Acne scarring is one of the most challenging areas of aesthetic dermatology. Established acne scars represent permanent structural changes to the dermis, and addressing them requires precision, patience, and a thorough understanding of scar type and tissue architecture. The right treatment depends entirely on what type of scarring is present.
Types of Acne Scarring
Icepick scars are narrow, deep channels extending into the dermis. Their depth makes them among the most difficult scar types to address with surface-level resurfacing alone.
Boxcar scars are wider, flat-bottomed depressions with defined edges. They are typically shallower than icepick scars and respond well to resurfacing and energy-based treatments.
Rolling scars have a wave-like undulating appearance caused by tethering of the dermis to deeper structures. The tethering itself must be addressed for meaningful improvement.
Treatment Options
Fractional CO2 laser
Fractional CO2 laser resurfacing produces substantial collagen remodelling and is particularly effective for boxcar and rolling scars.
TCA Cross
TCA Cross (trichloroacetic acid chemical reconstruction of skin scars) is a targeted procedure in which a high-concentration trichloroacetic acid solution is applied precisely within icepick and narrow boxcar scars. The controlled response this generates drives focussed collagen production within the scar channel, gradually filling and softening it over a series of treatments. It is the most effective available treatment for icepick scars specifically.
Laser Genesis
Laser Genesis supports skin quality and redness reduction as a supporting treatment alongside more targeted modalities.
Enlighten SR MLA
The Enlighten SR MLA handpiece provides fractional resurfacing with a shorter recovery period. It is well suited to mild to moderate boxcar scars and is used as part of a progressive treatment programme.
Subcision
Subcision is a minor procedure in which a fine needle is used to release the fibrous tethers anchoring rolling scars to the deeper tissue. By disrupting this tethering, the skin surface is released and the undulating texture improves. Subcision is frequently combined with resurfacing treatments for patients with a mixed scar profile.
Your Consultation
At consultation, the practitioner will assess scar type, severity, and distribution, and develop a treatment plan that sequences the most appropriate modalities for your specific presentation. Acne scar treatment is a gradual process requiring a series of treatments over several months. There is no obligation to proceed.
