There are five distinct types, they respond to entirely different treatments, and most faces have more than one. That's why a single laser so often disappoints.
Acne scars aren't one condition. Rolling scars need subcision to release fibrous tethering. Boxcar scars respond to resurfacing. Ice pick scars need TCA CROSS or punch techniques. Raised scars need corticosteroid, not resurfacing. And flat brown marks aren't scars at all — they're pigment, and they need a pigment laser. Most patients have two or three types simultaneously, which is why treating with one modality corrects part of the problem and leaves the rest.
The most common thing patients tell me about previous acne scar treatment is that it helped, but not enough. They had a course of laser, saw genuine improvement, and were left still unhappy.
That's almost never because the laser failed. It's because the laser addressed one of the two or three different problems present on their face, and nobody separated them out first.
Understanding which types you actually have is the entire decision. Everything else follows from it.
Broad, shallow depressions with sloping, indistinct edges — the surface looks undulating rather than pitted. They're most visible in raking light, and they can appear to shift or soften depending on the angle.
The key thing about rolling scars is that the depression isn't the problem. The skin is being pulled downward by fibrous bands anchoring it to deeper tissue. The dip you see is a tether, not a loss of surface.
Which is why resurfacing alone so reliably underperforms here. You can smooth the surface repeatedly and the depression stays, because the thing pulling it down was never touched.
Round or oval depressions with sharply defined, near-vertical edges — like a small crater punched into the skin. Unlike rolling scars, the edge is distinct and the base is flat.
These are a genuine loss of tissue rather than a tethering problem, which makes them the type resurfacing handles best. Ablative treatment softens the sharp edges and stimulates collagen to partially fill the base.
Deeper boxcar scars sometimes benefit from punch techniques, but most respond meaningfully to resurfacing across a series.
Narrow and deep — small at the surface but extending well down into the dermis, like a puncture. Often mistaken for enlarged pores until you look closely.
These are the most difficult acne scars to treat, and it's worth knowing that upfront. Because they're deep and narrow, resurfacing can't reach the base without removing an unacceptable amount of surrounding tissue.
The techniques that address them — TCA CROSS, which applies focused acid to the base, and punch excision, which removes the scar surgically — are different disciplines from resurfacing. If ice pick scars are your dominant type, that's worth discussing directly rather than starting a laser series that won't reach them.
Firm, elevated scars where the body produced too much collagen rather than too little. More common on the chest, back, and jawline than on the face, and more common in deeper skin tones.
These are treated in the opposite direction from everything above. The goal is flattening rather than filling, which means corticosteroid rather than resurfacing. Treating a raised scar with a device intended to stimulate collagen risks making it worse.
Dense keloids that haven't responded to injection alone sometimes need laser-assisted steroid delivery, where microchannels are created first so the medication can actually penetrate the tissue.
Flat brown or red marks where acne used to be. The skin surface is completely level — only the colour has changed.
These are not scars. They're pigment, and they're frequently what patients mean when they say they have acne scarring. The distinction matters enormously, because pigment responds to a pigment laser and doesn't respond to resurfacing in the way texture does.
Many also fade substantially on their own over six to twelve months with sun protection alone. Treating them is reasonable if you'd rather not wait, but knowing they aren't permanent changes the calculation.
Run a fingertip over the area with your eyes closed.
If you can feel a change in the surface — a dip, a rough patch, a raised area — that's textural scarring, and it needs a treatment that addresses texture.
If the skin feels perfectly smooth and the problem is only visible as colour, that's pigmentation. Different problem, different treatment, and often one that resolves substantially on its own.
Most patients find they have both.
Tethered rolling scars. Volume loss in the scarred region. Surface texture. And frequently flat brown marks from the original inflammation sitting on top of all of it.
Four mechanisms. A practice offering one modality treats one of them — and the patient concludes, reasonably, that acne scar treatment doesn't really work.
The combination protocol addresses them in one session: subcision releases the tethering, a biostimulator occupies the released space so it doesn't re-adhere, resurfacing treats the surface, and red light therapy reduces post-procedure inflammation. Sequenced correctly, in one visit and one recovery.
Acne scarring disproportionately affects deeper skin tones, and ablative resurfacing carries higher post-inflammatory hyperpigmentation risk above Fitzpatrick IV.
