Acne Scars: Types and Treatment Options

What are acne scars?

Acne scars are permanent structural changes left in the skin after active acne has healed. The most common are sunken (atrophic) scars; less frequently, raised hypertrophic or keloid scars may develop.

Not every discoloration seen after acne is a true "scar." While red or brown spots may improve over time, true scars involve changes in the skin's structure.

Briefly, what you need to know

Acne scars are not all the same.

Ice pick, boxcar, and rolling injuries are not treated the same way.

No single laser or single treatment can correct all scars equally.

Most patients require combination therapy.

First, it's important to get active acne under control.

The goal is not to promise "zero traces," but to significantly reduce the visibility of traces.

Are acne scars and acne marks the same thing?

No.

Post-acne scarring: There is red or brown discoloration of the skin, but the skin's surface structure is largely preserved.

Acne scar: A depression, raised area, or structural irregularity in the skin.

This distinction is important because the treatment of a blemish differs from the treatment of a scar.

What are the different types of acne scars?

Ice-pick tracks

These are narrow-open, deep scars that appear as if they were punctured with a needle.

For these types of scars, superficial resurfacing alone is often insufficient. More targeted methods such as trichloroacetic acid (TCA) CROSS or punch techniques may be considered.

Boxcar tracks

These are depressions with a wider base and distinct edges.

Different techniques may be required depending on the depth. Resurfacing, punch techniques, or combined approaches can be used.

Rolling tracks

The fibrotic bands located under the skin pull the surface downwards, creating a more wavy appearance.

Subcision is a particularly important treatment option for this type of scar. Current reviews support the fact that subcision is effective and generally safe in rolling/atrophic scars.

How to choose the right acne scar treatment?

The practical approach to treating acne scars is as follows:

First, identify the type of damage → then choose the treatment appropriate for that damage mechanism.

The main factors affecting treatment are:

track type,

depth,

number of tracks,

skin color/phototype,

presence or absence of active acne,

previous treatments,

expected recovery time,

Risk of post-inflammatory hyperpigmentation.

Which treatments are available?

Subcision

It specifically aims to release fibrotic bands under the skin, particularly in rolling scars.

It can be performed with a needle or cannula. Complications such as bruising, pain, tenderness, nodules, and pigment changes may occur; technique choice and anatomy are important.

Microneedling

This is one of the methods aimed at stimulating collagen regeneration in atrophic acne scars.

Systematic reviews of randomized trials support the idea that microneedling may be effective alone or in combination therapies. However, standardization regarding which combination is best is still limited.

Chemical peeling / TCA CROSS

Chemical peels are suitable for superficial or medium-depth scars; TCA CROSS, on the other hand, is particularly suitable for narrow and deep ice-pick scars.

Meta-analyses from 2026 did not show a clear, absolute superiority between microneedling and chemical peeling; the choice should be made according to the type of scar.

Fractional lasers

“"Fractional laser" is not a type of laser in itself; it is a form of fractional distribution of energy.

In atrophic acne scars, different systems can be used, including both ablative fractional CO₂/Er:YAG and non-ablative fractional Er:Glass.

Meta-analyses from 2024 and 2025 show that CO₂, Er:YAG, and Er:Glass systems may be effective, but their efficacy, pain, erythema, and healing time profiles differ. It is not accurate to define a single laser as the “best” for everyone.

Filling

In some large and sunken scars, fillers can be used to provide volume.

However, this is not suitable for every atrophic scar and is often combined with other techniques.

Platelet-rich plasma (PRP) and other辅助 methods

PRP has been particularly investigated in combination with other treatments. While some meta-analyses suggest that combinations may provide additional benefits, study quality and protocols are heterogeneous; therefore, we will not present PRP as the "main treatment for acne scarring".

Why is combination therapy necessary for acne scars?

Because even at the same percentage, at the same time:

ice-pick,

boxcar,

rolling

The traces can be found together.

A procedure might work very well for one type of scarring but be ineffective for another.

Therefore, current literature also supports the idea that a multimodal/combined approach is reasonable for most patients.

Can it be resolved in a single session?

Usually not.

The number of treatments varies depending on the type and depth of the scars, and the method used.

Because:

“"It will be completely finished in 3 sessions."”

In acne scar treatment, there is no guarantee of complete disappearance or full elimination.

Will acne scars disappear completely?

The realistic goal is often not to completely erase the trace, but to significantly reduce its visibility.

The healing rate varies from person to person, and multiple procedures may be required, especially for deep ice-pick or large fibrotic rolling scars.

Is it possible to treat scars while active acne is present?

The priority is often to get active acne under control.

Treating only old scars while new inflammatory lesions persist will not prevent new scarring.

Therefore, active disease and existing scars should be evaluated together.

Is the treatment different for people with dark skin?

Yes, parameter and method selection should be done more carefully, especially in energy-based or chemical treatments, due to the risk of post-inflammatory hyperpigmentation.

More aggressive treatment doesn't always mean better results.

Frequently Asked Questions

Can acne scars disappear with creams? True atrophic scars won't completely disappear with cream alone. Topical products may help with discoloration or overall skin quality, but structural depressions may require procedural treatments.

Is microneedling or laser better? There is no single answer. The choice depends on the type of scar, skin type, and expected healing time.

Is subcision performed on everyone? No. It is particularly meaningful in cases of fibrotic rolling scars.

Which scars is TCA CROSS used for? It can be particularly useful for narrow and deep ice-pick scars.

Will acne scars reappear? Treated old scars will not reappear as "acne scars"; however, new scars may develop if active acne continues.