Acne scar removal: how much is actually possible? Complete guide to treatments by scar type

Unfortunately, acne scars do not disappear on their own. While red or brown "marks" left behind may fade over time, indented or raised scars caused by damage to the dermal layer cannot be naturally restored by the skin itself. Therefore, most acne scars require professional care.

There is one point I would like to clarify first. The goal of scar treatment is not "100% complete removal," but rather "making them less noticeable." With current technology, it is difficult to erase scars without a trace, and the realistic improvement range is usually around 30 to 70%. Knowing this expectation beforehand makes a completely different level of satisfaction compared to not knowing it.

🔍 Acne Scars differ by type

Not all scars are the same. Since the treatment direction varies completely, knowing what type of scar you have is the first step.

The most common are depressed atrophic scars, which account for about 80 to 90% of all acne scars. These are further divided into three types.

• Ice pick scars: Narrow and deep, less than 2mm in width, looking as if punctured by an ice pick. They do not respond well to treatments that only target the surface.

• Boxcar scars: Broad, indented scars with sharp, well-defined borders.

• Rolling scars: Wavy, undulating scars caused by fibrous bands pulling the skin down from within.

On the other hand, there are also raised scars. Keloids are hypertrophic scars that grow and spread beyond the boundary of the original wound, sometimes accompanied by itching, redness, or pain. The approach is fundamentally different from that for depressed scars.

📌 Key Summary: 80 to 90% of acne scars are depressed atrophic scars, divided into ice pick, boxcar, and rolling scars, and their treatment methods are completely different from raised keloids.

🎨 Depressed scar or just a mark?

Many people mistake red or brown marks for "scars." These two should be distinguished.

Red marks (post-inflammatory erythema) are red traces caused by dilated blood vessels. Since the skin surface is not indented and only the color remains red, they are treated with vascular lasers.

Brown or grayish marks (post-inflammatory hyperpigmentation) are caused by leftover melanin pigment. These gradually fade with whitening care and consistent sun protection. If the skin feels smooth and even when touched, it is highly likely to be a mark, not a scar.

📌 Key Summary: If the surface is smooth, it is a mark caused by pigment or blood vessel issues; if you feel indentations when touching it, it is a dermal damage scar, and the treatment directions are different.

⚙️ What treatments are used for each type?

Since scars have different types, the methods vary as well. Here is a summary of typical approaches.

• Rolling scars → Subcision. The key is to physically sever the fibrous bands pulling the scar downward under the skin. However, since there is a possibility of re-adhesion where the cut areas stick back together, a combined, multi-session approach is often used.

• Ice pick scars → TCA CROSS. A high-concentration acid (usually 90-100%) is pinpoint-applied only inside the narrow and deep scars to induce regeneration, repeated about 3 to 6 times.

• Boxcar scars & overall texture improvement → Fractional laser or Radiofrequency (RF) Microneedling. These are relatively safe to apply even to darker skin tones because the burden of epidermal damage is relatively low.

For very deep scars that do not respond to lasers, surgical methods to excise and re-suture the scar may be considered. However, this is close to a last resort, and for most acne scars, prioritizing non-surgical procedures to aim for improvement without reopening the skin is recommended.

An auxiliary method involves injecting hyaluronic acid fillers into the depressed scar areas to add volume, but this is not permanent. The filler effect lasts approximately 6 to 18 months and requires repeating.

Keloids are completely different. The goal is not to induce regeneration but to flatten the overgrown tissue, focusing on preventing recurrence by combining intralesional drug injections and compression therapy.

📌 Key Summary: Subcision is mainly used for rolling, TCA CROSS for ice pick, and lasers/RF microneedling for boxcar scars, while keloids require the exact opposite approach to flatten the tissue.

⏳ How many sessions are required, and when will the effects show?

This is the most common misunderstanding. Scars rarely disappear after a single session. An average of 3 to 6 repeated sessions is required, and a treatment interval of 4 to 6 weeks is usually recommended.

There is a reason for this. Most procedures work by filling the skin with new collagen from within, and this collagen remodeling progresses gradually over 3 to 6 months, not immediately after the procedure. Therefore, the final result should be evaluated a few months later. This means there is no need to be disappointed looking in the mirror the day after the procedure.

For reference, the improvement rate of fractional lasers is reported to vary widely from 26 to 83% across studies, and an average improvement of around 25 to 50% is common after multiple sessions. Just looking at the numbers shows that an 'instant cure' is not realistic.

📌 Key Summary: It is appropriate to proceed with an average of 3 to 6 sessions at intervals of 4 to 6 weeks and check the final results after 3 to 6 months when collagen is filled.

🧴 Post-care is as important as the procedure

For scar treatments, results can differ based on care rather than the procedure itself.

First, if acne is still actively breaking out, calming the acne first must come before scar treatment. This is because new scars will continue to form if new acne keeps appearing.

Second, sun protection is essential throughout the entire treatment period. You must apply sunscreen with SPF 30 or higher daily to prevent pigmentation. If UV rays hit skin sensitized by the procedure, brown marks may remain darker.

Third, for some time after the procedure, it is better to temporarily stop using skin-irritating ingredients (retinol, AHA/BHA, high-concentration vitamin C, etc.) and focus on soothing the skin. If scabs form, do not force them off. Leave them until they fall off naturally so that the newly emerging skin can settle smoothly.

