[vc_row type=”in_container” full_screen_row_position=”middle” equal_height=”yes” content_placement=”top” scene_position=”center” text_color=”dark” text_align=”left” top_padding=”50″ bottom_padding=”0″ overlay_strength=”0.3″ shape_divider_position=”bottom” shape_type=””][vc_column column_padding=”no-extra-padding” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ column_shadow=”none” column_border_radius=”none” width=”2/3″ tablet_text_alignment=”default” phone_text_alignment=”default” column_border_width=”none” column_border_style=”solid”][vc_column_text]Acne scarring often requires a staged, combination approach. At Midland Skin, we tailor each acne treatment session to your individual scar pattern, skin type, and  treatment response

. Depending on your needs, on or more of the following may be combined in a single acne scar treatment session:

  • Subcision – releases tethered scars using a needle or cannula
  • Fractional Laser Resurfacing – stimulates collagen production via precise, microscopic thermal injuries. Reduces the height of the base of scars. Contracts scars. Tightens skin.  Technologies may include CO₂ (DeepFx, ActiveFx), Erbium:YAG (ProFractional), Erbium:Glass (Ultraclear), Halo hybrid lasers, or 1064 nm fractional nano-lasers.
  • Spot Laser Resurfacing & Laser Coring – smoothes sharp vertical edges of scars.
  • TCA CROSS – high-strength trichloroacetic acid to contract scars and build base of scars
  • Scar Excision – surgically removes deep scars using punch or elliptical excision.
  • Acne scar pigmentation treatment – this may include a topical treatments, and laser toning.
  • Acne scar redness reduction – using vascular laser
  • Biostimulators (e.g. PDLLA, PLLA, polynucleotides) – induce collagen production, delivered by injection or transdermally.
  • Hyaluronic Acid Fillers – immediately restore volume and contour beneath atrophic scars.

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Types of acne scars

Acne scars appear in several patterns, depending on how the skin heals after inflammation. The three main types are:

  • Ice-pick scars – narrow, deep holes that extend into the dermis, resembling tiny punctures made with a fine needle.
  • Rolling scars – caused by fibrous bands under the skin that pull it down unevenly, producing a wave-like or undulating surface.
  • Boxcar scars – round or oval depressions with sharp edges, giving the skin a pitted or cratered look.

This classification is, however, a significant oversimplification. Most people have overlapping scar types with varying depths and underlying tissue loss. There is often field damage, meaning that scarring extends beyond the visible indentations seen on the surface. Many patients also experience volume loss from thinning of the dermis or subcutaneous fat, which makes the skin appear hollowed or uneven.

In addition to these structural changes, scars may also show colour and tone differences, such as:

  • Hyperpigmentation – increased pigmentation leaving dark marks.
  • Hypopigmentation – loss of pigment leading to lighter patches.
  • Erythema – persistent redness caused by dilated surface vessels.

Why combine treatments for acne scarring?

No single treatment can address every component of acne scarring which is often complex. Combining methods allows each to target what it does best. These treatments are often layered or staged across multiple sessions depending on the type and severity of scarring, skin type, and individual response. Only the treatments that are required, or deemed safe, are provided in any given session. Sessions are spaced approximately every 3 months, typically requiring 2–5 visits. Treatments can be repeated beyond this, for as long as improvement is seen.

What UK NICE and NHS guidance says about acne scar treatment

The UK National Insitute of Clinical Excellence (NICE NG198) (updated 2023) recommends individuals suffering from acne scarring should be referred to a consultant dermatologist led team with expertise in scarring management for consideration of CO2 laser, punch elevation or glycolic acid peels .

The UK NHS (National Health Service)  says, “Treatments for acne scarring are regarded as a type of cosmetic surgery, which is not usually available on the NHS. Most scar treatments are classified as cosmetic in the NHS and are usually accessed privately…..Prices can vary widely (from around £400 to more than £10,000) depending on the type of treatment needed.”

What do the individual treatments do?

Subcision – A fine cannula releases fibrotic strands anchoring rolling scars. Bruising and swelling are common; repeat sessions may be needed. Local anaesthetic injection often required
Learn more about subcision.

TCA CROSS – High-strength trichloroacetic acid is placed precisely into ice-pick and box scars to stimulate new collagen. Concentrations vary (50-90%) depending on scar and skin type.
Learn more about TCA CROSS.

Spot resurfacing to smooth the edges – Using a small ablative CO2 or Er:YAG tip, this targets the hard edges of selected boxcar scars before full-face blending. It helps scars merge more naturally with surrounding skin while limiting overall downtime.

Fractional laser resurfacing – CO2 and Er:YAG fractional lasers trigger collagen remodelling through microscopic columns of ablation. Reported improvement ranges are often 30–70% across studies, with redness lasting about a few weeks or more depending on settings and skin type.
Learn more about fractional laser resurfacing.

