Late 20's, possible Ehlers Danlos. How can I remove acne scars? (Photos)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for sharing your photos and providing such detailed information. I completely understand how frustrating acne scars can be, especially when previous treatments like microneedling don’t give the results you hoped for.

Given your description — some scars heal thin and almost imperceptibly while others have a cigarette-paper texture, combined with very soft, velvety skin — it’s possible that your skin may have characteristics similar to Ehlers-Danlos, which can influence how your skin responds to trauma and treatments.

Here’s what to consider:

Chemical peels: These can improve surface texture but may be less effective for deeper scars, and in fragile or sensitive skin, there’s a slightly higher risk of prolonged redness or irritation.

Subcision (subdermal release): This is helpful for tethered scars, lifting them from underneath. In patients with very soft or fragile skin, care must be taken to minimize trauma and avoid excessive bruising.

Lasers: Fractional lasers or resurfacing lasers can be effective for both texture and pigmentation, but aggressive treatments may increase the risk of prolonged healing or irregularities if your skin is delicate.

Key takeaway: With your skin type, gentler, staged treatments tend to be safest and still effective. Often, a combination of subcision for deeper scars and mild resurfacing or laser for texture works best. Patience and careful monitoring are important to minimize risk and maximize results.

Your history suggests a need for personalized treatment planning to balance efficacy and safety, especially considering your skin’s potential fragility.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. CO2 laser resurfacing is one of the most effective treatments available for atrophic acne scars, particularly when microneedling or chemical peels haven’t given the results you want. The laser works by creating microscopic columns of controlled injury in the skin, which stimulates collagen remodeling and smooths out the uneven texture caused by scars. Most people notice a visible improvement after a few sessions—often around 40–60% reduction in scar depth and texture irregularities—but it’s rarely a complete removal. Compared to microneedling, CO2 resurfacing penetrates deeper and triggers stronger collagen regeneration, which makes it a more aggressive but potentially more rewarding option. I hope this helps and best of luck!

Your description fits a pattern where targeted treatment of each pit works better than broad diffuse methods. Being in your late twenties is an advantage because collagen response is typically stronger.
How to define the plan• Classify each mark with standardized photos and a simple pinch test• Treat the pits first, then use a gentle field treatment to blend texture
Tools that are commonly considered• TCA CROSS for true icepick scars in selected patients• Small surgical refinement for a stubborn single boxcar if present• Subcision only when a pit lifts with the pinch test, which suggests tethering• Non ablative fractional laser or RF microneedling to smooth overall texture after focal work
Why microneedling alone felt underwhelming• It stimulates collagen in a diffuse way while pitted scars need focal reconstruction at the base of each pit
Note on possible Ehlers Danlos featuresEhlers Danlos describes inherited connective tissue differences that can make skin feel soft and more elastic, bruise easily and form thin papery scars. This is not a diagnosis and only a specialist can confirm it. If such features are present the plan is adjusted for safety and predictability• Start with test spots and use conservative settings• Space sessions longer and expect a slower collagen response• Emphasize careful aftercare and daily sun protection• Avoid large single session ablative resurfacing when a targeted staged approach can meet the goal
A tailored plan based on clear photos and your healing history helps choose the safest settings while aiming for steady natural improvement. If you would like a more specific opinion for your case a short complimentary conversation with a patient coordinator can help gather details before any medical evaluation.
Wishing you gentle progress and results that match your skin’s youthful potential.Güray Yeşiladalı, MD