Acne Scarring:

Scar Treatment Options

Treatment is matched to scar type — a technique that works well for a rolling scar may do little for an icepick scar. Most patients get the best results from a combination of treatments across more than one visit, once their active acne is controlled. (Treating scars while acne is still active risks creating new scars in the process.)

Microneedling (Collagen Induction & remodeling Therapy)

A medical grade device passes fine needles into the skin, creating controlled micro-injuries too small to see individually. This triggers the body’s wound-healing response, stimulating new collagen and elastin production over the following weeks. Needle depth is typically adjusted between about 0.5mm and 3.0mm depending on the scar and treatment area.

• Best for: rolling and shallow boxcar scars; broad, diffuse scarring across a wide area

• What to expect: a course of multiple sessions (commonly 3–6), spaced several weeks apart, with gradual rather than immediate improvement

• Recovery: redness and mild swelling for a few days; minimal true downtime

• Often combined with topical treatments or platelet-rich plasma (PRP) applied immediately after treatment to enhance results

Medical grade devices should only be used by properly trained individuals; as self-performing at home or by untrained spa employees risks further skin damage, pigmentation, infection, and worsening scarring.

Subcision

A needle or blunt cannula is inserted under the skin, parallel to the surface, and moved in a fanning motion beneath the scar to mechanically break the fibrous bands tethering it to deeper tissue. Once released, the scar lifts — partly immediately, and partly over the following weeks as new connective tissue forms in the space created.

• Best for: rolling scars specifically — the tethering they depend on is exactly what subcision releases; a simple “pinch test” (does the scar smooth out when the skin is stretched?) helps predict who will respond well

• What to expect: performed under local anesthesia in-office; often combined with filler or additional collagen-stimulating treatments in the same session

• Recovery: bruising, swelling, and firmness under the skin are expected for 1–2 weeks as part of normal healing

• Not the right primary treatment for icepick scars (too narrow and deep for the tethering mechanism subcision addresses) or for raised hypertrophic/keloid scars

Dermal Fillers

Injectable fillers add volume directly beneath an atrophic scar, physically elevating the

depression to meet the level of surrounding skin.

• Hyaluronic acid fillers (e.g., Juvéderm, Restylane) give an immediate result but are temporary, typically lasting months to around a year, and are used off-label for this purpose

• Poly-L-lactic acid (Sculptra) works more gradually, stimulating the body’s own collagen production over time, with effects that can last up to about two years

• Calcium hydroxylapatite, CaHA (Radiesse) — used as hyperdilute it provides immediate volume plus a longer-lasting effect by stimulating the body’s own collagen production over time. Particularly useful after subcision to provide structural and biostimulatory support.

• Best for: rolling and shallow boxcar scars, especially in patients who want a quick, low-downtime result

• Often used alongside subcision, since releasing the tethering first gives the filler a better result

Phenol CROSS

CROSS stands for Chemical Reconstruction Of Skin Scars — a technique where a high-concentration chemical agent is applied with a fine, pointed applicator directly and only to the base of an individual scar (not the surrounding skin), causing controlled, localized tissue destruction that triggers fresh collagen remodeling as it heals. While the original CROSS technique used high-concentration trichloroacetic acid (TCA), phenol — typically 88% phenol (carbolic acid), or a 60% phenol/0.2% croton oil combination — is a well-studied alternative that penetrates the scar tissue more deeply, which can mean fewer sessions to reach a comparable result and makes it particularly suited to deep, stubborn icepick scars.

• Best for: icepick and narrow boxcar scars specifically — the pinpoint application is what makes it effective for these narrow, deep defects, and a poor fit for broad rolling scars

• Important safety distinction: this is not the same as a traditional full-face phenol peel, which carries a known risk of cardiac arrhythmia from systemic absorption over a large treated surface area and requires cardiac monitoring. Phenol CROSS treats only the tiny surface area of each individual scar, which is why it doesn’t carry that same systemic risk profile in the hands of an experienced provider — but it is a technique-sensitive procedure that should only be performed by a physician trained in it.

• What to expect: typically several sessions spaced weeks to months apart; often combined with microneedling and/or subcision as part of one overall scar-revision plan

• Recovery and risks: temporary scabbing/frosting at each treated spot as it heals; risk of temporary or, less commonly, permanent lightening of the treated skin(hypopigmentation), which is a more significant consideration for deeper skin tones — your dermatologist will factor your skin type into the treatment plan and technique

Other options we may discuss

Fractional laser resurfacing, dermabrasion, punch excision, and punch elevation are additional tools sometimes used for specific scar patterns, particularly as part of a combination plan. We’ll walk through which combination fits your scarring at your consultation rather than applying one technique to every scar type.