Acne scarring responds best when treatment is matched to the specific type of scar present, since atrophic (depressed) scars, hypertrophic (raised) scars, and post-inflammatory discoloration all have different underlying structures and respond to genuinely different tools — which is why a single universal "acne scar treatment" rarely delivers the best possible result on its own.
What are the different types of acne scars?
Most acne scarring falls into a few categories: rolling scars, which create a wave-like unevenness from bands of tissue pulling the skin down; boxcar scars, with sharper, defined edges and a broader depressed area; ice pick scars, narrow and deep; hypertrophic or keloid scars, raised rather than depressed; and post-inflammatory hyperpigmentation or erythema, which isn't true scarring but residual discoloration that can look similar at a glance.
Treatments for depressed (atrophic) scarring
- Microneedling, which stimulates new collagen production to gradually fill in shallow to moderate depressed scarring.
- Subcision, which releases the fibrous bands tethering rolling scars to deeper tissue, often combined with filler or your body's own collagen response to support the released area.
- Fractional laser resurfacing, particularly effective for boxcar and shallow ice pick scarring, remodeling the skin's surface and stimulating deeper collagen production.
- Dermal filler, for more immediate, though temporary, improvement in the appearance of depressed scars.
- TCA cross technique, a targeted, higher-concentration acid treatment specifically for deep ice pick scars.
Treatments for raised (hypertrophic) scarring
Raised scarring is generally addressed differently than depressed scarring, often involving corticosteroid injections to flatten and soften the tissue, laser treatment to reduce redness and thickness, or, in some cases, silicone-based topical treatments to support gradual flattening over time.
Treatments for post-inflammatory discoloration
Discoloration left behind after acne heals, whether pink, red, or brown, generally responds to different tools than true textural scarring: vascular laser treatment for residual redness, and pigment-focused treatments like chemical peels, topical brightening agents, or BBL for brown post-inflammatory marks. It's important to distinguish this from true scarring, since treating discoloration as if it were textural scarring wastes time and doesn't address the real issue.
Why combination treatment often works best?
Most patients have more than one type of scarring present at once, which is why the most effective plans often combine several approaches — for example, subcision paired with microneedling and laser resurfacing over a series of sessions, rather than relying on a single treatment to address every type of scar simultaneously.
How do you set a realistic treatment timeline?
Acne scar treatment is almost always a gradual, multi-session process, with visible improvement building over months as collagen remodels and skin texture changes. Significant, meaningful improvement is realistic for most patients, though complete elimination of all scarring isn't always achievable, particularly for deeper or more established scars.
How do you build your plan?
An accurate assessment of your specific scar types is the essential first step to an effective plan. A consultation lets us map out exactly what you're dealing with and build a combination approach suited to it.