Concern
Post Acne Scars
& Other Scars
Different scar types require different treatment mechanisms — accuracy matters
Acne scars form when inflammatory breakouts damage the dermis and the skin's repair process produces too much or too little collagen. The type and depth of scarring determines which treatment can reach and remodel it. Picosure, ablative and non-ablative laser, and Endymed address every scar type through different mechanisms.
Understanding the Concern
Scar Types & How They Form
Not all scars are the same structure — and the same treatment that dramatically improves rolling scars can be completely ineffective on ice pick scars. Understanding which type of scar you have is the most important step before choosing a treatment approach.
Ice Pick Scars
Narrow, deep, V-shaped holes that extend into the dermis. Caused by deep cystic acne destroying the follicular wall. The hardest scar type to treat because of their depth — require treatments that reach the full depth of the scar.
Boxcar Scars
Wide, angular depressions with sharp, defined edges. Caused by inflammation destroying collagen in a localised area. Shallow boxcar scars respond well to resurfacing; deep boxcar scars require more aggressive energy delivery.
Rolling Scars
Broad, undulating depressions with sloping edges caused by fibrous bands tethering the skin to deeper tissue. Create a wave-like texture across the skin surface. Subcision releases tethered fibrous bands before energy treatments to maximise results.
Hypertrophic Scars & Keloids
Raised scars caused by excess collagen production during healing. Hypertrophic scars remain within the original wound boundary; keloids extend beyond it. More common in darker skin types and on the chest, shoulders, and jawline.
Post-Inflammatory Hyperpigmentation
Flat dark marks left behind after inflammatory acne — not true scars, but discolouration from excess melanin triggered by inflammation. More pronounced in darker skin tones. Responds well to picosecond laser.
Surgical & Traumatic Scars
Scars from surgery, injury, burns, or other trauma. Depending on their age, depth, and texture, energy-based treatments can significantly improve their appearance by stimulating controlled collagen remodelling in the scar tissue.
Why Treatment Matters
Scars Do Not Improve on Their Own
Unlike active acne, scars are permanent changes to the skin's collagen structure. They do not improve without intervention — and as the skin ages and loses collagen, scars can become more visible over time. Modern energy-based treatments trigger controlled collagen remodelling, breaking down scar tissue and stimulating the body to replace it with healthier, more organised collagen. A combination strategy targeting multiple depths and scar types often produces the best results.
Treatment Comparison
Acne Scar Treatments Compared
Picosecond laser (755nm)
Epidermis to upper dermis
Converts the laser beam into a fractional pattern that creates pressure waves to stimulate collagen remodelling without ablation. Best for shallow scars, rolling scars, and PIH. Zero downtime.
Er:YAG resurfacing + Nd:YAG
Epidermis to deep dermis
Er:YAG ablates the scarred skin surface with precise depth control, triggering a wound-healing response that produces new collagen. Nd:YAG adds deep thermal remodelling. Most effective for moderate to severe scarring.
Fractional radiofrequency
Mid-dermis
Fractional RF microneedles deliver thermal energy directly into the scarred dermis. Colour-blind — safe for all skin tones including darker types. Particularly effective for ice pick and deep boxcar scars.
TCA Crossing
High-concentration TCA acid (focal)
Full scar depth (ice pick)
High-concentration TCA acid is applied focally into individual ice pick scars with a fine needle. The controlled chemical injury triggers inflammation and new collagen production that fills the scar channel from within — the most targeted approach for narrow, deep scars.
Subcision
Needle release of fibrous bands
Subdermis
A fine needle is inserted beneath rolling and tethered scars to sever the fibrous bands pulling the skin surface downward. Releasing these bands allows the depression to rise and creates space for new collagen to form. Often combined with energy treatments for maximum effect.
Microneedling
Collagen induction therapy
Epidermis to upper dermis
Micro-punctures trigger collagen induction. Effective for shallow rolling and boxcar scars. Less aggressive than laser with more sessions required.
Chemical Peels
Acid exfoliation (TCA, glycolic)
Epidermis to mid-dermis
TCA Cross is effective for ice pick scars. General peels improve surface texture and mild PIH. Often used as a complement to laser treatment.
CO2 Fractional Laser
Ablative laser resurfacing
Epidermis to deep dermis
Most aggressive resurfacing technology with the most dramatic single-session results. Requires 5-14 days downtime. Not offered at 99 Medispa.
Your Questions Answered
Frequently Asked Questions
Acne scars form when inflammatory breakouts damage the dermis and the repair process produces too much or too little collagen. They may appear as ice pick, boxcar, rolling, or raised scars. Flat post-inflammatory pigmentation can also remain after acne, but it is discolouration rather than a structural scar.
Treatment is matched to scar type and depth. Options at 99 Medispa include Picosure for shallow scars and pigmentation, ablative and non-ablative laser resurfacing for moderate to severe scarring, Endymed FSR for dermal remodelling, TCA Crossing for narrow ice pick scars, and subcision for tethered rolling scars.
Downtime depends on the treatment. Picosure has no downtime, Endymed FSR commonly causes 1-3 days of redness, ablative and non-ablative laser may require 2-5 days, subcision may cause bruising or swelling for 3-5 days, and TCA Crossing can cause local crusting for 3-7 days.
Acne scar treatment is suitable for people with stable post-acne scarring or other scars who want to improve texture and visibility. Active acne should be controlled first to reduce the risk of new scars. Treatment choice is adjusted for scar type, depth, distribution, and skin tone.
No. Ice pick, boxcar, and rolling scars are structural changes in the skin, while flat brown or red marks are post-inflammatory pigmentation or erythema. They may appear together, but they respond to different mechanisms and often need a staged combination plan.
Neither is universally better. Laser treatment can address selected scar depths, texture, and pigmentation, while RF microneedling focuses controlled energy within the dermis. Scar type, skin tone, downtime tolerance, and previous treatment determine which option or combination is more appropriate.
The number varies with scar type, depth, treatment choice, and the degree of change being sought. Most plans use a course of sessions with time between treatments for remodelling. Your consultation will set expectations and explain when progress should be reviewed.
Cost depends on the treatment method, area, and number of sessions in the recommended plan. A complimentary consultation is used to assess the scars and provide treatment and pricing options before you commit.
Book a complimentary consultation with 99 Medispa in Sydney CBD. A practitioner will assess your scars, explain the most suitable options, and design a personalised treatment plan.
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