East Asian skin requires one more point of attention. Darker skin tones (Fitzpatrick type III-IV or higher) tend to have a higher risk of hyperpigmentation after strong ablative lasers, so it is safer to choose gentler methods and meticulously follow post-care.

📌 Key Summary: Control active acne first, apply SPF 30 or higher sunscreen daily, temporarily stop irritating ingredients, and do not pick at scabs—this care determines the results.

🌿 How Onlif views scars

Gangnam Onlif Clinic does not aim for plastic surgery that alters facial structure, but rather focuses on removing skin concerns that hide your natural beauty. The same goes for scars.

Onlif's general scar care uses a pneumatic method instead of needles to break fibrous tissue adhesions under the skin while simultaneously delivering regenerative agents. Since it does not use needles, it is characterized by less bruising and swelling and a fast return to daily life. Depending on the scar condition, 3 to 5 or more sessions are recommended, usually at intervals of 1 to 2 months.

Active scars like keloids have completely different treatment goals. We first examine the activity of the tissue and then focus on flattening the overgrown parts and preventing recurrence. If there are constitutional factors, we approach it as a concept of management with regular follow-up visits even after stabilization.

Onlif chooses a system where, instead of one doctor trying to excel at every procedure, doctors specialize in the treatments they do best. Above all, because scar treatment starts with accurately reading the type and condition of the tissue, we do not apply the same method to everyone but design it on a 1:1 basis.

📌 Key Summary: Onlif first diagnoses the type and activity of scars, and proceeds with customized individual designs using non-surgical methods that reduce irritation and help natural recovery.

❓ Frequently Asked Questions

Do acne scars disappear on their own?

Red or brown marks may fade over time, but indented or raised scars caused by dermal damage do not recover on their own. In these cases, professional care is required.

Can a single laser treatment completely remove scars?

Almost never. An average of 3 to 6 repeated sessions is required, and the goal is also a less noticeable improvement of about 30 to 70% rather than complete removal. Setting realistic expectations is important.

How long after the procedure can I check the effects?

Since it takes time for new collagen to fill in the skin, final results are usually evaluated 3 to 6 months after the procedure. You do not need to feel disappointed if it does not look better right the next day.

Can I receive scar treatment while I still have active acne?

If you have active acne, calming the acne first is the proper order. This is because new scars will continue to form if new acne keeps appearing.

Is Korean skin more prone to hyperpigmentation after procedures?

The darker the skin tone, the higher the risk of hyperpigmentation after strong ablative lasers. You can reduce this risk by choosing less irritating methods and thoroughly protecting your skin from UV rays.

How soon after the procedure can I wear makeup?

It depends on the type of procedure and skin recovery status. Avoid makeup while you have scabs or sensitivity, and it is best to start carefully with non-irritating products according to the guidance provided.

Is it safe to get treatments if I have a keloid constitution?

Keloids require a completely different approach compared to depressed scars. We first diagnose the activity, then focus on flattening the tissue and preventing recurrence, and regular management is necessary due to constitutional factors. You must determine the direction after consultation.

It is difficult to judge the exact scar type and tissue condition solely with the naked eye. Finding the right path for your skin through professional diagnosis is the safest way.

Acne scar removal: Things to check before choosing a clinic

Even for the same procedure, the results and recovery process vary depending on where, by whom, and how it is performed.

Asking these questions during your consultation will help you make a decision.

• Is this a clinic that frequently performs the procedure? — Every clinic has different core treatments they specialize in. Check if they regularly perform acne scar removal.

• Can I verify the products and equipment used? — Ask if you can verify the product names and their authenticity (whether they are imported-approved products, or if there is an unboxing verification process) during the consultation.

• Do they explain the cost breakdown? — Rather than just hearing the total amount, you can make a better decision by listening to the explanation of what product is used, how much, and on what area.

• Do they design with the whole face in mind? — Even for the same procedure, the injection location and volume vary depending on face shape, skin condition, and left-right asymmetry.

• Do they explain adverse reactions and recovery processes beforehand? — Rather than a consultation that only talks about expected changes, a clinic that also informs you of potential adverse reactions and coping methods is better for making a decision.

• Is there a way to follow up after the procedure? — Check if the follow-up timeline, how to contact them if there is an issue, and the criteria for a return visit are established.

How Onlif Clinic performs acne scar removal

• We divide responsibilities — With the belief that a single doctor cannot cover all procedures, Onlif divides medical treatments among doctors specializing in different fields.

• We verify products and equipment together during consultations — We guide you through the products used and the unboxing verification process during the consultation.

• Costs are guided along with the plan after diagnosis — Since the treated area, volume, and range differ for each person, we explain what costs how much together.

• We design by looking at the overall facial balance — We look at the face through three axes: texture, balance, and signs of youth, planning to organize the parts that hide your natural impression rather than changing the shape.

• We address potential adverse reactions and the recovery process first — Along with the expected changes, we guide you through individual differences, potential adverse reactions, and countermeasures before the procedure.

• We monitor progress together after the procedure — If verification is needed during the recovery period, we provide guidance on return visits and communication channels.

If you are considering acne scar removal, it is best to first check what is possible and what is difficult in your current state.

Accurate diagnosis and treatment planning can only be determined through an in-person consultation. Find out through a consultation at Gangnam Onlif Clinic.