Acne Scar Treatment
Acne Scar Treatment
Acne causes scarring in some patients and not in others. When it does, the marks it leaves are changes in the structure of the skin rather than changes in color alone, and they do not fade on their own the way a post-acne red or brown mark will. They are, however, treatable. The right treatment depends on which pattern of scarring you have, because ice-pick, boxcar, rolling and raised scars each respond to different procedures. Most patients have more than one pattern on the same face, which is why a planned combination of treatments given in a deliberate order gives better results than any single procedure used everywhere. At the Dermatology and Laser Centre in Danville, CA we have extensive experience in the treatment of scarring and can provide improvement for most cases. Dr. Gallacher assesses the scarring herself, decides which technology suits each part of it, and performs the laser treatments personally.
Acne leaves scars in some people and not in others. When it does, the marks are changes in the structure of the skin, not just changes in colour, so they do not fade away on their own the way a red or brown post acne mark does. They can be treated. Which treatment you need depends on the shape of the scars you have: narrow deep pits, wider dents with sharp edges, broad shallow dips, or raised lumps. Most people have more than one kind on the same face. That is why a planned combination of treatments, done in a sensible order, works better than pointing one machine at everything. At the Dermatology and Laser Centre in Danville, CA we have a lot of experience with scarring, and we can improve most cases. Dr. Gallacher looks at the scars herself, decides which technology suits each part of the problem, and does the laser treatments herself.
Acne Scars: the essentials
The short version
Ice-pick, boxcar, rolling and hypertrophic or raised. Boxcar scars are most often on the temples and cheeks. Raised scars are most often on the chest and back, and can occur on the face and neck.
Narrow deep pits, wider dents with sharp edges, broad shallow dips, and raised lumpy scars. The dents with sharp edges usually sit on the temples and cheeks. The raised ones are usually on the chest and back, and sometimes on the face and neck.
Fractional CO2 laser resurfacing, Fraxel FTX non-ablative fractional resurfacing, Erbium laser, RF microneedling, subcision, surgical removal of individual scars, dermal fillers, and VBeam or intralesional steroid for scars that are red or thickened.
Fractional CO2 laser resurfacing, Fraxel FTX resurfacing, Erbium laser, RF microneedling, releasing tethered scars with a needle, cutting out individual scars, fillers, and VBeam laser or an injection into the scar when scars are red or thickened.
Fraxel FTX and RF microneedling are each usually a series of five to six treatments, three to four weeks apart. Severe scarring may instead be treated with one or two CO2 resurfacing sessions about three months apart. Up to 15 to 20 ice-pick scars can be removed surgically in a single session.
Fraxel FTX and RF microneedling are each usually five to six treatments, three to four weeks apart. Bad scarring may instead be treated with one or two CO2 sessions, about three months apart. As many as 15 to 20 narrow deep pits can be cut out in one session.
Fillers and non-ablative laser require little or no downtime. Fraxel FTX typically causes sunburn-like redness and swelling for several days. RF microneedling downtime is minimal. CO2 resurfacing requires the most recovery.
Fillers and the gentler lasers need little or no time off. Fraxel FTX usually leaves redness and swelling like sunburn for several days. RF microneedling needs very little time off. CO2 resurfacing needs the most recovery.
Filler gives an immediate contour change. After surgical removal of ice-pick scars, patients notice marked improvement 4 to 6 weeks after the procedure. Laser and microneedling results build over weeks as collagen forms, with maximum change visible after several months.
Filler changes the shape straight away. After narrow deep pits are cut out, most people see a clear improvement 4 to 6 weeks later. Laser and microneedling build up over weeks as new collagen forms, and the biggest change shows after several months.
Dr. Gallacher takes into account the type and severity of your acne scars, your skin tone, whether acne is still active, and how much downtime you can take, in order to determine which technologies to use and in what order.
Dr. Gallacher takes into account the type and severity of your scars, your skin tone, whether your acne is still active, and how much time you can take off. From that she decides which technologies to use, and in what order.
