Acne scarring: matching the treatment to the scar type
Most disappointment with acne scarring treatment comes from treating the wrong type. The identification matters more than the technology.
Acne scarring is one of the areas where a general treatment applied to a specific problem produces the most disappointment. "Acne scars" describes at least four distinct things, and the treatment that transforms one barely touches another.
Get the identification right and the expectations follow honestly.
The four types
Post-inflammatory marks — not actually scars
Flat brown or red marks where a spot healed. Run a finger over them: the skin is smooth. There is no textural change at all.
These are pigment, not scarring, and they fade on their own — brown marks over months, red marks often over a year. The most effective intervention is rigorous SPF, because sun exposure is what makes them persist.
Rolling scars
Broad, shallow depressions with sloping edges, giving skin an undulating look in raking light. Caused by fibrous tethering pulling the surface down.
These respond best of the true scar types. Microneedling at depth, across a course, breaks up tethering and stimulates collagen underneath. Realistic improvement: meaningful, across six or more sessions.
Boxcar scars
Round or oval depressions with sharp, defined vertical edges — like a shallow crater. Common on the cheeks and temples.
Partially responsive. Microneedling and resurfacing soften the edges and reduce the shadow they cast, which is what makes them visible. Shallow boxcars improve considerably; deep ones with sharp walls improve modestly.
Ice-pick scars
Narrow, deep, vertical tracks — as though the skin was punctured. Often on the cheeks.
These are the least responsive to anything non-surgical. They are too narrow and too deep for resurfacing to reach the base. Honest expectation: limited improvement from the treatments we offer. Anyone promising to clear ice-pick scarring with microneedling is overselling.
How to identify yours
- Daylight, no makeup, hand mirror.
- Hold the mirror so light comes from the side rather than straight on. Raking light reveals texture that flat light hides.
- Run a fingertip across. Smooth means pigment, not scar.
- For anything textured: are the edges sloping (rolling), sharp and round (boxcar), or narrow and deep (ice-pick)?
- Most people have a mix. Note the proportions — that decides what a realistic outcome looks like.
What we would suggest
| Type | Approach | Realistic outcome |
|---|---|---|
| Post-inflammatory marks | SPF, time, gentle resurfacing | Full resolution, no treatment strictly needed |
| Rolling | Microneedling course with PRP or exosomes | Good — meaningful improvement over 6+ sessions |
| Boxcar (shallow) | Microneedling and resurfacing | Moderate to good |
| Boxcar (deep) | Microneedling and resurfacing | Modest — softened edges rather than removal |
| Ice-pick | Limited non-surgical options | Minimal — be wary of anyone promising more |
| Treatment | Single | Course of 3 |
|---|---|---|
| PRP with microneedling | £150 | £400 |
| Exosomes with microneedling | £250 | £640 |
| Green Peel Classic | £280 | £480 (course of 2) |
The timeline is long
Scarring treatment is measured in months, not sessions. A realistic course is six or more microneedling sessions, four weeks apart — around six months of treatment — followed by three to six months of continued collagen remodelling before the final result is visible.
Photographs at the start, in the same raking light, from the same angle. This is essential. Improvement of this kind is invisible day to day and obvious in a twelve-month comparison.
Two things that must come first
- Active acne must be controlled. Treating scars while new lesions are forming creates new scars alongside the ones being treated. If acne is active, see a GP or dermatologist first.
- Isotretinoin needs a six-month gap. If you have taken oral isotretinoin, most practitioners will not perform resurfacing or microneedling until six months after finishing.
An honest closing note
Significant improvement in acne scarring is achievable. Complete resolution generally is not. A realistic target is skin that no longer draws attention to its texture in normal light — not skin that has never scarred.
Any clinic offering the second thing is selling you a disappointment on a payment plan.
Common questions
What is the best treatment for acne scars?
It depends entirely on the type. Rolling scars respond well to a microneedling course with PRP or exosomes. Shallow boxcar scars respond moderately. Ice-pick scars respond poorly to non-surgical treatment. Flat marks are pigment, not scarring, and fade on their own.
How do I know what type of acne scar I have?
In raking daylight without makeup, run a fingertip over the area. Smooth means pigmentation. Textured scars are either sloping-edged (rolling), sharp and round (boxcar) or narrow and deep (ice-pick).
How many microneedling sessions for acne scarring?
Six or more sessions four weeks apart is realistic — around six months of treatment, with collagen remodelling continuing for three to six months afterwards.
Can acne scars be completely removed?
Significant improvement is achievable; complete resolution generally is not. A realistic target is skin that no longer draws attention to its texture in normal light.
Can I have microneedling after isotretinoin?
Most practitioners require a six-month gap after finishing oral isotretinoin before performing microneedling or resurfacing treatments.
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