Acne Scars: What Procedures Can Improve Them?

It depends on the depth and shape of the scar and your skin type. RF needling (Virtue RF) delivers radiofrequency heat directly into the dermis through microneedles, which is advantageous for dermal remodeling in deep depressions; downtime is relatively short, and the risk of pigmentation tends to be comparatively low. Fractional lasers such as Fraxel induce regeneration from the surface, so they are known to be advantageous for shallow scars and when skin texture, pores, and pigmentation are also concerns.

It is not a matter of one being better than the other; they are tools with different expected effects. If deep rolling or boxcar scars are the main issue, the plan centers on RF needling; if surface irregularities and tone problems are prominent, the plan centers on fractional laser. They are often used in staggered sessions. The most efficient approach is to set priorities after a diagnosis.

If the scar has an adherent base, subcision may be necessary. In cases like rolling scars where fibrous bands under the dermis pull the skin downward, delivering energy to the surface alone cannot fully elevate the depression if the tension remains. Subcision is a procedure that uses a special needle to cut these adhesive bands and release the scar base; it has been described as an effective and safe approach in reviews examining treatments for depressed acne scars.

Subcision works well in combination rather than alone. Following it with collagen-inducing procedures such as RF needling or JUVELOOK helps fill the released space with new collagen and reduces the likelihood of the released area sinking again. If pulling the skin with your hand flattens the scar, it is likely adhesive; we recommend having it checked during a consultation.

Although individual results vary, improvement is often noticeable after 3 to 5 sessions at intervals of about 4 weeks. Scar treatment is a process that waits for new collagen to fill the damaged dermis, so changes appear gradually over weeks rather than immediately after the procedure, and results accumulate with successive sessions.

The number of sessions required depends on the depth, extent, and type of scar, as well as your skin type. Older, deeper scars may require a longer commitment. Rather than aiming for 100% improvement, a realistic approach is to gradually improve scars to a level where they are not noticeable under normal lighting. It is advisable to determine a treatment plan in consultation with a dermatologist.

We plan the sequence by distinguishing between 'color' issues such as redness and pigmentation, and 'texture' issues such as depressions. Red marks (erythema) and brown marks (post-inflammatory hyperpigmentation) at the site of healed acne may fade over time, but depressed scars are a structural problem that does not resolve on its own. Since color and texture respond to different treatments, a combined approach is needed rather than trying to address both with a single procedure.

Generally, active acne and inflammation are stabilized first. Then, redness is managed with vascular-targeting lasers, and brown pigmentation is managed with toning-type lasers, while remodeling treatments for depressed scars are performed. RF needling causes minimal epidermal damage, so the risk of pigmentation is relatively low, making it an option even for pigmented skin. Since the priority depends on your skin's condition, we recommend deciding the sequence through a consultation.