What causes acne scars and why do different treatments exist?

Acne scarring happens when acne damages deeper layers of skin, leading to indented scars (e.g., rolling, ice-pick, boxcar) or raised scars (hypertrophic/keloid). Treatment choice depends on scar type and severity.

What is subcision and how does it help acne scars?

Subcision is a minimally-invasive procedure where a fine needle or cannula is used to release fibrous bands tethering the scar down, allowing the skin to rise and stimulating collagen renewal. It’s especially useful for rolling scars that are tethered to deeper tissue.

What is TCA-CROSS and which scars is it best for?

TCA-CROSS (Chemical Reconstruction of Skin Scars) uses a high-strength acid (trichloroacetic acid) applied directly into each scar to induce a controlled healing response and new collagen formation. It’s especially effective for deep, narrow ice-pick scars that don’t respond well to other methods.

What is fractional laser resurfacing?

Non-ablative fractional lasers deliver energy in a fractional, pixelated pattern, producing discrete treatment zones across the skin rather than treating the entire surface. These treatment zones are separated by areas of untreated skin, which remain intact and support faster healing.
Because only a proportion of the skin is treated during each session, healing is typically quicker.
The risk of complications is reduced compared with fully ablative resurfacing.
Collagen remodelling is stimulated within the dermis without removing the epidermis.
This fractional delivery allows controlled skin remodelling while preserving surrounding skin, resulting in gradual improvement with minimal downtime.

What is Endoret and how does it support acne scar management?

Endoret PRP is rich in growth factors that stimulate fibroblast activity and collagen production and can support skin healing and collagen remodelling in acne scarring, particularly when combined with treatments such as laser or subcision. PRP is commonly used alongside procedures such as subcision, fractional laser resurfacing, or microneedling. It uses the patient’s own plasma and is primarily used to enhance skin quality rather than as a standalone scar-removal treatment.

What is scar elevation and how can it help boxcar acne scars?

Scar elevation is a minor surgical technique used to treat deep boxcar acne scars with sharp edges. The base of the scar is carefully released and lifted to the level of the surrounding skin, reducing the depth of the scar and making it less noticeable. The aim is to improve contour rather than completely remove the scar.

Can cryotherapy help hypertrophic or keloid acne scars?

Cryotherapy (freezing the scar tissue) is sometimes used for raised scars (hypertrophic or keloid) to reduce excess scar tissue. It can help flatten these scars by injuring the collagen matrix and triggering controlled healing. This technique is part of larger scar management strategies often discussed in dermatologist protocols for keloid scar care.

What about steroid injections for raised scars?

Steroid injections are a well-established method for treating hypertrophic and keloid scars. Injecting corticosteroids directly into the scar can help soften, flatten, and reduce scar tissue by decreasing collagen overproduction. This is often used in combination with other treatments (e.g., laser, cryotherapy) for best results.

Can vascular lasers help keloid scars?

Yes, particularly for:
Red, inflamed, symptomatic keloids
Itch, tenderness, and discomfort
Reducing scar activity and progression
Improving colour mismatch with surrounding skin

Vascular lasers target haemoglobin in abnormal blood vessels that supply the keloid. By reducing this blood supply, the laser can:

Decrease inflammation
Reduce erythema (redness)
Improve symptoms (itch/pain)
Slow further collagen overproduction

Importantly, vascular lasers are not primarily debulking treatments — they help control and stabilise keloids rather than flattening large, established scars on their own.