Restore contour
When scars leave volume gaps, hyaluronic acid fillers or PDLLA/PLLA biostimulators can rebuild structure. Effects develop gradually and usually need maintenance.

Common questions patients ask

What are the results like?
Gradual improvement is expected with each session in the majority of individuals. Overall, most patients experience some degree of improvement, in the order of 20–70% improvement depending on scar type, skin response, prior treatments, and healing capacity. While visible improvement is common, complete resolution of scarring is never achievable, and as for any other medical treatment, no guarantee of outcome or degree of improvement can be given.

How many sessions will I need?
An average of 3-5, at three monthly intervals. Sessions are continued for as long as benefit is seen.

Who should not have this treatment?

Not everyone benefits equally from acne scar treatments. While these procedures can make a visible difference for many, they also demand time, patience and realistic expectations.

You are not suitable for treatment if the following apply:

  • Unrealistic expectations – if you are hoping for completely smooth, flawless skin. Improvement, not perfection, is the realistic goal.
  • Desire for rapid results – collagen remodelling takes time, and . Even with effective procedures, visible change develops gradually over several months. You should be able to commit to this timeline.
  • Body dysmorphic disorder (BDD) or significant body image concerns – treatment can worsen distress in individuals struggling with body image. In these situations, psychological support should come before any aesthetic procedure.
  • Active acne or unstable skin conditions – treating active inflammation increases the risk of infection and poor healing. Procedures are deferred until the skin is stable.
  • Uncontrolled medical conditions or interfering medications – certain systemic illnesses or drugs can increase bleeding risk, delay healing or photosensitise the skin. These need to be reviewed before treatment.
  • Inability to follow aftercare instructions – successful healing requires commitment to wound care, strict sun protection and attending follow-up reviews.

A careful consultation determines whether treatment is suitable and when to start. In some cases, we recommend beginning with small test areas or medical therapy before proceeding to procedural treatment.

Downtime, risk and aftercare: what a typical week looks like

  • Days 1–2: heat, swelling and tightness tend to peak.
  • Days 3–6: fine crusting; keep moisturised; do not pick.
  • By Day 7: surface healed; redness can persist for weeks and fades gradually.

Antiviral cover is used when indicated. SPF 50 and strict sun avoidance are essential for at least eight weeks. Healing varies by age, skin type and energy used. Some redness can last months. Gradual improvement continues for up to a year as collagen remodels.

Key takeaways

  • Improvement is gradual and variable. Not all scars respond.
  • Combining subcision, CROSS, spot resurfacing and fractional laser offers the most flexibility.
  • Downtime averages a week; redness can linger.
  • There is a real, though small, risk of non-response or worsening.
  • NICE provides high-level guidance only. Success depends on specialist expertise.

References

  1. Liu, F., Zhou, Q., Tao, M., Shu, L., & Cao, Y. (2024). Efficacy and safety of CO2 fractional laser versus Er:YAG fractional laser in the treatment of atrophic acne scar: A meta-analysis and systematic review. Journal of Cosmetic Dermatology, 23(9), 2768–2778. https://doi.org/10.1111/jocd.16348
  2. Luong Nguyen Dac Thuy, T., Trang, V. T. T., Tran, N. N., & Doan, T. P. T. (2024). Comparing the use of 80% trichloroacetic acid and 50% trichloroacetic acid for the treatment of ice pick acne scars. Dermatologic Surgery, 50(9), 847–850. https://doi.org/10.1097/DSS.0000000000004228
  3. National Institute for Health and Care Excellence. (2021, updated 2023). Acne vulgaris: management (NG198). https://www.nice.org.uk/guidance/ng198
  4. Ptaszek, B., et al. (2025). The use of a fractional laser in acne scar treatment — A systematic review. Life, 15(6), 915. https://doi.org/10.3390/life15060915
  5. Shi, V. J., Ma, M. S., Koza, E., et al. (2024). Subcision with and without suction for acne scars: A split-faced, rater-blinded randomized control trial. Archives of Dermatological Research, 316(7), 344. https://doi.org/10.1007/s00403-024-03128-4

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What should I do next?

Contact us here to arrange an acne scarring consultation where you can discuss your needs with a medical specialist. Our fees can be reviewed here.

Author Details

Author: Dr Sajjad Rajpar

Date last reviewed: 1 October 2025

Conflict of interest and disclaimer

This information is based on the views of a UK Consultant Dermatologist (a doctor who is on the specialist register for Dermatology, the equivalent of which is ‘Board certified’ in the USA) who has supervised many patients successfully with acne over 20 years of practice. This information is intended for patients of this Clinic and under our care only. No part of this document should be construed as medical advice to those not under the care of this Clinic and under our care. Practices vary nationally and internationally, and we do not wish to contravene advice you have been provided by your own physician.

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