Acne scars are six different conditions. Here's how we treat each.

Most patients who come to me for "acne scar treatment" expect a single procedure — usually a laser — to fix everything. The truth is that acne scars are at least six different conditions, and each responds to a different treatment. A fractional CO2 laser that works beautifully on boxcar scars will do nothing for an ice pick scar.

This article explains the six types and what works for each. If you have acne scars, this is what your consultation should cover.

1. Ice pick scars

These are deep, narrow, V-shaped scars that look like large open pores. They extend into the dermis. First-line treatment: TCA cross (trichloroacetic acid chemical reconstruction of skin scars). High-strength TCA is applied precisely into each scar, triggering localised resurfelling. Done carefully, one scar at a time. Radiofrequency microneedling also helps.

2. Boxcar scars

Wide, square-edged, U-shaped depressions. First-line: fractional CO2 laser and/or subcision. The laser creates controlled micro-injuries that trigger collagen remodelling. Expect 5–7 days of redness per session, 3–5 sessions for significant improvement.

3. Rolling scars

Broad, wave-like depressions that make the skin look uneven. They're caused by fibrous bands tethering the skin down. First-line: subcision — a fine needle releases the bands, allowing the skin to rise. Often combined with filler or microneedling.

4. Hypertrophic scars

Raised, firm scars — usually on the jawline, chest, or back. First-line: intralesional steroid injections plus silicone gel sheeting. These scars over-produce collagen; steroids calm that down. Ongoing treatment, not one-and-done.

5. Post-inflammatory hyperpigmentation (PIH)

Flat brown or purple marks left after acne heals. These are not "scars" in the structural sense — they're pigment. First-line: chemical peels (salicylic or glycolic) plus a prescription topical (azelaic acid, hydroquinone, or retinoid). Fades over 4–6 sessions.

6. Post-inflammatory erythema (PIE)

Flat red marks — caused by dilated blood vessels near the surface. First-line: vascular laser (pulsed dye laser or IPL). Also responds to time — PIE fades on its own over 6–12 months, but laser speeds it up.

Why a single treatment won't work

If you have three ice pick scars, two boxcar scars, and some PIH — no single device treats all of them. You need TCA cross for the ice pick, fractional CO2 for the boxcar, and a peel for the PIH. A clinic that offers "one laser for all your scars" is either lying or doesn't understand the difference.

What to expect at your consultation

I will examine your skin under good lighting, identify which scar types you have, and write down a treatment plan that names each scar type and the treatment for it. I'll give you a realistic expectation — typically 40–70% improvement, not 100% elimination. And I'll photograph your skin so we can measure honestly, month by month.

Book a consultation if you're ready. If you're not, come for a 15-minute orientation chat — it's free.