Can scars be removed completely?

No — most scars are improved rather than removed. Atrophic acne scars typically improve 50–80% with a thorough combination plan over 4–6 months, which is usually highly satisfying. Hypertrophic and keloid scars can be flattened, softened and de-coloured but generally do not disappear entirely. Surgical and traumatic scars improve with collagen-supporting work and structured aftercare. Erasure is not a realistic goal — meaningful, sustained improvement is.

When should I start treating scars — and does the age of a scar matter?

Earlier is better. Newer scars respond more readily, and early intervention on red post-acne marks (PIE) and post-inflammatory hyperpigmentation (PIH) can prevent long-term pigmentation issues. For surgical scars, early silicone gel and (where appropriate) early laser meaningfully improve the final result. Established atrophic scars also respond — they just need more sessions over a longer timeline. There is no point at which a scar becomes 'too old' to treat.

Are scar treatments painful?

Discomfort varies by modality. Topical numbing cream is used for fractional laser, microneedling and subcision. Subcision and intralesional steroid involve a needle and are uncomfortable but brief. TCA CROSS produces a short burning sensation. Chemical peels tingle. Most sessions are well-tolerated, and we pace combination protocols across visits so no single session is unbearable.

Is scar treatment safe for melanin-rich and darker skin?

Yes — with carefully selected modalities and conservative settings. Patients with Fitzpatrick III–VI skin have a higher risk of post-inflammatory hyperpigmentation if treated aggressively, so we avoid devices and parameters that carry this risk, prioritise barrier-supporting topicals between sessions, and often start with non-energy options (peels, subcision, TCA CROSS) before adding laser. Patients in this group are often reviewed through our Skin of Colour Clinic pathway.

Will one treatment be enough?

Rarely. Scar treatment is almost always a staged course of 3–6 sessions over 4–6 months, sometimes with maintenance sessions added later. The exception is occasional single-modality work on a small, recent scar (e.g. one TCA CROSS on a single ice-pick scar). We are upfront about timelines and total expected sessions from the consultation — surprise extra sessions are not how we work.

What's the difference between true scars, PIH and PIE?

True atrophic scars are structural changes in the dermis — texture and contour are altered, and they do not resolve with skincare. Post-inflammatory hyperpigmentation (PIH) is brown discolouration left after inflammation (acne, eczema, injury) and fades over months — faster with topicals and SPF, slower in melanin-rich skin. Post-inflammatory erythema (PIE) is red discolouration after acne; it usually fades over weeks to months but vascular laser can accelerate it. Many patients have a mix — and the plan needs to address each separately because the treatments are different.

Can I treat scars while I still have active acne?

Generally no — active acne is controlled first. Treating atrophic scars while inflammatory acne is still cycling risks creating new scars and new pigmentation. The exception is early-stage PIE / PIH treatment on red and brown marks, which can run alongside ongoing acne care under medical guidance. Once acne is stable for 3–6 months, the structural scar work begins.

How is acne scarring treated differently from surgical or traumatic scars?

Atrophic acne scarring is typically distributed across the face with a mix of ice-pick, boxcar and rolling morphologies — so the plan combines subcision, TCA CROSS, fractional laser and microneedling across multiple sessions. Surgical scars are usually linear, predictable, and respond well to early silicone-gel support, fractional laser to soften and re-pigment, and sometimes vascular laser for residual redness. Hypertrophic and keloid scars are managed primarily with intralesional steroid (sometimes plus 5-FU), pressure and silicone — see our dedicated Hypertrophic & keloid scars page.

Outcome-based service

Scarring Treatments (Acne & Surgical)

Scarring Treatments at The Skin Doctor combine fractional laser (FRAC3), energy-based microneedling, subcision, TCA CROSS, peels and intralesional steroid to improve acne, surgical, traumatic and burn scars. Treatment is staged over 4–6 months, classified by scar morphology and skin type, and adapted for melanin-rich skin where pigmentation risk needs deliberate management.