What are acne scars?
What are acne scars?
Acne scars form when inflammation damages the skin and the healing process leaves either too little or too much collagen.
They form when inflammation damages the skin, and the healing leaves either too little of the skin’s supporting fibres, giving you a dent, or too much, giving you a raised lump.
Not every person with acne develops permanent scarring. Risk tends to increase with deeper inflammatory acne, delayed treatment, picking or squeezing, and individual healing tendencies. Active acne should usually be controlled before or alongside scar treatment so new scars are less likely to form.
Not everyone with acne ends up scarred. The risk goes up with deeper inflamed acne, with treatment that came too late, with picking and squeezing, and with how your own skin happens to heal. Active acne should usually be brought under control before, or alongside, scar treatment, so you are not making new ones while we treat the old.
Acne does not have to leave scars. Scarring is more likely with deep inflamed spots, with acne that went untreated for a long time, with picking and squeezing, and if your skin simply scars easily. It is also why the active acne has to be brought under control before and during scar treatment. There is no sense in resurfacing old scars while new ones are still forming. If your acne is still active, we treat it alongside the scarring, not afterwards.
Scarring is not an inevitable consequence of acne. It is more likely with deeper inflammatory lesions, with acne that goes untreated for a long time, with picking and squeezing, and with an individual tendency to scar. This is also why controlling active acne matters before and during scar treatment: there is little point in resurfacing scars while new ones are still being formed. If your acne is still active, we will treat that alongside the scarring rather than after it.
Which type of acne scar do I have?
Which kind do I have?
There are four types of acne scar, and the type decides the treatment. Most patients have a mixture, so most treatment plans use more than one procedure.
There are four types of acne scar, and the type decides the treatment. Most people have a mixture, so most plans use more than one procedure.
| Scar type | What it looks like, and how it is treated |
|---|---|
| Ice-pick | Deep, narrow pits, usually less than one tenth of an inch wide. In Dr. Gallacher's experience the only consistently successful treatment is surgical removal, usually followed by laser resurfacing. |
| Boxcar | Angular scars with sharp vertical edges, deep or shallow, usually found on the temples and cheeks. Shallow boxcar scars respond well to laser resurfacing. Deeper ones are best removed surgically. |
| Rolling | Damage beneath the surface of the skin produces shallow, wide undulations and a wave-like appearance. These are often the scars that are most noticeable in varying types of room lighting. Treated with subcision to release the tethering, often with filler and resurfacing alongside. |
| Hypertrophic and raised | Lumpy and raised, caused by excess collagen. They generally appear on the chest and back, but may occur on the face and neck. Treated differently from depressed scars: options include intralesional steroid and VBeam laser for redness. |
| Type of scar | What it looks like, and what is done about it |
|---|---|
| Narrow deep pits | Deep narrow pits, usually less than a tenth of an inch across. In Dr. Gallacher's experience the only treatment that reliably works is cutting them out, usually followed by laser resurfacing. |
| Sharp-edged dents | Dents with sharp straight edges, deep or shallow, usually on the temples and cheeks. The shallow ones respond well to laser resurfacing. The deeper ones are best cut out. |
| Broad shallow dips | Damage under the surface leaves broad shallow dips and a wave-like look. These are often the scars you notice most as the room lighting changes. Treated by releasing the tethering underneath with a needle, often with filler and resurfacing as well. |
| Raised lumpy scars | Lumpy and standing proud, from too much scar tissue. Usually on the chest and back, but they can appear on the face and neck. Treated quite differently from the dents. Options include an injection into the scar, and VBeam laser for the redness. |
Diagram showing ice-pick, boxcar, rolling and raised acne scar types
A diagram showing the four types of acne scar.
Ice-pick acne scars
Ice-pick scars: the narrow deep pits
Ice-pick scars are deep, narrow pits, usually less than one tenth of an inch wide. Because the scar extends well below the surface, resurfacing alone cannot reach the base of it. In Dr. Gallacher's experience there is really only one successful treatment for ice-pick scars: surgical removal. As many as 15 to 20 scars can be removed in a single session.
