Acne scars: how to choose the right treatment based on scar type
Every acne scar has a different shape and responds to different techniques. This guide helps you understand your case before your medical assessment.
Key points
- Ice pick: TCA CROSS as the primary technique
- Rolling: subcision is usually the priority (we do not perform it; we will guide you)
- Mixed scars typically require several combined techniques
Not all acne scars are the same. Their shape, depth and the underlying mechanism that causes them determine which technique can improve them. For this reason, treatment must be tailored to the morphology of each individual scar rather than being limited to a single technique.
This guide summarises general guidance only. It does not replace a medical assessment, which is essential for establishing a personalised plan.
Patient guide: acne scarsBefore anything else: scar or dark spot?
After acne, red or brown marks may remain without any skin depression. These are not atrophic scars but rather colour alterations, which tend to improve over time and with treatments specifically targeting pigmentation or vascular lesions.
True atrophic scars, on the other hand, are depressions in the skin. Three main types are distinguished.
The three types of atrophic scars
Ice pick
TCA CROSS
Boxcar
CO₂ Laser · TCA CROSS
Rolling
Subcision
Which technique for each type of scar?
Ice pick
Narrow, deep and pinpoint, like small holes in the skin.
- TCA CROSSMain technique
- Fractional CO₂ laserComplement for texture
Boxcar
Depressions with defined edges, wider than ice pick scars.
- Fractional CO₂ laserTexture and selected scars
- TCA CROSSSmall and deep boxcar scars
- Medical peelSuperficial irregularities
Rolling
Broad, undulating depressions anchored by fibrous bands beneath the skin.
- SubcisionPriority technique · we do not perform it, but we can guide you
- Fractional CO₂ laserComplement for texture
- BiostimulationSkin quality and firmness
Post-acne spots
Red or brown marks with no skin depression.
- Spots and pigmentationBrown marks
- Vascular lesionsRed marks
Mixed scars: combining techniques
In most patients, several types of scars coexist. For this reason, treatments are usually planned in a combined and sequential manner, respecting the skin's recovery times.
At Clínica Valorian, TCA CROSS is considered a complementary technique to fractional CO₂ laser, not a substitute. When subcision may be indicated, we explain this to you and guide you accordingly, as it is not a procedure we perform at the clinic.
What to realistically expect
Improvement of acne scars is gradual and usually requires several sessions. The goal is to visibly improve their depth and appearance, not to guarantee their complete elimination.
In skin with higher phototypes, the risk of pigmentation changes is greater, which makes the choice of technique and aftercare especially important.
Assessment at Clínica Valorian
During the consultation, we analyse your scars and propose a tailored plan, including the techniques we perform at the clinic and, where appropriate, guidance towards other techniques.
Request a medical assessment of your acne scars at Clínica Valorian, Marbella.
Frequently asked questions
How do I know what type of scar I have?
A first clue is its shape: small and deep (ice pick), with defined edges (boxcar), or broad and wavy (rolling). Many people have several types at once; a medical assessment allows them to be identified accurately.
Is there a single treatment for all acne scars?
No. Each type of scar responds differently, and it is common to combine several techniques depending on the morphology of the scars.
How many sessions will I need?
It depends on the type and depth of the scars and the technique chosen. Improvement is usually gradual and requires several sessions.
Should I wait until my acne is under control?
In general, yes: it is advisable to treat active acne first and address the scars once the condition is under control. The doctor will determine the right time.
Subcision for rolling scars
A medical technique designed to release the fibrous bands that pull certain acne scars downward. At Clínica Valorian we do not perform it, but we assess your scars and guide you.
TCA CROSS for acne scars
Specialised medical technique to improve certain atrophic acne scars through the localised application of trichloroacetic acid.
Medical peel
Supervised skin renewal.
Biostimulation
Injectable natural collagen inducers.
Master Index
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