Acne Scars: Why Should Treatment Methods Differ by Type?

Hello, this is Jamsil Gounsesang Dermatology Clinic.

Even after acne has calmed down, the marks left on the skin

become another concern for many people. Makeup

doesn't sit well, the skin texture becomes uneven, and

every time you look in the mirror, it catches your eye. Many people have already tried treatment several times

but haven't felt a big difference and are beginning to give

up, wondering, “Is this just something I have to live with?”

But the most important thing in acne scar treatment is

not the number of procedures, but the correct approach.

That is because not all scars can be treated the same way.

Even if they look similar on the surface, the treatment

strategy must change completely depending on the scar's

shape, depth, and the type of tissue adhesion.

In this post, we will look at the characteristics and treatment

methods by scar type, why personalized treatment is

necessary, and further, why it is important to receive a

diagnosis from a specialist.

1. Characteristics and Treatment Methods by Acne Scar Type

Acne scars are not a single form; they have various

structures, depths, and widths, and can be broadly

classified into four types depending on the pattern of skin

tissue damage. Each scar differs not only in its visible

appearance, but also in the condition of the fibrous tissue

under the skin, the extent of adhesion, and the depth of

damage, so the treatment method must also differ.

The first is the ice pick type.

These are narrow, deep scars that look as if they were

pierced by a needle, and because they often extend deep

into the dermis, improvement with laser alone is difficult to

expect. In such cases, punch excision to remove the scar,

or subcision to release adhesions, is combined with

regenerative treatment.

The second is the boxcar type.

These scars have clearly defined edges and a sunken,

square-like shape, and they often occur around the cheek-

bone area. They are mid-depth scars, but because they are

often spread over a broad area, subcision and fractional

laser are used together, and collagen regeneration

injections may be added if needed.

The third is the rolling type.

These scars have unclear borders, and the skin as a whole

looks uneven like waves. Because widespread adhesions

are the cause, extensive release procedures should come

first, and then dermal regeneration should be induced with

radiofrequency devices or collagen injections to expect

effective results.

The last is the hypertrophic or keloid type.

During the healing process of acne lesions, the skin instead

forms a firm raised bump, and these are commonly seen on

the jawline, back, or chest. In this case, unlike depressed

scars, the basic approach is treatment that suppresses the

overgrowth of fibrous tissue. Typical approaches include

steroid injections, radiofrequency ablation, and CO2 laser.

2. Why Type-Specific Treatment Is Important

The most common reason scar treatment fails is repeatedly

performing the same procedure without distinguishing the

type of scar. When procedures such as Fraxel or laser are

repeated simply because scars exist, skin irritation

accumulates, but the tissue release or reconstruction that is

actually needed does not occur, and the procedure ends

with little change.

For example, narrow and deep scars like the ice pick type

have limits with laser alone, and direct excision or

measures to release adhesions must come first. On the

other hand, rolling scars may look shallow on the surface,

but because they involve widespread adhesions, a procedure

that loosens the fibrous bands beneath the skin is definitely

necessary.

In addition, it is common for multiple scar types to appear

mixed together on one face. On the center of the cheeks,

there may be boxcar scars, on the jawline rolling scars, and

beside the nostrils ice pick scars at the same time. In such

cases, a layered approach that combines different

procedures according to each scar is needed.

If you receive a uniform procedure without an accurate

diagnosis like this, the skin may be unnecessarily irritated,

while the deep tissue that actually needs improvement may

be left untouched. If treatment takes a long time and the

effect is minimal, the cause should be found in an approach

that ignores the structural characteristics of the scar.

3. Why You Should See a Dermatology Specialist

Acne scar treatment is not simply a cosmetic procedure; it

is a medical treatment that structurally restores damaged

tissue below the dermis. Determining the scar's structure

and depth, and deciding which device and procedure order

to apply, is an area that requires the analytical ability of an

experienced medical professional.

In particular, procedures such as subcision, punch excision,

radiofrequency needles, and air dissection can be risky

without an understanding of the skin's anatomical structure

and the depth of the procedure, and may instead lead to

pigmentation, excessive inflammation, or abnormal

reactions. In addition, when inducing collagen regeneration,

high-level adjustment is needed to deliver energy deeply

enough while minimizing damage to the basal layer.

Dermatology specialists are experts with the most clinical

experience in classifying these structural scars and

establishing treatment strategies. If the goal is not merely

cosmetic improvement but the restoration of tissue damage

known as scars, it is advisable to consult with and plan

treatment with medical staff who have both medical

knowledge and procedural skill.

In addition, an experienced specialist can design a long-

term treatment plan, including appropriate adjustment of

treatment intensity based on the course of treatment,

monitoring for side effects, and designing combination

treatments. This integrated approach can be said to be the

core of acne scar treatment.

Scar treatment is about doing it properly,

not doing it often

Acne scar treatment is not simply about smoothing the

surface of the skin. True improvement is only possible when

adhesed tissue deep in the skin is released and collagen

regeneration is induced to restore the structure. To do that,

the starting point is to accurately know what type of scar you

have and what treatment is most needed.

Above all, the important thing is not a procedure that is the

same for everyone, but treatment that is right for you.

Meeting medical staff who structurally analyze each scar

and design the appropriate treatment step by step is the

fastest and most accurate way.

If you are struggling with acne scars, it may not be time to

start treatment again, but time to take a different approach.

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In accordance with Article 56, Paragraph 1 of the Medical Service Act, this post is provided by Jamsil Gounsesang Dermatology Clinic for the purpose of providing medical information. Please note that all procedures/surgeries carry the risk of side effects such as bleeding, infection, and nerve damage, so please proceed carefully after sufficient consultation with medical staff.