Acne Scar Treatment: One Thing More Important Than Equipment (Complete Breakdown by Type)

Hello.

This is Beauty’s Doctor, Wi Youngjin.

There is one point I want to emphasize first in acne scar treatment.

👉 There is no single treatment that can solve every scar.

Many people ask,

“How many Fraxel sessions do I need?”

“Can this one laser get rid of everything?”

but

in actual treatment,

it is not that simple. Why scar treatment is difficult

A scar is not simply a matter of being “pitted.”

The following factors are all different:

• Scar type

• Depth

• Width

• Location

• Skin type

• When the scar formed

• Current skin elasticity

👉 Only when all of these factors are considered is a treatment plan complete.

That is why, when someone recommends only one specific device without a consultation, you should be cautious.

1. Ice-pick Scar

This is the most difficult type to treat.

Its features are

• Narrow and deep, like a needle prick

• Small on the surface but deep inside

• Connected to the deep dermal layer

The problem is that the internal damage is much deeper than the size visible on the surface.

Key point of treatment

👉 You need to fill the inside, not just the surface

✔ TCA CROSS

This is currently one of the most effective methods.

• A high-concentration acid is applied into the scar

• A protein coagulation reaction occurs

• Collagen regeneration is induced

With repeated treatment,

the scar gradually fills in from below.

Usually,

• At 4–6 week intervals

• 4–6 sessions or more

are needed before changes become visible.

⚠ Caution

• Concentration

• Depth

• Accuracy

👉 This is a very important procedure.

✔ CO2 laser (adjunct)

By itself, it has limitations.

That is because it is difficult to address deep structure.

However,

after other treatments have filled it in,

it is very useful as a step for smoothing the surface.

2. Boxcar Scar

This type responds relatively well to treatment.

Features

• Clear borders

• Vertical shape

• Flat bottom

👉 It feels like a square-shaped indentation.

Key point of treatment

👉 Surface regeneration + collagen induction

✔ Fractional CO2 laser

This is a representative treatment device.

• Creates columns of microscopic thermal injury

• Preserves surrounding normal skin

• Fast recovery + strong regeneration

Usually,

• After 3–5 sessions

• Noticeable improvement

✔ Ablative CO2 laser

• Stronger resurfacing

• Effective for deep scars

However,

• Recovery time is longer

• There is a risk of hyperpigmentation

👉 Skilled settings are important.

✔ Radiofrequency microneedling

• Stimulates deeper layers of the dermis

• Causes less damage to the epidermis

👉 Lower risk of hyperpigmentation 👉 Better for darker skin tones

3. Rolling Scar

This is the type most often overlooked.

At first glance,

• Broadly

• Softly

• Wavy in shape

👉 The cause is different.

Main cause

👉 Adhesions under the skin (fibrous bands)

The skin is being pulled downward.

Key point of treatment

👉 The pulling structure must be broken

✔ Subcision

This is the key treatment for rolling scars.

• A needle is inserted under the scar

• Adhesive tissue is cut

• The skin rises upward

👉 It can be effective on its own,

but

✔ Combining PRP / filler

• Fills the space

• Helps prevent readhesion

• Promotes collagen regeneration

👉 The effect becomes much better.

4. Hypertrophic Scar

This is not a depressed scar,

but a raised one.

It often occurs on

• The jawline

• The chest

• The back

✔ Steroid injection

• Suppresses collagen production

• Flattens the scar

👉 The most basic treatment

✔ Vascular laser (PDL)

• Reduces redness

• Helps suppress recurrence

👉 Better results when combined

5. Keloid

This is the most difficult type.

Features

• Expands beyond the original boundary

• High recurrence rate

• Strongly influenced by individual tendency

Key point of treatment

👉 Single treatment is not enough

✔ Steroid + 5FU

• Inhibits collagen

• Suppresses cell proliferation

👉 Reduces recurrence rate

✔ Laser + radiation

👉 A combined treatment approach is needed

6. Red Marks (PIE)

This is not a scar.

👉 It is a blood vessel issue.

✔ IPL

• Constricts blood vessels

• Improves in 2–4 sessions

👉 Almost no downtime

✔ PDL / Vbeam

• Stronger vascular targeting

👉 Effective for old marks

7. Hyperpigmentation (PIH)

👉 A state of excess melanin

✔ Laser toning

• Low-intensity repetition

• Safe pigment removal

✔ Pico laser

• Faster improvement

• Less thermal damage

Very important point

👉 Sunscreen is essential

👉 If you do not use it, it will come back

8. This Is How Actual Treatment Proceeds

In reality,

most cases are mixed scars.

So treatment is carried out not with a single device, but with combination therapy.

Typical treatment sequence

• Subcision (release adhesions)

• TCA CROSS (deep scars)

• Fractional laser (surface)

• Pigment / vascular treatment

👉 At each step,

• 4–6 week intervals

• Time is needed for regeneration

Total treatment period

6 months to 1 year or more

⚠ Be sure to check before treatment

The following are very important.

• Currently taking isotretinoin

• Recent strong sun exposure

• Pregnancy / breastfeeding

If a procedure is performed in this condition,

there is a possibility of worsening scars The key to acne scar treatment is not the equipment, but the diagnosis.

And

👉 order

👉 combination

👉 timing

determine the outcome.

Thank you for reading this long post.

This was Wi Youngjin.