Which treatment combination would minimize the appearance of my rolling, boxcar, ice pick and papular scars? (photos)

Thank you for sharing your concerns and photos. Acne scars are often complex because, as you mentioned, multiple scar types may coexist and require different treatment modalities. The key is often not just the procedure itself, but the right sequence, intensity, and number of sessions.

For ice pick scars, TCA CROSS remains one of the most effective methods, as it targets the depth and helps stimulate new collagen formation.
For rolling scars, subcision is beneficial, but results may be more pronounced when paired with platelet-rich plasma (PRP) or biostimulatory fillers such as poly-L-lactic acid (Sculptra) to prevent tethering and support healing.
For boxcar scars, fractional ablative lasers (like CO₂ or Er:YAG) or microneedling with radiofrequency can help refine the edges and texture over multiple sessions.
For papular scars, light electrocautery can be useful, though occasionally laser resurfacing or excision may be considered if they are prominent.

It is important to note that a combination approach—TCA CROSS + subcision with filler support + resurfacing (fractional laser or microneedling RF) in a staged manner—tends to yield the most improvement over time. Because scar remodeling is gradual, several sessions are usually required, and improvements are typically seen progressively rather than after just one or two treatments.

Patience and persistence are essential, but with the right tailored plan, meaningful results can be achieved.

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. 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 discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon