Is there one "best" treatment for acne scars?

No. The evidence consistently shows that combination approaches outperform any single modality. Network meta-analyses and international consensus recommendations support layered, staged plans matched to scar type (ice-pick, boxcar, rolling), scar depth and skin type — rather than "one device for everyone."

When should I start treating acne scars?

Earlier is generally better, but active acne should be controlled first. Treating scars while inflammation is still ongoing risks more pigmentation, new scarring and disappointing results. Once acne is settled and stable, treatment can usually begin within months — not years.

How many sessions will I need?

This depends on scar type, severity and the modalities chosen. Most plans involve multiple sessions over 6–12 months, spaced 4–8 weeks apart depending on the device and recovery pattern. We plan in stages so each session builds on the previous result rather than over-treating in one sitting.

Can acne scars be completely removed?

True structural scars rarely disappear entirely. Realistic goals are softening scar edges, reducing shadowing, improving texture and lifting indented areas — meaningful and durable improvement is achievable for most patients, but "back to baseline" is not. We discuss this clearly upfront so expectations match what the evidence supports.

I have darker or melanin-rich skin — is laser scar treatment safe?

Yes, with appropriate patient selection, device choice and conservative settings. Microneedling and RF microneedling are particularly useful in melanin-rich skin because they spare the surrounding tissue. Fractional ablative devices need more careful parameter selection to reduce post-inflammatory pigmentation risk. Care is delivered through our Skin of Colour Clinic where pigment-safety is the primary planning consideration.

What is subcision and is it painful?

Subcision uses a fine instrument under local anaesthetic to release the fibrous bands tethering rolling scars to deeper tissue. The procedure itself is well tolerated with local anaesthetic. There is usually some bruising and swelling for a few days afterward. Subcision is rarely used alone — it is typically combined with microneedling, fractional laser or filler within a staged scar program.

How much downtime should I expect?

It depends on the modality. Microneedling and RF microneedling typically cause 1–3 days of redness and mild swelling. Chemical peels range from minimal downtime (superficial) to a week of peeling (medium-depth). Fractional laser resurfacing usually involves 4–7 days of redness, mild swelling and skin shedding. Subcision causes bruising for a few days. Your plan is sequenced so downtime is predictable and manageable.

Acne

Acne Scarring Treatments — A Structured, Combination-Based Approach

Doctor-led acne scar care in Melbourne. Acne scarring is structural — evidence supports combination approaches (microneedling, RF microneedling, chemical peels, fractional laser, subcision) over single-modality. Staged plans classified by scar type (ice-pick, boxcar, rolling) and adapted for melanin-rich skin where pigmentation risk is managed deliberately.

By Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA

Published 2026-06-06 · Updated 2026-07-10 · 10 min read · Editorial policy

In brief

Acne scars are structural — combination approaches outperform single modalities (network meta-analyses + 2022 international consensus).
Active acne must be controlled first; treating scars during ongoing inflammation risks new pigmentation and new scarring.
Atrophic scars classify as ice-pick, boxcar or rolling — each responds best to different combinations.
Energy-based devices (fractional laser, RF microneedling) are first-line for many atrophic scars.
Microneedling + chemical peels ranks among the strongest combinations for improvement and patient satisfaction.
Subcision releases tethered rolling scars and is most effective inside a staged program, not used alone.
Distinguish true scars from PIH (brown marks) and PIE (red marks) — marks need different strategies.
Treatment is staged over 6–12 months; meaningful improvement is realistic, complete clearance is not.
Care is adapted for melanin-rich, pigmentation-prone skin through the Skin of Colour Clinic pathway.
Care provided across two Melbourne clinics — Ivanhoe and Diamond Creek.

Quick definition

Acne scarring is a structural skin change — disrupted collagen during the healing of inflamed acne lesions — not a surface problem. The main types are atrophic (indented: ice-pick, boxcar, rolling) and, less commonly, hypertrophic (raised). Treatment is combination-based and staged over 6–12 months. The strongest evidence supports layered approaches: microneedling and RF microneedling, chemical peels, fractional laser resurfacing and subcision — matched to scar type, depth and skin tone. Active acne must be controlled first, and post-acne marks (brown PIH or red PIE) are addressed with separate pigment or vascular strategies rather than scar-remodelling alone. Realistic goals: significant improvement, not complete clearance.

Acne scarring can persist long after active acne has settled, affecting skin texture, contour and confidence. At The Skin Doctor we approach acne scarring as a structural skin condition, not a surface problem.

Modern research consistently shows that:

there is no single best treatment for all acne scars
combination approaches are superior to standalone treatments
outcomes depend on scar type, depth, skin type and inflammatory history ^(1,2,5)

Our role is to assess these variables carefully and design a layered, evidence-based plan that prioritises safety, realism and long-term skin health.