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

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

In brief

Multiple modalities combined per scar type and skin type — no single device fits all scars.
Atrophic (ice-pick, boxcar, rolling), hypertrophic, keloid and pigmented scars all addressed.
Course of 3–6 sessions over 4–6 months is typical — staged pathway, not a one-off.
Early intervention on new scars and red post-acne marks (PIE / PIH) prevents long-term pigmentation.
Realistic outcome is 50–80% improvement — meaningful and satisfying, but not erasure.
Atrophic acne scars are classified by morphology — each subtype responds best to different modalities.
Suitable for melanin-rich skin (Fitzpatrick III–VI) with carefully selected modalities via the Skin of Colour Clinic pathway.
Distinguishes true scars from post-inflammatory pigmentation (PIH) and erythema (PIE) — these need different strategies.
Active acne must be controlled before atrophic scar treatment — to avoid creating new scars and pigment.
Hypertrophic and keloid scars handled on a dedicated pathway — different physiology, different management.

Quick definition

Scarring Treatments at The Skin Doctor is a doctor-led, combination-based pathway for atrophic acne scarring (ice-pick, boxcar, rolling), surgical and traumatic scars, and pigmented post-inflammatory marks. We use fractional laser (FRAC3), energy-based microneedling, subcision, TCA CROSS, chemical peels, and intralesional steroid — chosen per scar morphology, depth and skin type, never one-device-fits-all. Treatment is staged over 3–6 sessions across 4–6 months, with a realistic target of 50–80% improvement — not erasure. Hypertrophic and keloid scars run on a dedicated pathway. Care is adapted carefully for melanin-rich skin through the Skin of Colour Clinic.

Scars are a normal part of the skin’s healing process — but not all scars behave the same way, and not all require the same approach. At The Skin Doctor, scarring is treated as a structural skin issue, not just a cosmetic concern. Our goal is to improve texture, softness, colour and comfort while respecting how your skin heals and remodels over time.

All scar treatment plans are doctor-led, evidence-informed and tailored to scar morphology, location, age, your individual skin characteristics, and your goals.

Types of scars we treat

General scars — atrophic, surgical, traumatic, post-procedure

Including acne scars (ice-pick, boxcar, rolling), surgical scars (post-mole removal, post-skin-cancer excision, post-Caesarean, abdominal), traumatic and burn scars, and post-procedure scars. These scars may be flat, indented, irregular or discoloured, and respond well to texture- and collagen-supporting treatments combined with structured aftercare.

For broader context across the full atrophic acne scar pathway, see our acne scarring treatments article → and the dedicated general scar treatment → page.

Hypertrophic and keloid scars

Some scars heal with excess collagen production, becoming raised, firm, itchy or painful. Keloid scars may extend beyond the original injury and continue to grow over time. These scars require specialist assessment and cautious management — aggressive or inappropriate treatment can worsen them.

These are handled on a dedicated pathway — see Hypertrophic & keloid scar treatment →.

Can acne scars be removed?

Realistically — improved substantially, not erased. A staged combination plan (subcision, TCA CROSS, fractional laser, RF microneedling) typically achieves 50–80% improvement in atrophic acne scarring over 4–6 months, which most patients find genuinely satisfying. “Scar removal” in the sense of returning the skin to exactly how it was before is not something any honest clinic can offer — the realistic goal is smoother texture, softer scar edges and far less visible shadowing. For a deeper look at what the evidence supports, see the acne scarring treatments article →.

Modalities we use

Most scars need more than one modality. The mix is chosen per scar type, depth and skin type — not by what’s fashionable.

Fractional non-ablative laser (FRAC3 / 1064 nm Nd:YAG)

Delivers controlled micro-columns of laser energy into the dermis to stimulate collagen remodelling without ablating the skin surface. Particularly useful for atrophic acne scarring, surgical scars and texture irregularities. The 1064 nm wavelength is safer in melanin-rich skin than shorter-wavelength fractional lasers.

Energy-based microneedling (RF microneedling)

Combines microneedling with radiofrequency energy delivered into the deeper dermis. Strong for rolling and boxcar atrophic scars and for skin-quality improvement around scarred areas. Sometimes combined with topical agents at the time of treatment.

Subcision

A specialised technique that uses a fine needle or cannula to release the fibrous bands that tether rolling scars to the deeper dermis. Often the single most effective treatment for rolling-type atrophic acne scars. Bruising is expected for several days after.

