesia. Come see me or another board-certified plastic surgeon in our area to explore the best options for you.

That vertical scar is unlikely to have resulted from pimples. It is spread. Although it might be improved by scar revision, it cannot be eradicated entirely. There is no such thing as perfection in plastic surgery, as in life, only the potential for improvement. Best wishes.