How do acne scars form, and what types are there?
An acne scar forms when deep inflammation in the hair-follicle and oil-gland unit damages collagen in the dermis and repair is uneven. If tissue is lost, a depressed (atrophic) scar results; if too much tissue forms, a raised (hypertrophic) scar or keloid develops. Depressed scars on the face are commonly divided into three types: ice pick, boxcar and rolling.
A pimple begins when a hair follicle and its oil gland become blocked and inflamed. When inflammation stays near the surface, it usually heals without a scar; in deep, large and long-lasting inflamed pimples, especially cystic and nodular acne, the collagen and supporting tissue in the dermis are damaged. If the body cannot produce enough tissue while repairing this damage, a depression remains on the skin surface; sometimes scar tissue forms hard bands that tether the skin to the layers below and pull the surface down. Squeezing pimples, delaying treatment and a genetic tendency are among the factors that can raise the chance of scarring. Early and appropriate treatment of active acne is therefore also the first step of scar treatment. How acne itself is treated is a separate dermatological question.
Ice pick scars are narrow, deep, pointed pits; although their openings are small, they can reach deep into the dermis. Boxcar scars are wider, with sharp edges and a flat base, and can be shallow or deep. Rolling scars have ill-defined edges and give the skin a wavy, shadowed look, and they usually form when bands of connective tissue beneath pull the surface down. Several of these types can coexist on one face. On the chest, back and shoulders and along the jawline, raised scars and keloids may be more common. Identifying the scar type correctly directly affects which method will be meaningful, so at examination the dominant types and their distribution are noted separately.
Is every red or brown mark an acne scar?
No. The red-pink marks (post-inflammatory erythema) and brown marks (post-inflammatory hyperpigmentation) left after pimples are mostly colour changes without a pit or raised area. They tend to fade with time and are handled with different methods from true acne scars that leave a depression. Telling them apart prevents unnecessary procedures.
Red marks are related to small dilated vessels in the area after inflammation and are especially visible in lighter skin. Brown marks come from increased pigment stimulated by inflammation and are more common in darker skin. In both, the skin surface is usually flat; no pit or raised area can be felt when touched. A large part of these marks can lighten by themselves over months, and regular sun protection and not squeezing pimples support this. For marks that do not fade for a long time, treatments aimed at colour and vessels may be planned after a dermatological assessment. Such marks are not the primary target of methods such as microneedling radiofrequency or polynucleotides. Whether a plan for marks runs at the same time as scar treatment is decided by the physician.
Another reason the distinction matters is that some scar treatments can temporarily increase marks. Especially in darker skin, new brown marks can develop after needle-based or heat-delivering procedures, so starting scar treatment while pigmentation is still active is often postponed or planned with lower settings. At examination, scars are viewed from different angles and with light coming from the side; side lighting shows depressions as shadows, while flat colour changes lose their prominence in this light. The same person can have both depressed scars and colour changes; in that case the plan is built to include steps for both problems in the right order.
What can microneedling radiofrequency do for acne scars, and what can it not do?
Microneedling radiofrequency stimulates remodelling of scar tissue and new collagen production through heat delivered from fine needles entering the dermis. It is often assessed for boxcar and rolling scars and overall surface roughness. In deep, narrow ice pick scars or where the hard bands pulling a scar down are pronounced, it may remain limited on its own.
In microneedling radiofrequency the needles can reach the depth at which the scar lies and deliver energy directly to the dermis. The micro-channels and heat zones formed contribute over time to irregular scar tissue being replaced by a more organised collagen structure. Depth and energy can be adjusted to the scar type and skin thickness, and different settings may be used in different areas of the face within one session. Because the method spares most of the skin surface, recovery is generally shorter than with methods that strip the whole surface. A numbing cream is applied beforehand and single-use needle tips are used. Morpheus8, Potenza and Scarlet are devices in this class, and no general ranking among them can be made.