TCA CROSS

Trichloroacetic acid Chemical Reconstruction of Skin Scars — a focused application of high-concentration TCA into the base of individual deep scars (particularly ice-pick scars) to stimulate localised collagen rebuilding. Done one scar at a time across multiple sessions.

Chemical peels

Medical-grade peels (glycolic, salicylic, mandelic, Jessner’s, mid-depth TCA) for skin-quality improvement around scarred areas, post-inflammatory pigmentation, and as part of a staged surface-rejuvenation pathway. See skin peels and facials → for more on this modality.

Intralesional steroid (for raised scars)

For hypertrophic and keloid scars, intralesional corticosteroid (sometimes combined with 5-FU) is the cornerstone of management. Delivered into the scar at carefully spaced intervals. Handled on the dedicated hypertrophic & keloid scars → page.

Silicone gel and pressure support

For new scars, surgical scars, and raised scars, daily silicone gel and (where appropriate) pressure support significantly improve final cosmetic outcome. The least glamorous but among the most evidence-supported parts of scar care — usually run for 3–6 months from the time the wound closes.

Care for pigmentation-prone and melanin-rich skin

Patients with melanin-rich skin (Fitzpatrick III–VI) have a higher risk of post-inflammatory hyperpigmentation after aggressive scar treatment. We adapt the plan by:

using safer wavelengths (1064 nm Nd:YAG) for laser work
starting with non-energy modalities (peels, subcision, TCA CROSS) where appropriate
emphasising pigment-stabilising topicals between sessions
using conservative settings and longer intervals between sessions

Patients in this group are often reviewed through our Skin of Colour Clinic pathway.

Book a scar consultation

If a scar is bothering you — visually or physically — a medical scar consultation can clarify what type of scar you have and what can realistically be improved. The booking panel in the sidebar takes you to the consultation.

You may also find these helpful:

What to expect

Scar assessment and classification

Scars are classified by type — atrophic (ice-pick, boxcar, rolling), hypertrophic, keloid, or pigmented — and by depth, tension and age. Fitzpatrick skin type and any active inflammation (e.g. ongoing acne) are also assessed because these change the safest pathway.
Tailored combination plan

Most scars need more than one modality. Fractional laser (FRAC3), energy-based microneedling, subcision, TCA CROSS, chemical peels and intralesional steroid are combined based on scar morphology and skin type — not a one-device-fits-all plan.
Staged treatment sessions

A course of 3–6 sessions over 4–6 months is typical. Sessions are spaced to allow healing and collagen turnover between treatments; combination protocols may use different modalities at different sessions.
Aftercare and prevention

Daily broad-spectrum SPF 50+, gentle barrier-supporting skincare, silicone gel for raised scars, and (where appropriate) pressure support form the foundation of long-term scar care.
Review at 6 and 12 months

Clinical photographs track progress. Additional sessions or maintenance work can be added if the result has not stabilised — particularly for deeper atrophic scars or larger scarred areas.

Results timeline

After first session Mild texture improvement; redness, swelling and pinpoint bleeding settle over 24–72 hours.
6–8 weeks Early collagen response visible — improved smoothness, tone and softening of established scars.
3–4 months Cumulative improvement across the treatment course becomes obvious; further sessions are layered in based on response.
6 months Final results from the initial course become visible — typically 50–80% improvement in atrophic scars and meaningful flattening / softening of raised scars.
12 months Full collagen remodelling result. Further maintenance sessions can be added; long-term scar care (SPF, silicone, pressure where applicable) continues.

Ideal candidate

Adults with atrophic acne scars — ice-pick, boxcar or rolling
Patients with red post-acne marks (PIE) and post-inflammatory hyperpigmentation (PIH)
Patients with surgical scars — post-mole removal, post-skin-cancer excision, post-Caesarean, abdominal or limb
Patients with traumatic, burn or injury scars
Patients with new scars who want early intervention to optimise healing — silicone, pressure, early laser
Patients wanting a staged, combination-based approach rather than a single device or modality
Most Fitzpatrick skin types when treatments are carefully selected — including melanin-rich skin via the Skin of Colour Clinic pathway
Patients with realistic expectations — 50–80% improvement is meaningful and satisfying; erasure is not the goal

Frequently asked questions

Can scars be removed completely?

