Acne scar treatments

This page covers the treatments used for acne scarring and what each one is for. For the scar types themselves - ice-pick, boxcar, rolling, hypertrophic and keloid - see acne scars.

The two pages belong together because the single most common reason acne scar treatment disappoints is a mismatch: a treatment aimed at the surface applied to scarring that is not on the surface.

First: is the acne controlled?

Scar treatment on skin that is still actively breaking out is a poor investment. New scars form during the course, and several resurfacing treatments are unsuitable on inflamed skin.

Get the acne under control first. If you have recently taken oral acne medication, say so - resurfacing is usually deferred for a period afterwards because of healing risk.

Also worth establishing before you spend anything: a good proportion of what people call acne scarring is post-inflammatory pigmentation, which is flat, and which fades on its own over months with sun protection. Flat marks and pitted scars are different problems.

Matching treatment to scar

Scar	Treatment	Why
Ice-pick - narrow and deep	Individual treatment of each scar, then resurfacing; excision for the worst	Deeper than resurfacing reaches
Boxcar, shallow	Fractional or ablative laser; skin needling	Within resurfacing depth
Boxcar, deep	Resurfacing plus individual treatment	Partial improvement realistic
Rolling - wavy undulation	Release of the tethering bands, then needling or laser	The cause is tethering, not the surface
Volume-loss divots	Dermal filler	Lost volume needs replacing
Hypertrophic and keloid	Cortisone injections, silicone	Reduction, not resurfacing
Flat dark or red marks	Sun protection, topicals, peels, light-based treatment	Pigment, not contour

The treatments

Laser resurfacing

CO2 and erbium for deeper resurfacing with more downtime; Fraxel fractionally, with faster recovery and more sessions for the same total effect. The mainstay for boxcar and textural scarring.

Skin needling, often with Factor 4

Collagen stimulation for depressed and textural scarring, in a course four to six weeks apart. A reasonable option for darker skin types, where heat-based resurfacing carries more pigment risk.

Surgical excision

For individual deep ice-pick or boxcar scars - replacing a pit with a fine line, which is usually the better-looking of the two.

Dermal fillers

Lift individual depressed scars where volume has been lost. Temporary; repeated as the filler absorbs.

Cortisone injections

For raised hypertrophic and keloid scars - reducing bulk, redness and itch. A course rather than one injection.

Peels, microdermabrasion and epidermal levelling

For surface texture and the pigmentation that accompanies scarring. Useful adjuncts; not a treatment for contour.

LED, cosmeceutical skincare and depigmenting treatments

Supporting treatments - speeding recovery between sessions, and addressing the pigment component.

Mineral make-up

Cover while the course progresses, and physical sun protection for treated skin.

What results are realistic

Acne scarring improves. It does not disappear. A realistic outcome from a well-chosen course is a substantial reduction in how noticeable the scarring is - not a return to unmarked skin.

Expect several sessions over months, expect to combine approaches, and expect deep ice-pick scarring to improve least. Results continue developing for six to twelve months after treatment as collagen remodels.

Individual results vary with scar type and depth, skin type, age and healing.

Risks

• Redness, swelling, crusting and peeling - days to weeks depending on the treatment
• Post-inflammatory hyper-pigmentation, notably more likely in darker skin types
• Hypo-pigmentation, which can be permanent
• Infection, including reactivation of cold sores after facial resurfacing
• New or worsened scarring, particularly with aggressive treatment or keloid-prone skin
• Skin thinning or dimpling after cortisone injection
• Lumps, asymmetry or vascular complications after filler
• Incomplete improvement
• Prolonged sun sensitivity after treatment

See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. Dermal skin treatments start from $130. Because this runs as a course, ask for the cost of the whole plan rather than a single session. Not covered by Medicare.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.