Most patients then benefit from skin resurfacing with one of several lasers, which removes surface layers of the skin and leaves it soft, smooth and unscarred. The laser treatment is usually performed 6 to 12 weeks after the surgical removal, so that the areas where the scars were removed have time to heal and improve maximally before they are resurfaced. Occasionally the order is reversed and the surgical excision is performed immediately after laser resurfacing. Patients notice a dramatic improvement 4 to 6 weeks after the procedure.
Dr. Gallacher performs both the surgical removal and the laser resurfacing herself.
Ice-pick scars are deep narrow pits, usually less than a tenth of an inch across. The scar goes a long way below the surface, so resurfacing on its own cannot reach the bottom of it. In Dr. Gallacher's experience there is really only one treatment that works for these: cutting them out. As many as 15 to 20 can be removed in one session.
Most people then benefit from laser resurfacing, which takes off the surface layers and leaves the skin soft, smooth and unscarred. The laser is usually done 6 to 12 weeks after the scars are cut out, so the treated spots have time to heal and settle first. Occasionally it is the other way round, and the scars are cut out immediately after the resurfacing. Most people see a dramatic improvement 4 to 6 weeks after the procedure.
Dr. Gallacher does both the surgery and the laser herself.
Rolling acne scars
Rolling scars: the broad shallow dips
Rolling scars are undulations that occur in acne prone skin. They are shallow and wide, and they give the skin a wave-like appearance. These are often the scars that are most noticeable in varying types of room lighting, which is why patients frequently describe them as looking worse in some rooms than in others.
They are tethered from beneath. Subcision is a procedure during which those tethered scars are gently released so that the surface can lift and the contour improves. Injection with soft tissue fillers such as Restylane or the RHA collection may provide temporary relief from rolling scars, and it is often best to use fillers in combination with other cosmetic procedures rather than on their own.
Rolling scars are broad shallow dips in acne prone skin. They give the skin a wave-like look. These are often the scars you notice most as the lighting in a room changes, which is why people say they look worse in some rooms than others.
They are held down from underneath. Subcision is a procedure that gently releases those tethers, so the surface can lift and the contour improves. Injecting a soft tissue filler such as Restylane or the RHA collection can give temporary relief, and fillers usually work best combined with other treatments rather than used on their own.
Boxcar acne scars
Boxcar scars: the sharp-edged dents
Boxcar scars are small, clearly defined indentations with sharp vertical edges. They occur all over the face, most notably on the temples and cheeks. Treatment of shallow boxcar scars can be accomplished with laser skin resurfacing. Deeper boxcar scars are best removed surgically, and the resurfacing is then used to smooth and tighten the treated area afterwards.
Boxcar scars are small, clearly outlined dents with sharp straight edges. They appear all over the face, mostly on the temples and cheeks. The shallow ones can be treated with laser resurfacing. The deeper ones are best cut out, and the laser is then used afterwards to smooth and tighten the area.
How are acne scars treated?
How are they treated?
Treatment is customized to the scar types present; combination therapy is often used when a patient has more than one scar pattern.
The plan is built round which types you actually have, and most people have more than one, so treatments are often combined.
- Fractional CO2 resurfacing can improve texture and depressed scars by creating controlled resurfacing and collagen remodeling; it generally involves more recovery than non-ablative options.
- Fraxel-type non-ablative fractional resurfacing can improve texture with less downtime, but a treatment series is usually needed.
- RF microneedling creates controlled micro-injuries and radiofrequency heating to stimulate collagen and can be useful for selected atrophic scars.
- Subcision releases fibrous bands beneath rolling scars so the surface can lift.
- Dermal filler may temporarily support selected depressed scars, especially after tethering has been addressed.
- Vascular laser or intralesional medication may be useful when scars are persistently red or raised.
- Fractional CO2 resurfacing improves texture and dents by resurfacing the skin and setting off rebuilding underneath. It needs more recovery than the gentler options.
