Acne scar treatment encompasses a set of specific techniques, often combined, to improve the appearance of acne-damaged skin and restore a smoother, more even texture. Acne scars form when deep acne inflammation destroys collagen and dermal structures, leaving depressions, irregularities, or excess scar tissue. A multimodal, personalized approach offers the best results, simultaneously addressing different aspects of scar damage.
There are several techniques for acne scar treatment, selected based on scar type: • Fractional CO2 laser: the gold standard for acne scars, stimulating deep skin renewal and massive new collagen production through thousands of thermal micro-columns • Subcision: a surgical technique that releases deep fibrous adhesions anchoring the scar to underlying tissue, allowing the skin to rise and level out • Microneedling (also with radiofrequency): creates controlled micro-perforations that stimulate collagen and elastin production, progressively improving texture • Hyaluronic acid fillers: direct filling of deep atrophic scars (rolling and boxcar) for an immediate volumizing effect • Medium and deep chemical peels (TCA): renewal of superficial layers and stimulation of dermal remodeling
• Atrophic "boxcar" scars: sharp-edged depressions with a flat base, among the most common and treatment-responsive • "Icepick" scars: narrow and deep like needle punctures, the most difficult to treat and often requiring subcision or direct excision • "Rolling" scars: wide depressions with blurred edges giving the skin an undulating appearance, responsive to subcision and fillers • Post-acne hypertrophic scars, raised and reddened, treatable with laser, injections, and pressure therapy • Diffuse skin texture irregularities and post-acne enlarged pores giving the skin a rough appearance
• Untreated active acne: stabilizing acne before addressing scars is essential, otherwise new inflammatory lesions can generate additional scars, negating the treatment • Ongoing isotretinoin therapy or completed less than 6-12 months ago, as the medication alters the skin's regenerative capacity, increasing the risk of abnormal scarring • Active skin infections such as herpes or dermatitis in the treatment area • Pregnancy and breastfeeding, as a precautionary principle regarding procedure safety
Individual treatments last 30 minutes to 1 hour depending on the technique used and the extent of the area being treated. Fractional CO2 laser takes approximately 30-45 minutes for the full face, subcision 20-30 minutes, microneedling 30-45 minutes. Multiple sessions spaced 4-8 weeks apart are generally needed to allow complete healing and new collagen production between treatments. Recovery varies from a few hours (microneedling) to 7-10 days (high-intensity CO2 laser).
The type of anesthesia varies by technique. For microneedling and superficial peels, a topical anesthetic cream applied 30-45 minutes before is sufficient. For medium to high-intensity fractional CO2 laser, a stronger anesthetic cream or nerve block anesthesia is needed to ensure comfort throughout the procedure. Subcision requires infiltrative local anesthesia in the treatment area. For extensive combined treatments in a single session, light sedation may be offered.
Results are progressive and cumulative: each session contributes to improving skin texture. First visible improvements are noticed 4-6 weeks after the first session, when new collagen begins to form. Optimal results are achieved 3-6 months after completing the entire treatment cycle, when neocollagenesis and dermal remodeling reach their peak. For deeper scars, improvement continues progressively up to 12 months. Most patients achieve a 50-70% improvement in scar appearance.
The number of sessions depends on scar severity, predominant type, and technique used. For mild to moderate scars, a cycle of 3-4 sessions of fractional laser or microneedling may be sufficient. For severe scars, 5-6 sessions combining different techniques (subcision + laser, filler + microneedling) may be necessary. Sessions are spaced 4-8 weeks apart. After the initial cycle, annual maintenance sessions can be scheduled. The treatment plan is personalized after careful evaluation of scar type and depth.
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