Change usually builds up with sessions; most plans suggest a few sessions a few weeks apart, and the result is assessed a few months after the last session. Because ice pick scars are narrow and deep, microneedling radiofrequency may not address them adequately; for these, different methods such as targeted chemical applications or minor surgical techniques may come up in dermatology. In rolling scars, applying a device alone without releasing the bands pulling the surface down may not give the expected change. Risk of pigmentation in darker skin, isotretinoin use and a tendency to keloids also affect settings and timing. For this reason microneedling radiofrequency is often planned not alone but together with other steps chosen for the scar type.
How are polynucleotides, subcision and other methods added to the plan?
Subcision aims to release the bands of connective tissue that pull rolling scars down, using a fine needle or cannula. Polynucleotide injections may be used to support skin quality in the scar area, and hyaluronic acid filler or biostimulators for broad depressions with volume deficiency. These methods can sit in the same plan as microneedling radiofrequency, at different times.
In subcision a fine needle or cannula is placed under the skin and the hard bands that tether the scar to the tissue below are cut or loosened, so that the surface can relax upwards. The procedure is done under local anaesthetic, and bruising and swelling afterwards can last from a few days to a few weeks. To reduce re-adhesion of the released area, some plans also use hyaluronic acid filler or a biostimulator. Products containing polynucleotides are planned to support tissue quality and elasticity in the scar area, often alternating with microneedling radiofrequency sessions. In some plans, microneedling radiofrequency sessions begin a few weeks after subcision. Details of polynucleotide products aimed at scar areas, such as Rejuran S, are on the relevant page.
Each method has different limits. Polynucleotide injections do not fill deep scars on their own and their effect is gradual; because the product is salmon-derived, people with fish allergy are assessed separately. Filler can quickly soften the look of some broad rolling scars, but its effect fades with time and it is not suitable for narrow scars. In dermatology practice, fractional lasers, chemical peels and targeted chemical applications for ice pick scars are also among the options used; which is needed depends on the scar type. One commonly used order is control of active acne first, then steps for bands and deep scars, then microneedling radiofrequency sessions for surface texture. This order is not a fixed rule and is adapted to how the scars respond in each person.
Who may not be suitable for acne scar treatment, and when should it start?
Starting scar treatment while active, inflamed acne continues is generally postponed until acne is under control. Pregnancy and breastfeeding, a cold sore or infection in the area, a tendency to keloids, electronic implants such as a pacemaker (for radiofrequency) and recent isotretinoin use are the main situations that can change the plan.
Scar treatments carried out while active pimples continue can mean racing against new inflammation and new scars; acne treatment is therefore run by a dermatologist or the relevant physician, and the skin is allowed to settle. Although some microneedling radiofrequency devices are known to be usable on acne-prone skin, this use is considered together with appropriate medical treatment and at the physician's decision. If you have taken oral isotretinoin, you must say when you stopped; there is no single consensus on the waiting time, and timing is set individually according to the type of procedure. The retinoid and acid products you use are also asked about before treatment. Whether to pause them and when to restart is told to you specifically.
In people with a tendency to keloids or raised scars, every procedure involving needles and heat can carry a new risk of scarring, so the need is weighed carefully. In darker skin the chance of pigmentation after treatment may be higher, so settings, skin preparation and sun protection are planned accordingly. In people with a history of cold sores, preventive measures may be discussed by the physician. If radiofrequency is to be used, a pacemaker, an implanted defibrillator and metal implants in the area are assessed separately; if polynucleotides are planned, fish allergy is asked about. Scar treatments are usually postponed during pregnancy and breastfeeding. Bleeding disorders and blood-thinner use are also assessed, especially for procedures that go under the skin, such as subcision. Suitability is decided by the physician by considering your health history and examination findings together.
What are realistic expectations for acne scar treatment, and how long does it take?
The realistic goal is reduced depth and shadowing of scars and a smoother-looking skin surface; complete disappearance of scars is not expected. The process is mostly spread over a few months to a year and involves more than one method and session. Response varies from person to person with scar type, depth, skin type and healing characteristics.