No — most scars are improved rather than removed. Atrophic acne scars typically improve 50–80% with a thorough combination plan over 4–6 months, which is usually highly satisfying. Hypertrophic and keloid scars can be flattened, softened and de-coloured but generally do not disappear entirely. Surgical and traumatic scars improve with collagen-supporting work and structured aftercare. Erasure is not a realistic goal — meaningful, sustained improvement is.
When should I start treating scars — and does the age of a scar matter?

Earlier is better. Newer scars respond more readily, and early intervention on red post-acne marks (PIE) and post-inflammatory hyperpigmentation (PIH) can prevent long-term pigmentation issues. For surgical scars, early silicone gel and (where appropriate) early laser meaningfully improve the final result. Established atrophic scars also respond — they just need more sessions over a longer timeline. There is no point at which a scar becomes 'too old' to treat.
Are scar treatments painful?

Discomfort varies by modality. Topical numbing cream is used for fractional laser, microneedling and subcision. Subcision and intralesional steroid involve a needle and are uncomfortable but brief. TCA CROSS produces a short burning sensation. Chemical peels tingle. Most sessions are well-tolerated, and we pace combination protocols across visits so no single session is unbearable.
Is scar treatment safe for melanin-rich and darker skin?

Yes — with carefully selected modalities and conservative settings. Patients with Fitzpatrick III–VI skin have a higher risk of post-inflammatory hyperpigmentation if treated aggressively, so we avoid devices and parameters that carry this risk, prioritise barrier-supporting topicals between sessions, and often start with non-energy options (peels, subcision, TCA CROSS) before adding laser. Patients in this group are often reviewed through our Skin of Colour Clinic pathway.
Will one treatment be enough?

Rarely. Scar treatment is almost always a staged course of 3–6 sessions over 4–6 months, sometimes with maintenance sessions added later. The exception is occasional single-modality work on a small, recent scar (e.g. one TCA CROSS on a single ice-pick scar). We are upfront about timelines and total expected sessions from the consultation — surprise extra sessions are not how we work.
What's the difference between true scars, PIH and PIE?

True atrophic scars are structural changes in the dermis — texture and contour are altered, and they do not resolve with skincare. Post-inflammatory hyperpigmentation (PIH) is brown discolouration left after inflammation (acne, eczema, injury) and fades over months — faster with topicals and SPF, slower in melanin-rich skin. Post-inflammatory erythema (PIE) is red discolouration after acne; it usually fades over weeks to months but vascular laser can accelerate it. Many patients have a mix — and the plan needs to address each separately because the treatments are different.
Can I treat scars while I still have active acne?

Generally no — active acne is controlled first. Treating atrophic scars while inflammatory acne is still cycling risks creating new scars and new pigmentation. The exception is early-stage PIE / PIH treatment on red and brown marks, which can run alongside ongoing acne care under medical guidance. Once acne is stable for 3–6 months, the structural scar work begins.
How is acne scarring treated differently from surgical or traumatic scars?

Atrophic acne scarring is typically distributed across the face with a mix of ice-pick, boxcar and rolling morphologies — so the plan combines subcision, TCA CROSS, fractional laser and microneedling across multiple sessions. Surgical scars are usually linear, predictable, and respond well to early silicone-gel support, fractional laser to soften and re-pigment, and sometimes vascular laser for residual redness. Hypertrophic and keloid scars are managed primarily with intralesional steroid (sometimes plus 5-FU), pressure and silicone — see our dedicated Hypertrophic & keloid scars page.

References

Microneedling in the treatment of atrophic scars — a systematic review of randomised controlled trials. Int Wound J. 2021.DOI: 10.1111/iwj.13559
Fractional CO2-laser versus microneedle radiofrequency for acne scars — a randomized split-face trial. Lasers Surg Med. 2023.DOI: 10.1002/lsm.23655

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Medically reviewed by Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA · Published 2026-06-06 · Updated 2026-07-10 · Editorial policy