Acne Scars: How Treatment Differs by Scar Type
Acne scars rarely disappear after a single treatment session. The first step is to identify their shape. A narrow, deep scar and a broad, shallow depression involve different tissue changes. That is why the same laser, used in the same way, can produce different results from one scar to another.
Why do acne scars form?
When acne inflammation extends deep into the skin, it can damage the dermis around a pore. Too little collagen during healing leaves a depressed scar; too much can produce a raised, hypertrophic scar. Patients often ask whether a cream can fill these depressions. Once a scar is sunken, treatment needs to stimulate the dermis to make new collagen.
What are the different types of acne scars?
The three-category classification widely used today was published in the Journal of the American Academy of Dermatology in 2001. Its authors argued that identifying the scar type is the first step in planning the right treatment sequence[1].
| Scar type | Appearance | Suitable treatments |
|---|---|---|
| Ice pick | Narrow opening with a deep depression | Deep nonablative fractional laser, punch excision |
| Rolling | Broad depression with gently sloping edges | Fractional CO2 laser, plasma, release of fibrous bands beneath the scar |
| Boxcar | Box-shaped depression with sharply defined edges | Fractional CO2 laser, plasma |
Most faces have a mix of all three types. Red or brown marks are assessed separately: their main issue is discoloration rather than a depression in the skin. The laser and treatment depth need to suit each scar. Without enough experience, it is easy to miss this mix and treat the whole face the same way.
Why does each scar type need a different approach?
Rolling scars are often tethered to fibrous tissue underneath, so releasing those bands can help. Boxcar scars have a depressed, relatively flat base and benefit from broader dermal stimulation to rebuild tissue from below. Ice pick scars are narrow but deep; resurfacing alone may not reach their base. The 2001 classification paper proposed choosing among punch excision, subcision to release fibrous attachments, and laser resurfacing according to scar type[1]. In practice, broad rolling and boxcar scars tend to respond well to fractional CO2 lasers, while deep ice pick scars require an approach that reaches their base, such as 1540XD.
How do lasers help fill acne scars?
Acne scar lasers create tiny columns of controlled heat in the skin. As these areas heal, new collagen forms. A meta-analysis of six studies involving 467 patients with depressed acne scars found higher skin smoothness scores with ultrapulse fractional CO2 laser treatment than with other treatments[2].
Picosecond lasers can also be used in a fractional mode. A meta-analysis of seven studies found improvement comparable to conventional fractional lasers, with less post-treatment pigmentation and pain but more temporary pinpoint bleeding[3]. We often consider this option for patients prone to pigmentation or sensitive to pain, including those who found recovery from Fraxel difficult.
What can support recovery after laser treatment?
Adding growth factors or cells after dermal laser stimulation can support repair. In one study, adipose-derived stem cell conditioned medium was applied to only one side of the face after fractional CO2 treatment. That side showed greater elasticity and hydration, less roughness and a lower melanin index; biopsies also showed greater dermal collagen density[4]. One patient who had three sessions of UltraPulse and Pearl Toning told us they had noticed considerable improvement and felt that the deep scars on their temples had filled in after Pearl Toning.
How does Dong-An Joongsim Clinic treat acne scars?
At Dong-An Joongsim Clinic, a doctor first assesses scar shape, depth, and skin type before choosing a laser. Options include UltraPulse (Encore), Deep Pulse fractional CO2, JOULE ProFractional, plasma laser (Legato II), and nonablative 1540XD. The laser, depth, and number of sessions are selected for each scar. A natural skin substitute, SynNanoskin, is then used as a dressing to support repair.
For patients who prefer less downtime, we may suggest Discovery PICO, which targets the dermis while preserving the epidermis. To address scars, pores, and firmness together, we may discuss the plasma and radiofrequency device Opus. We sometimes recommend it first when thin skin makes laser treatment a concern. For patients with many deep scars, we also discuss adding scar injections such as Core Pulling, which can improve results when combined with laser treatment. Dr. Chang-Hwan Cho has lectured on acne scar treatment at the Korean Aesthetic Surgery and Laser Society and international conferences in Indonesia and Vietnam. At Dong-An Joongsim Clinic, your doctor personally handles both your consultation and your treatment, with individual attention throughout.
What should you know before treatment?
Scars do not become smooth overnight. Treatment is often spread over several sessions to allow new collagen to form. Autologous fibroblast treatment begins to produce visible filling after 2–3 months, so patience matters. The number of sessions and downtime depend on scar depth, extent, and skin type, and results vary. We usually address active acne first because ongoing inflammation can create new scars. During treatment, careful sun protection and moisturizing, along with a multivitamin containing vitamin C, can support repair.
Acne scar treatment: common questions
How should I choose an acne scar clinic in Apgujeong, Gangnam, Seoul?
Different scars respond to different lasers. Look for a clinic that assesses your scars first and has several scar-treatment lasers available. At Dong-An Joongsim Clinic, a doctor examines your scars personally before planning the combination of laser and stem cell treatment.
Can creams or skincare products fill acne scars?
Topical products alone are unlikely to fill established depressions. A common approach combines lasers that stimulate new collagen in the dermis with regenerative treatment, selected for the scar type.
Which lasers are used for depressed acne scars?
Fractional CO2 lasers and plasma are commonly used for broad rolling and boxcar scars. Narrow, deep ice pick scars are usually treated with a nonablative fractional laser that reaches deeper.
When will I see improvement?
New collagen takes time to form, so improvement develops over weeks to months. Autologous fibroblast treatment begins to show results around 2–3 months after treatment.
Is acne scar treatment painful?
Numbing cream makes treatment tolerable for most patients. Discomfort depends on the area treated and the type of laser.
References
- Jacob CI et al., “Acne scarring: a classification system and review of treatment options”, Journal of the American Academy of Dermatology, 2001. https://pubmed.ncbi.nlm.nih.gov/11423843/
- Lin L et al., “A systematic review and meta-analysis on the effects of the ultra-pulse CO2 fractional laser in the treatment of depressed acne scars”, Annals of Palliative Medicine, 2022. https://doi.org/10.21037/apm-22-70
- Li J et al., “Fractional picosecond laser for atrophic acne scars: A meta-analysis”, Journal of Cosmetic Dermatology, 2023. https://doi.org/10.1111/jocd.15862
- Zhou BR et al., “The efficacy of conditioned media of adipose-derived stem cells combined with ablative carbon dioxide fractional resurfacing for atrophic acne scars and skin rejuvenation”, Journal of Cosmetic and Laser Therapy, 2016. https://doi.org/10.3109/14764172.2015.1114638