Scar tissue remodels slowly. A gap of a few weeks is left between sessions, and the effect of each session keeps developing in the following weeks, so it is normal not to see a marked change after the first sessions. The result is mostly assessed a few months after the last session. For a sound assessment, photographs taken in the same light, especially side lighting, are used at the start of treatment and at reviews. Boxcar and rolling scars respond more clearly in most plans, while change may stay more limited in narrow, deep scars. The number of sessions and the order of methods are reassessed at each review according to how the scars respond. Keeping review appointments helps the result be assessed correctly.
Scar tissue that has softened with treatment is generally not expected to return to its earlier state; however, as skin thins and volume decreases with age, scars can look more prominent again, and new pimples can leave new scars. Keeping acne under control, regular sun protection and suitable skincare are therefore important for maintaining the result. Maintenance sessions can be discussed in later years if needed. Before and after photographs of other people reflect their own skin structure; the change achievable in your skin can be discussed more realistically after your scars are examined for type and depth at consultation. Before deciding, it is advisable to think about the length of the process and the recovery periods against your calendar. A gradual plan in which the skin's response to each step is followed is often a safer approach than a busy, hurried schedule.
Frequently asked questions
Will my acne scars go away completely?
In most people acne scars can soften markedly with treatment, but complete disappearance is not expected. The aim is less depth and shadowing and a smoother skin surface. How much change can be achieved depends on scar type, depth, skin type and the methods chosen; this expectation is discussed openly before treatment begins.
Is microneedling radiofrequency enough for ice pick scars?
Because ice pick scars are narrow and deep, microneedling radiofrequency alone is often limited. Methods such as targeted chemical applications aimed at the scar walls or minor surgical techniques may come up in dermatology; microneedling radiofrequency can then be planned for surface texture. Which step is needed is decided after the number and depth of scars are examined.
Can I start scar treatment if I still get an occasional pimple?
A few occasional pimples are not always an obstacle, but when widespread, inflamed acne continues, scar treatment is generally postponed. Bringing acne under control first with appropriate treatment reduces new scars and protects the result of scar treatment. Needle-based procedures are not done while there are inflamed pimples in the area; timing is set by the physician according to the state of the skin.
How many sessions does acne scar treatment take?
The number of sessions varies from person to person. Microneedling radiofrequency is often planned as a few sessions a few weeks apart; if subcision or targeted methods are needed, they are added as separate steps. Skin-quality treatments such as polynucleotides can also be spread across sessions. The whole process usually spans a few months and is updated at each review according to how the scars respond.
Is acne scar treatment riskier in darker skin?
In darker skin, brown marks may be more likely to develop after needle-based and heat-delivering procedures. This does not mean treatment cannot be done; energy and depth settings, skin preparation before treatment and regular sun protection afterwards are planned accordingly. Insulated-needle systems are thought to help protect the upper layer; the choice is made by the physician.
Does using a dermaroller at home help acne scars?
The needles of home dermaroller devices are usually short and may not reach scar tissue in a meaningful way. Used in non-sterile conditions, over active pimples or with dulled devices, they can cause infection, irritation and pigmentation. A home dermaroller therefore does not replace a scar treatment planned after a physician's assessment; if you are thinking of using one, consult your physician first.
Can acne scars on the back and chest be treated too?
Yes, scars on the back and chest can also be assessed, but raised scars and keloids may be more common in these areas. Methods such as microneedling radiofrequency may be considered for depressed scars, while raised scars and keloids need different treatments and needle-based procedures are weighed carefully. Body skin can heal more slowly than facial skin, so session intervals and expectations are planned accordingly.
When can I return to work or school after acne scar treatment?
Recovery time depends on the method chosen. After microneedling radiofrequency, redness and pinpoint marks usually last a few days, and most people return to daily life after a short break. After subcision, bruising and swelling can last from a few days to a few weeks. If you have an important event, it is advisable to plan the session calendar accordingly and leave enough recovery time between the last session and the event.
This content is for general information and does not replace a personal medical assessment.