What would be the best treatment/ approach to these type of acne scars ? (Photo)

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

Just today, I had two other Realself followers ask precisely the same question. The following was my response:
"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. "