Different scar types respond to different modalities. Combining them thoughtfully outperforms any single treatment.
Acne scars are not one thing. There are icepick, boxcar, rolling, and atrophic scars, and each responds best to a different modality. Successful treatment usually combines several tools across a series of sessions.
Icepick scars. Narrow, deep, sharply defined. These respond best to TCA CROSS (a very targeted chemical technique that damages the scar base to trigger collagen re-fill) and occasional punch excision. Fractional laser and microneedling alone rarely fill them fully.
Boxcar scars. Wider, well-defined edges, shallower than icepick. Fractional resurfacing (iPixel or fractional CO2), medical microneedling with radiofrequency, and subcision of tethered edges are the mainstays.
Rolling scars. Broad, shallow undulations from fibrous tethering below the skin. Subcision (releasing the tethers with a fine needle) plus a biostimulator or filler to lift the depression, followed by a resurfacing modality to refine texture.
Atrophic and general textural change. Fractional non-ablative resurfacing (Clear + Brilliant, Fraxel) over a series of sessions, combined with medical microneedling for depth, gradually rebuild dermal density.
The role of salmon DNA and growth factors. Polynucleotides (salmon DNA) infused after microneedling can accelerate the collagen and elastin response. We often combine microneedling with salmon DNA in the same session for clients with moderate to severe scarring.
Why this takes time. Scar remodelling is a real biological process, not a cosmetic overlay. New collagen takes 60 to 90 days to organise. A full course of scar treatment is typically 6 to 8 sessions across 6 to 9 months, with visible progression at each stage.
What we address first. Any active acne. Treating scars while the skin is still producing new lesions is a losing strategy, we stabilise the current acne (see our adult acne piece for the approach) before starting scar work.
Post-inflammatory hyperpigmentation versus scars. What often distresses clients as scars are actually flat dark marks (PIH), not textural scars. Those respond to a different protocol entirely, brightening acids, targeted laser, and sun protection, without the collagen-remodelling work needed for true textural scars. We identify which is which at consultation.
The honest read. There is no single treatment that gives dramatic improvement in one session for genuine acne scarring. There are combinations that produce 50 to 70 percent visible improvement across a course. That is what we work toward.