Book a scarring consultation

Understanding acne scars

Acne scarring develops when inflammation disrupts normal collagen formation during healing.

Atrophic (indented) scars

Ice-pick scars — narrow, deep tracts
Boxcar scars — broader, sharply edged depressions
Rolling scars — undulating depressions caused by fibrous tethering

Post-acne marks (not true scars)

Some patients are most affected by lingering brown marks (post-inflammatory hyperpigmentation, PIH) or red marks (post-inflammatory erythema, PIE) rather than true indentations. These are treated differently from scarring and often respond best to targeted pigment or vascular strategies rather than scar-remodelling alone.

If marks are your main concern, assessment may be via:

Pigmentation consultation →
Pigmentation & tattoo removal →
Skin of Colour Clinic → (for melanin-rich or pigmentation-prone skin)
Post-inflammatory hyperpigmentation →

Correct diagnosis matters because each scar type responds differently.

What the evidence tells us

Recent systematic reviews, network meta-analyses and international consensus recommendations demonstrate that:

combination treatments outperform single-modality approaches ^(1,2)
microneedling combined with chemical peels ranks among the strongest options for improvement and patient satisfaction ⁽¹⁾
energy-based devices (fractional lasers and RF microneedling) are considered first-line tools for many atrophic scars ^(3,5)
treatment should be tailored and staged, rather than aggressive and one-off ^(4,5)

We use this evidence to guide treatment selection rather than “one device for everyone.”

Core treatment modalities we use

Microneedling and RF microneedling

Microneedling creates controlled micro-injury to stimulate collagen remodelling. Microneedle bipolar radiofrequency adds targeted thermal energy deeper in the dermis.

Best suited for:

rolling scars
mild-to-moderate boxcar scars
patients where pigment safety is a priority

High-quality evidence supports microneedling as an effective option, with better outcomes when combined with other modalities rather than used alone. ⁽¹⁾

See Collagen stimulation & skin remodelling → for the service pathway.

Chemical peels (often combined)

Chemical peels can contribute by:

improving surface texture and unevenness
supporting collagen remodelling over time
addressing post-acne pigmentation alongside texture

When combined with microneedling, peels are associated with:

greater improvement in scar appearance
higher patient satisfaction
better overall clinical outcomes ^(1,2)

See Skin peels & facials →.

Fractional laser resurfacing

Fractional lasers create microscopic treatment zones that stimulate collagen remodelling while leaving surrounding skin intact for faster recovery than fully ablative resurfacing.

Best suited for:

boxcar scars
mixed atrophic scarring
patients seeking stronger structural change

Systematic reviews report many patients experience meaningful improvement — typically partial improvement rather than complete clearance. ⁽³⁾ Downtime and pigmentation risk are carefully assessed before treatment.

See Facial resurfacing & skin renewal →.

Subcision (scar release)

Subcision releases the fibrous bands that tether rolling scars to deeper tissue. It is commonly used:

before microneedling or fractional laser
in combination plans where tethering is a key driver of shadowing and depth

Subcision is rarely used alone and is typically most effective within a staged program. ^(4,5)

See General scar treatment →.

Supportive and adjunctive treatments

Depending on your scar pattern and skin type, we may also include:

LED support to assist recovery and reduce inflammation — see Laser & light therapies for acne →
Treatment for persistent redness where appropriate — see Vascular spot laser →
Pigment stabilisation strategies when pigmentation risk is high — Skin of Colour Clinic → and Pigmentation consultation →

Why combination treatment works best

Acne scars are multi-layered and can involve:

surface texture change
dermal collagen loss
fibrotic tethering and contour distortion

For this reason, results are often best with stacked, complementary therapies, for example:

subcision + microneedling
microneedling + chemical peels
fractional laser + adjunctive therapies

Rather than over-treating in a single session, we focus on progressive, durable improvement with staged treatments. ^(1,2,5)

What to expect from treatment

improvements occur gradually, over months
multiple sessions are usually required
downtime depends on the modality (from minimal to several days)
realistic goals are discussed clearly upfront

Our aim is to:

soften scar edges
reduce shadowing
improve texture and overall skin quality

Complete removal is not realistic, but meaningful improvement is achievable.

Who is suitable for acne scar treatment?

You may be suitable if:

active acne is controlled or improving — for controlling active acne see Acne →, Laser & light therapies for acne → and Photodynamic acne therapy →
you have realistic expectations
you can commit to a staged plan

We take extra care in patients with:

melanin-rich or pigmentation-prone skin — Skin of Colour Clinic →
a history of pigmentation after inflammation or procedures — Pigmentation consultation →

Your next step

If acne scarring is affecting your confidence or skin quality, a consultation allows us to:

identify scar type and depth
discuss evidence-based options
design a personalised, staged treatment plan