How do I get rid of indented acne scars? (photos)

I am a 37 yrs old woman. I have acne scars from teenage acne. I have tried several treatments such as needling, subcision, chemical peels etc. However, these treatments were done several years ago with little to no difference. I did one Fraxel Restore session last year but had PIH that took a while to go. Are there any options to get rid of the indented scars?

Doctor Answers 5

Acne Scar Treatment without Laser

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Anyone with genetic tendencies toward hyperpigmentation is at risk for post inflammatory hyper pigmentation with laser or heat based treatments. It's difficult to have to trade one problem for another, so you have to be especially careful when treating anyone with skin that already has a lot of potential for pigment response.

(If you tan easily or have genetic backgrounds from grandparents or beyond, you're likely at risk.)

One type of fractional treatment uses radio frequency instead of laser - called eMatrix. The RF energy bypasses much of the melanin layer in the skin so the incidence of PIH is lessened.

Collagen stimulation is what helps the skin become smoother and the way to collagen production is through small "injuries" to the skin. Fraxel accomplishes the injury and the collagen stimulation but the heat from the laser affects the skin layers that contain melanin. With a number of sessions, you can get good results but as you experienced, the cost is pigmentation and often PIH lasts a long time.

Sometimes there is better suppression of pigmentation if the skin is pretreated and co-treated with melanin suppressing agents like hydroquinone. Talk to your dermatologist about a laser alternative like eMatrix and the possibility of using a topical agent to prevent post treatment discoloration.

Treating indented scars

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You would be looking at multi-modality treatments, meaning a few things would be required. Fractionated lasers (ablative) and microneedling/dermaroller can be quite helpful, some subcision, and possibly some deeper chemical peels. Stubborn scars should be excised. Best to speak with your dermatologist about your best treatment options. 

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

Acne Scars Respond To Multiple Therapies

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Before I discuss a possible treatment, I believe a few comments about the treatments you have already undergone are in order.

First it should be empasized that treatments, such as subbcision and medical microneedling, depend heavily for their success on promoting neocollagenesis, i.e. the stimulation of new, native collagen synthesis. As a result, successful treatment with either of these modalities typically require a SERIES of two to four treatment sessions spaced at four to six week intervals (an interval sufficient to allow for maximal new collagen production). It is rare to see any significant improvement after just one treatment session.

What this means is that successful treatment  or progress with these two types of treatments cannot be adequately assessed until a treatment area has undergone at least two or three treatment sessions. 

Superficial chemical peels--even a series of them-- are unlikely to have any significant effect, and deep chemical peels would be accompanied by a very substantial risk of leaving dyspigmentation--even permanent loss of pigmentation.

It's no surprise that the fraxel did little, since, in general, fraxels seem to be backed by a lot more device manufacturer backed marketing hype than hard science.

The Nonsurgical 3D Vectoring Facelift is something to consider that I have found especially helpful when a large portion of the cheeks is covered with acne scarring. The stretching, smoothing and contouring that results immediately provides stretching of the indented areas making them more light reflective.  For more information on this technique check out the archives of

Indented acne scar and best treatment

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Acne scars are best treated with a combination approach.  Some patients will need both fillers such as Restylane injected into the scars and lasers such as Fraxel or eMatrix for the overall texture and scars.  If you had significant PIH from Fraxel then I would suggest you consider the eMatrix.  It will take several treatments of the eMatrix but the radio frequency based laser can treat all skin types and is uniquely able to treat these types of acne scars.  For the best results please consult a board certified dermatologist who has a great deal of experience with these scars and treatment with lasers.

Acne Scar Treatment for Olive Skin

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For indented scars on patients with olive skin I like to recommend eMatrix with micro needling and PRP.

The Ematrix system uses Sublative RF- fractioned bi-polar radio frequency technology to effectively place heat energy into the dermis. This causes deep dermal impact with minimal down time. The reason I choose the Ematrix is because the RF technology is safe and effective for all skin types and has a very small possibility for hyperpigmentation.

Ematrix gives best results with a series of treatments usually 5 treatments at one month intervals. The addition of PRP injections and micro needling help expedite healing time and bring nutrients to the skin that will allow for rapid improvements in skin tone and texture, cell turn over and collagen stimulation.

I find the combination of Ematrix with micro needling and PRP gives my patients the most improvement. The combination of treatments done at the same time work synergistically to enhance the benefits you receive giving you more improvement than if you were to do each treatment individually.

Consult with a Board Certified Dermatologist to see what treatment is best for you and how many sessions you will need.

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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.