- Fraxel type resurfacing improves texture with less time off, but needs a course of sessions.
- RF microneedling makes tiny controlled injuries and adds heat, to trigger rebuilding. Useful for certain dented scars.
- Releasing tethered scars from underneath: a needle is used to cut the strands holding a dip down, so the surface can lift.
- Filler can temporarily prop up certain dents, especially once anything tethering them has been released.
- A laser aimed at blood vessels, or an injection into the scar, when scars stay red or raised.
Fractional CO2 laser resurfacing
Fractional CO2 laser resurfacing
CO2 laser resurfacing is one of the most useful techniques in the treatment of acne scarring. With this procedure thin layers of skin are removed, layer after layer, until the scars improve or disappear. At the same time the skin tightens, which helps to smooth out the remaining scars.
It is particularly good for shallow boxcar scars, and it is also the treatment used to smooth and tighten scars that have already been treated by other surgical means such as subcision and excision. In that sense it is often the finishing step rather than the first one.
In our practice CO2 laser resurfacing is often combined with one or several other treatments for acne scars, and this combination approach consistently yields superior results compared with a single therapy. In most cases the surgical treatment of scars is completed before laser resurfacing, and the laser treatment is scheduled 6 to 12 weeks after the last surgical treatment to allow your skin time to heal and remodel.
CO2 resurfacing requires more recovery than the non-ablative options. Dr. Gallacher performs it personally and sets the parameters for your skin.
CO2 laser resurfacing is one of the most useful treatments for acne scarring. Thin layers of skin are removed, layer after layer, until the scars improve or go. At the same time the skin tightens, which helps smooth out what is left.
It is especially good for shallow dents with sharp edges. It is also the treatment used to smooth and tighten scars that have already been cut out or released from underneath. So it is often the last step rather than the first.
In our practice CO2 resurfacing is usually combined with one or more other treatments, and that combination consistently gives better results than any one treatment on its own. In most cases the surgery on the scars is finished first, and the laser is booked 6 to 12 weeks after the last surgical treatment, to give your skin time to heal and settle.
CO2 resurfacing needs more recovery than the gentler options. Dr. Gallacher does it herself and sets the settings for your skin.
Fraxel FTX fractional non-ablative resurfacing
Fraxel FTX: resurfacing without removing the surface
For patients who want laser treatment of acne scars but would prefer a less invasive procedure, non-ablative resurfacing with the Fraxel FTX laser offers the potential for significant improvement. It is performed as a series of five to six treatments, three to four weeks apart, and it helps to smooth acne scars as well as fine to moderate wrinkles.
One hour of topical numbing cream is applied before the procedure. Sunburn-like redness and swelling for several days are usually the only after effects of this very effective treatment.
We also use the Fraxel FTX laser for other types of scars, such as those appearing after trauma or surgery. When scars are thickened or pink, we may additionally recommend intralesional steroids and VBeam laser to treat the redness.
If you want laser treatment for acne scars but would rather have something less invasive, the Fraxel FTX laser can still give a real improvement. It is done as a course of five to six treatments, three to four weeks apart, and it smooths acne scars as well as fine to moderate lines.
Numbing cream is left on for an hour before the treatment. Afterwards, redness and swelling like sunburn for a few days are usually the only after effects.
We also use the Fraxel FTX laser on other kinds of scars, such as scars after an injury or an operation. If scars are thickened or pink, we may add an injection into the scar and VBeam laser to treat the redness.
Erbium laser
Erbium laser
Erbium laser treatment sends an intense, pulsating beam of light into the targeted area. It eliminates damaged cells on the surface of the skin, allowing new skin to form in its place. Most patients require several treatments for maximum results. Erbium is one of the resurfacing options Dr. Gallacher selects between, depending on the depth of the scarring and how much recovery time is appropriate for you.
Erbium laser sends a strong pulsing beam of light into the treated area. It removes damaged cells from the surface of the skin so that new skin can form in their place. Most people need several treatments to get the full result. Erbium is one of the resurfacing options Dr. Gallacher chooses between, depending on how deep the scarring is and how much recovery time suits you.
