Acne Scarring
Library / Skin Conditions / Acne Scarring
Skin Health Library · Conditions
Acne Scarring
Different scars need different tools — the art is matching the treatment to the scar.
Acne scars form when inflammation from breakouts damages the skin’s collagen — either destroying it (leaving a depression) or triggering excess (leaving a raised scar). Because not all acne scars are the same, no single treatment fixes all of them. The key to real improvement is identifying the scar type and matching the approach to it.
It’s also important to separate true scars from discoloration. The flat red or brown marks left after a pimple (post-inflammatory erythema or hyperpigmentation) are not scars at all and are treated very differently — often with skincare, time and sun protection rather than resurfacing.
Honest expectations matter: the goal is meaningful improvement, not erasure, and the best results usually come from a thoughtful combination of treatments over time.
Realistic by Design
The goal is meaningful improvement, not erasure — and usually it takes more than one tool.
Matching Treatment to Scar
Scar Type Drives the Plan
The single most important step is identifying the scar type — because each responds to different tools.
Acne scars, matched to treatment
A simplified orientation — your plan is individualized after assessment
Common scar types
- Ice pick — narrow, deep pits
- Boxcar — sharp, defined edges
- Rolling — undulating, wave-like
- Hypertrophic / keloid — raised
- Discoloration (PIE/PIH) — not true scars
Treatments often used
- Fractional laser resurfacing
- Subcision (for rolling/tethered)
- TCA CROSS (for ice pick)
- Microneedling / RF microneedling
- Skincare + sun protection (for discoloration)
Educational summary only; scar types often coexist and plans are individualized. Discoloration is treated differently from true scars.
The TypesUnderstanding Your Scars
Recognizing the type of scarring is the foundation of an effective plan:
Ice Pick
Narrow, deep pits that look like the skin was pierced; often need targeted techniques like TCA CROSS.
Boxcar
Round or oval depressions with sharp, defined edges; often respond to resurfacing and microneedling.
Rolling
Broad, undulating depressions caused by tethering beneath the skin; subcision is frequently key.
Hypertrophic & Keloid
Raised scars from excess collagen; treated differently and cautiously, especially in keloid-prone skin.
PIE (Red Marks)
Post-inflammatory erythema — flat red marks that are not scars and often fade with time and care.
PIH (Brown Marks)
Post-inflammatory hyperpigmentation — flat brown marks treated with skincare and sun protection, not resurfacing.
The OptionsHow Acne Scars Are Treated
Effective acne-scar treatment is rarely one-and-done. It usually layers techniques matched to your specific scars, performed in a planned sequence over time.
Laser resurfacing
Fractional laser resurfacing remodels collagen and refines the skin surface, improving boxcar and rolling scars and overall texture. Device choice matters for safety — see the erbium guide and fractional vs. fully ablative.
Subcision and TCA CROSS
Rolling scars tethered beneath the surface often need subcision to release them; deep ice-pick scars may respond to focal TCA CROSS. These address what a laser alone cannot.
Microneedling and skincare
Microneedling (with or without radiofrequency) stimulates collagen for texture and shallow scars, while a medical skincare plan supports results and addresses discoloration.
Why combination wins
Because scar types coexist, the strongest results usually come from combining approaches — and from treating active acne first, so new scars don’t form while old ones are being corrected.
Related reading
First Things First
Treat the active acne first — then correct the scars it left behind.
How We DecideEvidence-Based Practice
Aesthetic medicine changes rapidly, and novelty alone is not evidence. At Onassis Skin Health, treatment and skincare protocols are developed with reference to peer-reviewed medical literature and respected clinical guidance — then interpreted for the individual in front of us.
Research does not replace clinical judgment. It informs it.
Published evidence is read in the context of your anatomy, skin type, medical history, risk profile, lifestyle and desired outcome. Product and technique selection, dosing or placement, and pre- and post-care all follow from that combination of evidence and individualized assessment — not from what is simply popular or available for purchase.
When AppropriateA Combined Plan
Because scar types coexist, acne-scar treatment is often sequenced across complementary approaches:
+ Medical Skincare
A prescriptive regimen — including ZO Skin Health when appropriate — to treat the concern directly and support any in-office treatment.
+ In-Office Treatment
Laser or other procedures when they genuinely add value, matched to your skin and goals.
+ Photoprotection
Daily broad-spectrum sunscreen to protect results and prevent the concern from worsening.
Combinations are recommended only when each element contributes meaningfully to your goals. Sometimes the right plan is a single, well-chosen treatment — and sometimes it is choosing not to treat at all.
What to ExpectSetting Expectations
Candidacy and plan depend on your scar types, skin tone and whether acne is still active. Richer skin tones need careful device selection to avoid pigment changes, and keloid-prone skin calls for caution. Improvement is gradual and usually requires a series; we’ll give you an honest picture of what’s achievable for your scars before we begin.
QuestionsFrequently Asked
Can acne scars be completely removed?
Rarely erased entirely, but they can often be meaningfully improved — typically with a combination of treatments over time.
Are red or brown marks the same as scars?
No — those are discoloration (PIE/PIH), not true scars, and are treated with skincare, time and sun protection.
Which treatment is best?
It depends on your scar type; most plans combine approaches such as laser, subcision and microneedling.
How many sessions will I need?
Usually a series; the number depends on scar type and severity and is set after assessment.
Should I treat active acne first?
Yes — controlling active acne first prevents new scars from forming during treatment.
Consultation
Reserve Your Appointment
Begin with an assessment, not an obligation to treat. Book a consultation, or send a question below.
Have a question first?
Send it below and we'll get back to you. Your message reaches us tagged with the page you're on, so we can answer in context.
Prefer to call or email?
424.333.1212 · info@onassisskinhealth.com