Acne Scar Treatments Compared: Which Option Is Right for You

Which acne scar treatment is right for you depends mainly on “the type of scar.” No single method suits everyone. Shallow rolling scars often respond to Subcision or fractional laser; deep, narrow ice pick scars are often addressed with TCA Cross; and filler helps fill in depressed grooves. Doctors therefore usually assess and combine several methods to suit each person. Results vary by individual.

What Are Acne Scars and What Causes Them

Acne scars (atrophic acne scars) are depressed scars that form after acne inflammation, when the skin’s repair process produces collagen unevenly, causing that area of skin to sink into grooves or pits.

In general, acne scars result from inflammation that reaches deep into the dermis, damaging tissue and the collagen structure. When the body repairs the area but produces less collagen than before, or when fibrous bands pull the skin downward, the skin does not return to its original smoothness. Risk factors include severe inflammatory acne, squeezing and picking at acne, leaving inflammatory acne untreated for a long time, as well as genetics and individual skin characteristics.

An academic article in the journal of the American Academy of Dermatology explains that the mechanism behind acne scarring is linked to the immune system’s response and the breakdown of collagen in the skin layers, which is why prevention during the inflammatory acne stage matters. Understanding the cause also helps you set more reasonable expectations for treatment results, because scars that are older and deeper naturally require more time and more sessions.

How Many Types of Acne Scars Are There, and How Do They Differ

Atrophic (depressed) acne scars can be divided into three main types according to shape and depth, a classification widely used in dermatology. Knowing which type of scar you have is the starting point for choosing a suitable treatment.

• Ice pick — deep, narrow scars with a small opening that look like a hole punched straight down. They often reach into the dermis and are considered fairly challenging to treat, and they often respond poorly to fractional laser.
• Boxcar — scars with sharply defined edges, steep walls, and a flat base, with a cross-section resembling the letter U. They can be shallow or deep; the shallow type usually responds better to treatment than the deep type.
• Rolling — shallow scars with sloping edges that give the skin a wavy, undulating look. They are caused by fibrous bands beneath the skin that pull the surface downward, so they respond well to techniques that release those bands, such as Subcision.

In reality, one person usually has several types of scars mixed together on the face rather than just one. For this reason, doctors often do not rely on a single method but plan a combination of techniques to address each scar type in different areas. Assessment by sight and by physically touching the skin, performed by an experienced doctor, is therefore important, because photographs alone may not fully convey the depth and the nature of the fibrous bands beneath the skin.

How Does Each Acne Scar Treatment Work

Several acne scar treatments are in use today. Each works on a different principle and tends to work best on a different type of scar. Understanding these principles helps you see why a doctor chooses or combines each method.

Fractional laser works by delivering thermal energy into the skin in many tiny points, leaving normal tissue between the points, to stimulate new collagen production and help the skin repair itself faster. It suits rolling scars and shallow boxcar scars, while deep, narrow ice pick scars often respond poorly.

Subcision is a procedure that uses a needle or a specialized-tip cannula inserted beneath the skin to cut the fibrous bands that hold the scar down. Once the bands are released, the skin that was previously pulled down lifts up. It usually suits rolling scars. A review of clinical research in the Journal of Cosmetic Dermatology (2023) notes that Subcision often gives better results when used in combination with other methods.

TCA Cross uses high-concentration trichloroacetic acid (TCA) applied as a spot into each individual scar to stimulate localized collagen production. It is often used on ice pick scars and narrow boxcar scars that are too deep for laser or filler to reach. It generally needs to be repeated several times.

Filler helps fill in depressed scars so they look smoother right after the procedure. It suits certain rolling scars. The effect is temporary, depending on the type of material, and must be repeated periodically.

Microneedling RF (radiofrequency microneedling) uses tiny needles to deliver radiofrequency energy into the skin layers to stimulate collagen. Several studies published via NIH/PubMed used 3–4 sessions spaced about 3–4 weeks apart, and found that combining it with Subcision often produced higher satisfaction than doing it alone. That said, results vary by individual.

Which Method Suits Which Type of Scar

The simple principle is to “match the treatment to the type and depth of the scar.” In practice, however, doctors often combine several methods because most people have multiple scar types at once. The table below summarizes the overall picture so the differences are easier to see.

A key observation from the research is that treating acne scars “usually does not finish in a single session,” and using several methods together often gives more satisfying results than a single method. For example, a doctor might start with Subcision to release the fibrous bands, follow with laser or Microneedling RF to stimulate collagen, and use TCA Cross on specific ice pick scars. However, the sequencing and choice of methods should be under the assessment of an experienced doctor, because it must account for skin type, the risk of post-inflammatory hyperpigmentation (especially in darker skin), and each person’s expectations. Results vary by individual. You can see an overview of the approach at acne care programs.

How to Care for Your Skin After an Acne Scar Procedure

After an acne scar procedure, proper skin care affects recovery and helps reduce the risk of side effects. Every procedure that stimulates the skin needs time to heal and build new collagen.

In general, doctors usually advise avoiding strong sunlight and applying sunscreen consistently, because skin after a procedure is sensitive to light and more prone to dark marks. You should avoid picking or peeling off any scabs that form, keep the skin moisturized, and avoid irritating products such as strong exfoliating acids while the skin has not fully recovered, and strictly follow your doctor’s individualized advice. Information from the American Academy of Dermatology emphasizes that treating acne scars takes time before a change is visible and often requires more than one session, so you should set realistic expectations.

The thing to pay particular attention to is that if you notice anything abnormal, such as unusually severe redness and swelling, increasing pain, pus, or signs of infection, you should contact the clinic so the doctor can assess it promptly. You should not buy medication or use products on your own without consulting, because inappropriate care may affect the treatment outcome.

Roughly How Much Does Acne Scar Treatment Cost

The cost of acne scar treatment spans a very wide range because it depends on many factors, so no fixed figure can be given, and it should be assessed based on each person’s actual condition.

Factors that affect the price include the type and number of scars, the size of the area that needs treatment, the method or combination of methods the doctor chooses, the number of ongoing sessions required, and the type of devices and materials used, as different fillers, for example, have different prices. Because acne scar treatment usually requires several sessions and often combines multiple techniques, the total cost over a full course varies from person to person.

The appropriate approach is to come in for the doctor to assess the type and depth of your scars first, then plan and estimate the cost based on the actual plan, for accuracy and a close match to the problem. Ask for details and the latest prices via LINE @onnyxclinic. All costs depend on the doctor’s assessment and each individual’s skin condition.

Summary and Consulting a Doctor

Achieving satisfying acne scar results starts with understanding which type of scar you have, then choosing a method, or combining several methods, to suit your skin. No single method suits everyone, and results vary by individual. If you are concerned about acne scars and unsure where to start, you can come in for an experienced doctor at Onnyx Clinic to assess your skin and create an individualized plan. Message us with questions and to make an appointment via LINE @onnyxclinic.

References

• American Academy of Dermatology — Acne scars: Consultation and treatment
• American Academy of Dermatology — Acne scars: How to care for your skin after treatment
• Journal of the American Academy of Dermatology — Acne scarring—pathophysiology, diagnosis, prevention and education: Part I
• NIH / PubMed Central — Subcision for Atrophic Acne Scarring: A Comprehensive Review
• Journal of Cosmetic Dermatology (2023) — Subcision in acne scarring: A review of clinical trials
• NIH / PubMed Central — Efficacy and safety of microneedling radiofrequency in acne scars