VBeam and non-ablative laser for red scars
VBeam and gentler lasers for red scars
Non-ablative lasers such as the VBeam are associated with minimal or no downtime. Results are progressive and patients require multiple treatments. New and red colored scars respond better than older and deeper ones, so this is a treatment we reach for early rather than late.
Published studies of non-ablative laser treatment report that scar remodeling continues for up to six months after the laser treatment has been given. Patients who notice only minimal improvement during the treatment course report at least 50 percent improvement six months later, and 70 percent of all treated patients notice significant improvement after completing the series of laser treatments.
We usually recommend topical creams alongside the laser to enhance the results. When scars are thickened as well as red, intralesional steroid may be used with the VBeam.
Non-ablative lasers such as the VBeam need little or no time off. The results build up gradually, and you need several treatments. New red scars respond better than old deep ones, so this is a treatment we use early rather than late.
Published studies of non-ablative laser treatment report that the skin carries on remodelling the scar for up to six months after the laser has been done. People who see only a small improvement during the course report at least 50 percent improvement six months later, and 70 percent of everyone treated notices a significant improvement once the course is finished.
We usually add creams alongside the laser to improve the result. When scars are thickened as well as red, an injection into the scar may be used with the VBeam.
RF microneedling
RF microneedling
RF microneedling stimulates the skin's natural healing abilities and collagen production. Patients need five to six treatments, three to four weeks apart, for optimal results. The outcome is smoother, rejuvenated skin and an improved appearance of acne scars. Downtime is minimal, which makes it a practical option for patients who cannot take time away from work.
RF microneedling sets off the skin's own healing and makes it produce collagen. You need five to six treatments, three to four weeks apart, for the best result. The skin ends up smoother and fresher, and the acne scars look better. There is very little time off, which makes it a practical choice if you cannot take time away from work.
Dermal fillers for depressed scars
Fillers for dented scars
Dermal fillers such as Restylane, the RHA collection and others are injected into the scarred areas to fill in and smooth out depressions in the skin. The procedure requires no downtime and results may last 6 to 16 months depending on the filler used. It offers immediate results and requires periodic touch ups to maintain them. Any bruise from an injection given here is treated with the VBeam laser at no charge.
Filler is most useful for rolling and other broad depressed scars, and it works best once anything tethering the scar from beneath has been released.
Fillers such as Restylane, the RHA range and others are injected into the scarred areas to fill in and smooth out the dips. There is no time off, and the result may last 6 to 16 months depending on which filler is used. You see the improvement straight away, and you need occasional top ups to keep it. If you bruise after an injection with us, we treat it with the VBeam laser and do not charge for it.
Filler is most useful for broad shallow dips, and it works best once anything holding the scar down from underneath has been released.
The order treatments are done in
The order treatments are done in
With acne scarring the sequence matters as much as the choice of device. In most cases the surgical treatment of individual scars is completed first, whether that is the removal of ice-pick scars, the excision of deep boxcar scars, or the subcision of tethered rolling scars. Laser resurfacing is then scheduled 6 to 12 weeks later, so that the skin has time to heal and remodel before it is resurfaced, and so that the resurfacing can smooth and tighten what the surgery has corrected.
Redness and thickening are treated on their own track, with VBeam and where appropriate intralesional steroid, and this can run alongside the rest of the plan.
For best results we often customize a few treatments. Dr. Gallacher takes into account the type and severity of your acne scars in order to help you determine the best options for you.
With acne scarring the order matters as much as the machine. In most cases the individual scars are dealt with surgically first: cutting out narrow deep pits, cutting out deep dents, or releasing tethered scars from underneath. The laser resurfacing is then booked 6 to 12 weeks later, so the skin has time to heal and settle first, and so the resurfacing can smooth and tighten what the surgery has corrected.
Redness and thickening are treated on a separate track, with VBeam laser and, where it helps, an injection into the scar. That can run at the same time as the rest of the plan.
