Acne is one of the most common skin conditions seen in teenagers and young adults. With timely and appropriate treatment, active acne can be controlled. However, after acne heals, pits, depressed scars and uneven skin texture may remain on the face for a long time. These are known as acne scars.
Acne scars are not merely a cosmetic concern. Clearly visible scars can often affect a person’s confidence and social interactions. Therefore, choosing the right treatment for acne scars is important.
The most important point is that every acne scar is not the same, and therefore one treatment cannot be suitable for every scar. The type and depth of the scar, skin type, tendency for pigmentation, presence of active acne and the patient’s expectations must all be considered while deciding the treatment approach.
The major types of acne scars are Ice-pick scars, Boxcar scars and Rolling scars. In many patients, two or even all three types may be present on the same face.
Ice-pick Scars
Ice-pick scars are narrow but relatively deep. They appear like small openings or punctures in the skin and may extend into the deeper layers.
Therefore, creams or superficial treatments alone may not always provide the desired improvement.
In appropriate patients, a targeted treatment such as TCA CROSS may be used. This treatment focuses specifically on individual scars.
Boxcar Scars
Boxcar scars are depressed scars that may be round or rectangular in shape, with relatively well-defined edges. Some boxcar scars are superficial, while others may be deeper.
Depending on the depth of the scar and the condition of the skin, suitable options may include Microneedling, MNRF, Fractional CO₂ Laser, Subcision or combination treatments.
Rolling Scars
Rolling scars give the skin a wavy or uneven appearance. They may occur because of fibrous bands beneath the skin that pull the surface downward.
In suitable patients, Subcision can be an important treatment for such scars. Depending on the individual case, treatments such as MNRF or Fractional Laser may subsequently be considered.
Why Is Combination Treatment Sometimes Necessary?
Many patients do not have only one type of acne scar. Ice-pick, boxcar and rolling scars may occur together on the same face.
Therefore, instead of using one treatment for the entire face, a scar-specific and combination approach may be more appropriate.
For example, Subcision for rolling scars, TCA CROSS for selected ice-pick scars, and MNRF or Fractional CO₂ Laser for improving overall skin texture may be used according to the individual scar pattern.
In selected patients where there is significant volume loss due to scarring, dermal fillers may also be considered. However, fillers are not necessary for every acne scar. The decision should be based on the patient’s facial anatomy, scar structure and desired outcome.
Controlling Active Acne Is Equally Important
Before starting acne scar treatment, or alongside it, it is important to control active acne appropriately.
If new acne continues to develop repeatedly, there is a possibility of formation of new scars. Therefore, treatment should focus not only on existing scars but also on active acne control and long-term scar management.
Realistic Expectations Are Important
Having realistic expectations is an important part of acne scar treatment.
Not every scar can be completely eliminated. The main goal of treatment is to reduce the depth and visibility of scars, improve skin texture and make the overall appearance of the face smoother.
Many patients may require more than one sitting or a combination of different procedures to achieve good results. Therefore, patience and regular follow-up are also important parts of the treatment process.
Today, many advanced treatment options are available for acne scars. However, just because a particular laser or procedure is popular does not mean it is suitable for every individual.
The right acne scar treatment begins not with choosing a treatment, but with making the correct diagnosis.
Therefore, people with acne scars should not select a treatment on their own. A proper skin examination is important to understand the type and depth of the scars and to plan the most appropriate treatment.
Because every acne scar is structurally different — and therefore every patient should have an individualized treatment plan.
Dr. Sambhaji Tupe
Dr. Pratima Tupe
Skin, Hair & Cosmetology Consultants
Dr. Tupe Skin & Hair Clinic
Bhandup, Mumbai
Email: pratimatupe@gmail.com
Instagram: @dr_tupe_skin_and_hair_clinic
Website: tupeskinclinic.com
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