Worth knowing: subcision is mechanical rather than energy-based, so it carries no pigmentation risk at any skin type. For the surface component, RF microneedling or Erbium are frequently better choices than CO2. See our guide to choosing a laser for your skin tone.
Treating scars while acne is still active means new scars form as old ones are corrected, and resurfacing over inflamed skin carries higher complication risk. If you're still breaking out meaningfully, that needs dermatologic management before cosmetic scar work begins — and any practice willing to start resurfacing on active acne is doing you a disservice.
Standard practice is a waiting interval after finishing a course before ablative treatment. Tell your provider if you've taken it recently, even if you think enough time has passed.
Meaningful reduction in scar depth. Smoother, more even surface. Scarring that's noticeably less apparent in ordinary lighting and much less apparent in photographs.
Not erasure. Scarring that formed over years does not resolve completely, and any provider promising smooth skin from a single protocol is overselling.
Most patients need two to four sessions spaced six to eight weeks apart. Where a biostimulator is involved, collagen continues developing for three to six months after each session — so what you see at three months isn't the final result.
The patients who end up happiest are consistently the ones who understood the timeline and the ceiling before they started.
Almost every acne scar consultation starts with someone showing me a face and calling it one thing. It's usually three or four things. Sorting out which types are actually present — and which of them the treatment being considered will and won't touch — is most of the appointment, and it's the part that determines whether they're satisfied a year from now.
What is the best treatment for acne scars?
There is no single best treatment, because acne scars are not one condition. Rolling scars need subcision to release the fibrous tethering beneath them. Boxcar scars respond to resurfacing. Ice pick scars typically need TCA CROSS or punch techniques. Raised scars need corticosteroid rather than resurfacing. Flat brown marks are pigment, not scarring, and need a pigment laser. Most patients have more than one type, which is why single-modality treatment often disappoints.
What is the difference between rolling, boxcar, and ice pick scars?
Rolling scars are broad, shallow depressions with sloping edges, caused by fibrous bands tethering the skin downward. Boxcar scars are round or oval with sharply defined vertical edges, like a small crater. Ice pick scars are narrow and deep, extending well into the dermis like a puncture. Each has a different underlying structure and responds to different treatment.
Does laser alone fix acne scars?
Not for rolling scars. A rolling scar is skin tethered downward by fibrous bands beneath it, and resurfacing smooths the surface without releasing the tether — so the depression remains. Laser works well for boxcar edges and general texture, but treating tethered scarring with resurfacing alone is the most common reason patients feel laser did not work for them.
What is subcision for acne scars?
Subcision uses a cannula passed beneath a depressed scar to sever the fibrous bands tethering it downward, allowing the skin to lift. It is the only technique that addresses the tethering itself — no laser, filler, or microneedling releases a fibrous band. It is the primary treatment for rolling acne scars.
Are the brown marks left after acne actually scars?
Usually not. Flat brown or red marks left after acne clears are post-inflammatory pigmentation rather than true scarring — the skin surface is level, only the colour has changed. These respond to pigment treatment such as picosecond laser and often fade substantially on their own over months. True scarring involves a change in skin texture that you can feel.
How many sessions do acne scars need?
Most patients need between two and four sessions spaced roughly six to eight weeks apart, depending on scar depth and extent. Where a biostimulator is part of the protocol, collagen continues developing for three to six months after each session, so the final result is well after the last appointment.
Can acne scars be completely removed?
No. Acne scarring can be significantly improved in depth, texture, and appearance, but scarring that formed over years does not resolve completely. Realistic outcomes are meaningful improvement rather than erasure, and any provider promising smooth skin from a single protocol is overstating what is achievable.
Should active acne be treated before scar treatment?
Yes. Treating scars while acne is still active means new scars continue forming as old ones are corrected, and resurfacing over inflamed skin carries higher complication risk. Active acne should be controlled first, which typically means dermatologic management before cosmetic scar correction begins.
Is acne scar treatment safe for darker skin tones?
Yes, with appropriate device selection. Subcision is mechanical rather than energy-based and carries no pigmentation risk, which makes it appropriate across all Fitzpatrick types. Ablative resurfacing carries higher post-inflammatory hyperpigmentation risk above Fitzpatrick IV, where RF microneedling or Erbium are frequently better choices.
Dr. Mortazavi will identify each scar type present and tell you which treatments address them — including the ones that won't.
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