For the best result we usually customise a few treatments. Dr. Gallacher takes the type and severity of your scars into account in order to help you work out the best options for you.
Our experience with scarring
Our experience with scarring
At the Dermatology and Laser Centre in Danville, CA we have extensive experience in the treatment of scarring and can provide improvement for most cases. Dr. Gallacher is a board certified, fellowship trained dermatologist who has served on the faculty at Stanford University and UC Davis. She performs all laser procedures herself and does not delegate them, and she selects the specific technology for each indication rather than treating every scar with the same device.
At the Dermatology and Laser Centre in Danville, CA we have a great deal of experience treating scars, and we can improve most cases. Dr. Gallacher is a board certified dermatologist with fellowship training, and she has taught on the faculty at Stanford University and UC Davis. She performs every laser treatment herself and does not hand it to anyone else. She also picks the particular technology to suit each problem, rather than using the same device on every scar.
Who may be a good candidate for acne scar treatment?
Who is it suitable for?
Candidates generally have stable scars, realistic expectations, and skin that can safely undergo the proposed procedure.
People whose scars have settled, who understand what is realistic, and whose skin can safely have the treatment being proposed.
- Acne is reasonably controlled or being treated at the same time.
- The scar type can be matched to an appropriate procedure.
- You can follow sun-protection and aftercare instructions.
- You understand that improvement, not perfectly scar-free skin, is the realistic goal.
- Your scars are mature rather than newly formed, or you understand that new and red scars are treated on a different track from older, deeper ones.
- You are able to commit to a course of treatment rather than a single visit, since most of these procedures work as a series.
- Your acne is reasonably under control, or is being treated at the same time.
- Your type of scar can be matched to a treatment that suits it.
- You can follow the sun protection and the aftercare.
- You understand the goal is real improvement, not perfectly unmarked skin.
- Your scars have settled, or you understand that new red scars are treated differently from old deep ones.
- You can commit to a course of treatment rather than one visit, because most of these treatments work as a series.
Who may need to postpone or choose a different approach?
Who should wait, or do something different?
Treatment may be delayed or modified when active infection, uncontrolled acne, recent tanning, impaired healing, or a high risk of pigment change makes a procedure less safe.
Treatment may need putting off or changing when there is an infection, when the acne is still out of control, after recent tanning, when healing is a problem, or when the risk of the skin healing a different colour is high.
Laser and resurfacing settings also need to be selected carefully for different skin tones. A consultation is important because the safest option is not the same for every patient.
Laser and resurfacing settings also have to be chosen carefully for different skin tones. That is why the consultation matters. The safest option is not the same for everyone.
What are the benefits, risks, and alternatives?
What are the benefits, risks and alternatives?
| Topic | Key points |
|---|---|
| Potential benefits | Smoother texture, softer scar edges, less visible depressions or redness, and improved overall skin uniformity. |
| Common temporary effects | Redness, swelling, tenderness, dryness, peeling, bruising, or temporary darkening depending on the procedure. |
| Less common or serious risks | Infection, prolonged redness, post-inflammatory hyperpigmentation or hypopigmentation, scarring, and procedure-specific complications. Injectable fillers also carry rare but serious vascular risks. |
| Alternatives | Camouflage makeup, topical treatment for mild discoloration, chemical peels for selected scars, or choosing no procedure. |
What you can gain Smoother texture, softer scar edges, shallower dents, less redness, and skin that looks more even overall.
What is normal afterwards Redness, swelling, tenderness, dryness, peeling, bruising, or temporary darkening, depending on which treatment.
Less common or serious risks Infection, redness that drags on, skin ending up darker or lighter, and scarring. Fillers also carry a rare but serious risk of blocking a blood vessel.
Other options Camouflage make up, creams for mild discolouration, a chemical peel for certain scars, or deciding not to have anything done.
