Acne scar treatment in Busan Seomyeon, matched to the scar type you have.

Scarring is where treatment expectations and mechanisms most often fail to line up. Understanding which shapes you have explains why a friend's excellent result may not be available to you, and what combination would actually work.

Ice pick scars

Narrow, deep and vertical — like a puncture rather than a depression, often on the cheeks. They extend far deeper than they are wide, which is why fractional resurfacing improves their edges without reaching their base. The methods that work are TCA CROSS, which chemically remodels the scar from inside, and punch excision for the deepest. A laser course alone typically leaves these largely unchanged.

Boxcar scars

Wider, with defined vertical walls and a flat base — like a small crater. These respond well to fractional resurfacing, since remodelling can soften the walls and raise the base over a course. Shallow boxcar scars often improve substantially; deep ones with sharp edges may need subcision or excision alongside.

Rolling scars

Broad, shallow depressions with sloping edges, produced by fibrous bands tethering the skin to deeper tissue. The surface is not damaged so much as pulled down — which is why resurfacing alone underdelivers here. Subcision releases the tethering bands, and the released depression is then supported with a booster or filler while it heals. That combination works where laser alone does not.

Why does one course improve some and not others?

Because each method reaches a specific depth and geometry. A patient with mixed scarring treated only with fractional laser sees the boxcar scars improve, the rolling ones improve slightly and the ice pick ones stay. That is a predictable outcome rather than a failed treatment — and it is why the assessment lists what you have before a plan is proposed.

What about the marks that are not scars?

Most of what patients call scarring is pigment. Brown marks are post-inflammatory hyperpigmentation and clear with toning over a course. Red or purple marks are dilated vessels and need vascular laser. Neither is textural, and treating them with resurfacing is a much larger intervention than they require — see toning or resurfacing.

How do I work out which types I have?

Photograph yourself under a lamp positioned to one side rather than in front. Directional light throws shadow into every depression, which is why scarring looks worse under a spotlight and nearly invisible in flat daylight — and that shadow is exactly what reveals shape. Narrow dark points are ice pick. Small craters with visible edges are boxcar. Broad soft dips that shift as you move are rolling. Most faces show two or three types, and the proportions matter more than the total count when a plan is being built.

Where does this sit alongside other treatment?

After acne control and usually before anything structural. Skin quality work with boosters pairs naturally alongside a resurfacing course, since barrier support speeds recovery between sessions. Energy lifting and botox are unrelated and can happen at any point. What we would avoid is starting scar work in the same period as a course of pigment treatment on the same area, since both compete for the same recovery capacity and neither gets a fair assessment.

Why must active acne be controlled first?

Because treating scars while breakouts continue means treating a moving target, and because resurfacing inflamed skin raises the pigmentation risk considerably on higher Fitzpatrick types. The usual sequence is three to six months of control, then a scar course once the skin has been quiet — see adult acne in your thirties.

How much improvement is realistic?

Fifty to seventy per cent across a full course for most patients with mixed scarring, which is a meaningful change and not clearance. Scars are permanent structural damage and no treatment restores original skin — the goal is skin that reads as textured rather than scarred, and photographs well under directional light. Any clinic promising clearance is describing something that does not happen.

How long does a full plan take?

Six to twelve months for mixed scarring, since methods are sequenced rather than combined. Typically subcision and TCA CROSS for the shapes that need them, then a fractional course of four to six sessions at four to six week intervals, ideally scheduled into the low-UV months — see winter: the safest window.

What should the consultation cover?

Which shapes you have and in what proportion, whether acne is still active, your Fitzpatrick type and PIH history, and what sequence is proposed with a session count and a total. A plan that names one laser without typing the scars has skipped the step that determines whether it will work — see how a consultation works. Asking which of your scars each part of the plan addresses is a fair question, and the answer tells you whether the assessment happened at all.