"The acne has all settled, but the pitted marks won't go away."
"I've had several rounds of laser, but the deep scars are just as they were — why is that?"
These are things people worrying about acne scars bring up all the time.
Hello, I'm Director Kwon Si-jin & Yoon Ju-hyun at DA Clinic Myeongdong ^^
We're getting ready to open our doors in Myeongdong soon, and since so many people have been asking about scars ahead of our opening, we wanted to put together this overview for your information first.
Let me start with the bottom line. With acne scars, knowing 'what type your scar is' comes before 'which treatment you have'.
If you repeat just one treatment without knowing the type, the effect is slow and only the cost piles up. Read this for just 3 minutes and you'll see the standards worth keeping in mind, wherever you have it done.
Scars Divide Broadly Into 'Pitted' and 'Raised'
Let me set up the big picture first.
Acne scars divide into the atrophic type, where the surface is pitted inward, and the hypertrophic type, which protrudes outward.
The atrophic type is where the surface has sunk as the dermal collagen was lost, while the hypertrophic type is, conversely, where it has protruded as collagen was over-produced.
Even though they're grouped under the same name 'acne scar', the causes are actually the opposite.
So a treatment that's good for the atrophic type doesn't suit the hypertrophic type, and vice versa. This is exactly why type diagnosis comes first.
Pitted Scars (Atrophic) Also Have a Different Answer for Each Shape
The atrophic type divides again into three according to shape. Just like the craters on the moon's surface are all different ㅎㅎ
Rolling scars are a wide, round, undulating, pitted form. Often the connective tissue beneath the dermis pulls the surface down, so a common direction is to cut that tether with subcision and fill it in with filler or collagen-inducing material.
Boxcar scars are pitted in a square shape with angular edges. They're often approached by adding fractional laser to subcision to refine the edges.
Ice pick scars are a narrow, deep form, as if pricked with an awl. Being narrow and deep, it's hard for a laser to reach the bottom, so methods such as punch excision or TCA CROSS — dropping high-concentration TCA onto it like a dot — are often considered alongside.
So even within the same atrophic type, the way you work on it differs by shape. (Which combination is right varies by individual)
Raised Scars (Hypertrophic) Need a Different Approach Again
The hypertrophic type isn't pitted but raised, so rather than filling it in, you go in the direction of flattening it down.
A hypertrophic scar is a form that rises plumply within the bounds of the original scar, and it sometimes settles down in part over time.
A keloid grows beyond the original bounds, spreading out, and it tends to be hard to expect it to improve on its own.
In both cases, steroid injection, compression therapy, lasers, and the like are used.
Keloids in particular have a constitutional tendency and there may be a family history, so if you tell us in advance before the treatment, we weigh up the suitability and set the direction. It's a scar that can actually grow larger if handled forcefully.
In the End, You Solve It With a 'Combination', Not 'One Thing'
As you may have sensed by now, scar treatment rarely ends with a single treatment.
A representative example is subcision, a technique that uses a fine needle to cut the connective tissue within the dermis that's pulling the scar down. If you fill the cut-open space with filler or collagen-inducing material, a corrective effect is added.
The non-ablative fractional laser has a limit on the depth it reaches, so deep rolling and boxcar scars may not be enough with the laser alone.
So you look at the depth and shape of the pitting and weave together subcision, fractional, and filler in stages.
Wherever you have it done, rather than 'one thing does it all', it helps to look at 'whether it's a combination suited to my scar'.
Honestly, It's Not a Scar That Vanishes in One Go
This is the part I want to be the most honest about here.
Acne scars aren't erased clean with a single treatment — it's a treatment where you build up several sessions and refine it in stages.
Usually around 5–10 sessions at intervals of 4–8 weeks, finely adjusting the intensity and method of the next treatment while watching the response at each session. (The number of sessions needed varies greatly by individual depending on the scar type and depth)
And it's more realistic to set the goal at 'staged improvement that visibly reduces it' rather than 'complete removal'.
Also, please keep in mind that while you're refining the scars, new acne coming up can create new scars, so care that subsides the acne itself has to go along with it.
Frequently Asked Questions
Q. Do scars disappear completely?
A. With acne scars, we set reducing them in stages, rather than erasing them completely, as the realistic goal. A scar is a state where the structure has changed down to the dermal layer, so it's hard to return it to the original skin with a single treatment. That said, if you build up treatments suited to the type over repeated sessions, you can expect changes where the pitting becomes shallower and the texture becomes smoother. Because the degree of improvement differs from person to person depending on the type and depth of the scar, we tend to be honest about the expected range of change first, at the time of diagnosis.
Q. Can't I just get the laser alone?
A. Among acne scars, shallow forms can be helped with the laser alone, but deep scars have limits with the laser alone. The non-ablative fractional laser has a limit on the depth it reaches, so it's hard for it to release even the connective tissue within the dermis that's pulling the scar down. That's why for deep rolling or boxcar scars, a combination is commonly used — first cutting the connective tissue with subcision, filling it with filler or collagen-inducing material, then adding the laser. The suitable combination may vary depending on the scar's shape.
Q. How many times do I need to have scar treatment?
A. Acne scar treatment is usually long-term care, accumulated over around 5–10 sessions at intervals of 4–8 weeks. Rather than going excessively strong in a single session, the approach proceeds at a conservative intensity each session, watching the response and finely adjusting the next treatment. Doing it this way lets you refine the texture little by little while reducing downtime and the risk of pigmentation. That said, the number of sessions and intervals needed differ from person to person depending on the scar type and depth and the skin's condition, so it's best to decide while watching the condition.
In Closing
If I sum up today's content in one line, it's this.
With acne scars, knowing first 'whether my scar is atrophic or hypertrophic, and what shape it is' decides the result — more than 'which treatment'.
This isn't an article recommending a treatment, but an informational article we've put together for your reference while preparing to open.
DA Clinic Myeongdong is set to open soon. We'll share news of our opening and treatment information first on our blog and Instagram ^^
Thank you for reading to the end. This was Director Kwon Si-jin & Yoon Ju-hyun at DA Clinic Myeongdong.
This column is an informational article intended to provide general medical information; the effects and side effects of treatments may vary by individual. DA Clinic Myeongdong is set to open soon. (Medical Service Act Art. 56)