Camouflage make up, creams for mild discolouration, or deciding not to have anything done. Most acne scarring is a change in the structure of the skin, so treatments that work only on the surface do little for the depth of a scar.New row. Why combination treatment is used / Why we combine treatments
In our practice, combining CO2 resurfacing with one or more other treatments consistently gives better results than any single treatment, because different shapes of scar need different solutions.
Camouflage makeup, topical treatment for mild discoloration, or choosing to have no procedure. Because most acne scarring is a structural change in the skin, treatments that act only on the surface have limited effect on scar depth.
In our practice, combining CO2 resurfacing with one or several other procedures consistently yields superior results compared with a single therapy, because different scar shapes need different mechanical solutions.
A private treatment room at Dermatology and Laser Centre in Danville, CA.
One of the private treatment rooms at Dermatology and Laser Centre in Danville, CA.
What is recovery like?
What is the recovery like?
Recovery depends on the procedure: injections and lighter treatments may have little interruption, while ablative resurfacing can require several days or longer of visible healing.
It depends on the procedure. Injections and the gentler treatments barely interrupt anything. Stronger resurfacing needs several days or more of visible healing.
Redness, swelling, tenderness, or bruising may occur after many procedures.
Redness, swelling, tenderness or bruising, after most of these procedures.
Peeling or crusting can occur after resurfacing; deeper treatments may take longer.
Peeling or crusting after resurfacing. The deeper treatments take longer.
Collagen remodeling continues and texture may gradually improve.
The rebuilding underneath carries on, and the texture keeps gradually improving.
After Fraxel FTX, redness and swelling like sunburn for a few days are usually the only after effects. After RF microneedling there is very little time off. After filler there is none. CO2 resurfacing needs the most recovery of anything on this page. After narrow deep pits are cut out, most people see a dramatic improvement 4 to 6 weeks later, and any laser resurfacing is booked 6 to 12 weeks after the surgery.
After Fraxel FTX, sunburn-like redness and swelling for several days are usually the only after effects. After RF microneedling, downtime is minimal. After filler, there is no downtime. CO2 resurfacing requires the most recovery of the options on this page. After surgical removal of ice-pick scars, patients notice a dramatic improvement 4 to 6 weeks later, and any laser resurfacing is scheduled 6 to 12 weeks after the surgery.
What results can I realistically expect?
What can I realistically expect?
The goal is meaningful improvement in scar depth, texture, or color; complete removal of every scar is not a realistic promise.
A real improvement in how deep the scars are, in the texture, and in the colour. Not the complete removal of every scar. Nobody can promise that.
Some procedures, such as filler, can create an immediate contour change. Laser and microneedling results are more gradual because collagen remodeling takes time. A staged plan may be recommended when scars are mixed or severe.
Some things, such as filler, change the contour immediately. Laser and microneedling work more slowly, because the rebuilding takes time. If your scars are mixed or severe, we may recommend doing it in stages.
The improvement carries on after the treatments stop. Published studies of non-ablative laser report that the skin keeps remodelling the scar for up to six months, so what you see at the end of a course is not the final result. People who see only a small improvement during the course report at least 50 percent improvement six months later. After narrow deep pits are cut out, the improvement is usually obvious at 4 to 6 weeks. Filler is the exception. It changes the shape straight away, and it needs topping up, because the result lasts 6 to 16 months depending on which filler is used.
Improvement continues after the treatments finish. Published studies of non-ablative laser report that scar remodeling continues for up to six months after treatment, so the result you have at the end of a course is not the final one. Patients who notice only minimal improvement during a course report at least 50 percent improvement six months later. After surgical removal of ice-pick scars the improvement is usually obvious at 4 to 6 weeks. Filler is the exception: it changes contour immediately, and it needs periodic touch ups because the result lasts 6 to 16 months depending on the filler used.
Illustrative result
What a result can look like
The pictures below show the kind of change acne scar treatment can produce. They are shown to illustrate what the treatments do, not to predict your own outcome, which depends on the scar types present, your skin, the procedures chosen and the number of sessions. Drag the divider to compare, or open any picture for the detail. Individual results vary.
