When the acne itself finally settles, the scars are often what’s left behind. They’re the part that nobody warned you about in the chemist aisle, and they’re frequently the bigger long term concern than the acne ever was. The skin has changed and won’t quite return to how it was without targeted work.
Acne scars come in two main families: atrophic and hypertrophic. They look different, behave differently, and respond to different treatments. Getting the diagnosis right is half the work of treating them well. Here’s a clear walk through both types, the subtypes within each, and the realistic approach to genuinely shifting them.
Atrophic scars: when skin sinks
Atrophic scars are the more common type from acne. They form when the body’s healing response after an acne lesion produces less tissue than it should, leaving an indented or depressed mark in the skin. There are three main subtypes worth recognising.
Ice pick scars
Narrow, deep, V shaped scars that look like the skin has been punctured with a fine point. They’re often found on the cheeks and can be the trickiest atrophic scars to treat because the damage extends quite deep.
Boxcar scars
Wider, U shaped depressions with sharper edges, like small craters. They can be shallow or deep, and respond reasonably well to a range of treatments depending on depth.
Rolling scars
Broader undulations across the skin surface, where bands of fibrous tissue pull the skin down from underneath. They give the skin a slightly wavy or rolling appearance under angled light. Often the most amenable to combined treatment approaches.
Hypertrophic and keloid scars: when skin overgrows
Hypertrophic scars and keloids are the opposite problem. Rather than too little healing tissue, the body produces too much, leaving raised firm scars that stand proud of the surrounding skin.
Hypertrophic scars stay within the boundary of the original lesion. Keloids extend beyond the original boundary and can continue to grow over time. Both are more common on the chest, back, shoulders and jawline, and are more likely in people with darker skin tones, where the healing response is more vigorous.
Treatment for raised scars is fundamentally different to atrophic scars. Treatments that build collagen would make raised scars worse. The work is around modulating the existing scar tissue rather than stimulating more.
Treating atrophic scars
Atrophic scar work usually involves a combination of treatments running over months to years.
Microneedling at appropriate depth
The workhorse for atrophic scars. Properly executed needling stimulates collagen in the depressed areas, gradually filling them from underneath. Best for boxcar and rolling scars, with limited but real effect on ice pick scars.
SQT bio liquid microneedling
For sensitive skin types and darker skin tones where traditional needling carries higher pigmentation risk. Gentler but still effective over a longer course.
TCA CROSS for ice pick scars
Highly specific application of trichloroacetic acid into individual ice pick scars, encouraging the depths to heal upwards. Targeted, slow but effective for stubborn deep scars.
Plaxel Plasma for specific scars
Useful for individual prominent scars and for some boxcar configurations.
DMK enzyme work alongside
Doesn’t directly fill scars but supports the skin chemistry that helps any structural treatment work better.
Treating hypertrophic scars
Raised scars need a different approach. Gentle pressure therapy, silicone gel sheeting and specific topical actives can soften hypertrophic scars over months. Steroid injections, which are outside our scope and typically a GP or dermatologist referral, are sometimes appropriate for stubborn keloid scars.
We’ll always assess raised scars carefully and refer where appropriate. Treating them with collagen building approaches would make them worse, so the diagnostic step matters.
Realistic timelines and combination work
Atrophic scar treatment is measured in months and often years rather than weeks. A course of microneedling for moderate scarring typically runs six to eight sessions over twelve months, with continued improvement visible for up to two years after the final session as collagen continues to remodel.
Combination approaches consistently outperform single treatments. The protocols we build often include needling sessions alongside DMK enzyme work, TCA CROSS for specific ice pick scars, and ongoing home care with appropriate active ingredients. The clients who do best treat scar improvement as a long project rather than a quick fix.
Realistic expectations matter. Scars can be substantially improved, sometimes dramatically. Complete restoration to never having had acne is rarely achievable. The goal is meaningful improvement that makes the scarring no longer a daily concern.
Frequently asked questions
Can acne scars be completely removed?
Substantial improvement is achievable for most acne scarring, often dramatic with the right combination of treatments and time. Complete restoration to skin that never had acne is rarely possible. The realistic goal is meaningful improvement that makes the scarring no longer a daily concern, and most clients are very happy with what’s achievable with patient course based work.
What about laser treatment for acne scars?
Some laser treatments work well for specific atrophic scar types in the right hands. Others carry significant risk on darker skin tones and can cause pigmentation problems that are worse than the original scars. We generally favour microneedling, SQT, TCA CROSS and Plaxel Plasma over laser approaches, partly for safety on a wider range of skin tones and partly because the results are at least as good in our experience.
How long until I see results?
Microneedling for scarring builds visible improvement over months rather than weeks. Most clients see meaningful change at three to six months into a course, with continued collagen remodelling for up to two years after the final session. Patience pays off considerably with scar treatment.