The pictures below show the kind of change acne scar treatment can make. They are there to show what the treatments do, not to predict your result, which depends on the types of scar you have, your skin, the treatments chosen and how many sessions you have. Drag the line across to compare, or open any picture to see it larger. Results are different for everyone.
Questions patients ask
How many acne scar treatment sessions will I need?
How many sessions will I need?
It depends on the scar type and the procedure. Most patients require five to six sessions, three to four weeks apart, whether the treatment is Fraxel FTX or RF microneedling, for significant improvement. Severe cases may benefit from one or two CO2 laser resurfacing sessions spaced three months apart. Fillers or surgical excision can provide quicker correction depending on the scar type, and up to 15 to 20 ice-pick scars can be removed in one session. Your plan is set after Dr. Gallacher has examined your skin.
It depends on the type of scar and the treatment. Most people need five to six sessions, three to four weeks apart, whether that is Fraxel FTX or RF microneedling, to get a significant improvement. Bad cases may do better with one or two CO2 resurfacing sessions, three months apart. Fillers or cutting the scars out can correct things faster, depending on the scar, and as many as 15 to 20 narrow deep pits can be removed in one session. Your plan is set once Dr. Gallacher has examined your skin.
Is acne scar treatment painful?
Does it hurt?
Discomfort is minimal. Numbing cream, cooling or local anesthesia is used for comfort, and for Fraxel FTX the numbing cream is applied for a full hour beforehand. Procedures such as Fraxel and CO2 may feel warm or prickly. Fillers and injections are generally well tolerated, with only brief redness or tenderness afterwards.
It is not very uncomfortable. Numbing cream, cooling or a local anaesthetic is used to keep you comfortable, and for Fraxel FTX the numbing cream goes on a full hour beforehand. Fraxel and CO2 can feel warm or prickly. Fillers and injections are generally easy to tolerate, with only brief redness or tenderness afterwards.
How long does it take to see improvement?
How long before I see a difference?
Fraxel FTX and RF microneedling results build over weeks as collagen forms, with maximum change visible after several months. Fillers show immediate improvement. CO2 resurfacing delivers dramatic results after the initial healing. After surgical removal of ice-pick scars, patients notice a dramatic improvement 4 to 6 weeks after the procedure.
Fraxel FTX and RF microneedling build up over weeks as new collagen forms, and the biggest change shows after several months. Fillers improve things straight away. CO2 resurfacing gives a dramatic result once the initial healing is done. After narrow deep pits are cut out, most people notice a dramatic improvement 4 to 6 weeks later.
Q4. Can acne scars be completely removed? Keep the live answer as written. Both registers are accurate.
Q5. Should active acne be treated before scar procedures? Keep the live answer as written. Both registers are accurate.
Can acne scars be completely removed?
Can acne scars be removed completely?
No procedure can guarantee complete removal. The realistic goal is to reduce scar depth, soften edges, improve texture, and make scars less noticeable.
No procedure can promise that. The realistic aim is to make them shallower, soften their edges, improve the texture, and make them much less noticeable.
Should active acne be treated before scar procedures?
Should my acne be treated first?
Usually yes. Ongoing inflammatory acne can create new scars, so controlling active breakouts is an important part of a long-term scar plan.
Usually, yes. Acne that is still inflamed keeps making new scars, so getting the breakouts under control is part of any long term scar plan.
Who performs the treatment?
Who actually does the treatment?
Dr. Gallacher performs all laser and surgical scar procedures herself. She does not delegate them.
Dr. Gallacher does all the laser and surgical scar treatments herself. She does not hand them to anybody else.
Talk it through with a physician first.
Every plan starts with an assessment of your skin, your anatomy and what you actually want to change.
This page is general health information, not medical advice. It cannot tell you whether a treatment is right for you. Approved uses, risks and results differ from person to person, and product labelling changes. Ask us at Dermatology and Laser Centre about your own situation, or make an appointment, and seek urgent care for any serious symptom.
