SKIN CONCERN
ICE-PICK SCARS
Small, narrow and deep indentations that can look like tiny holes or enlarged pores.
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ROLLING SCARS
Broad, shallow depressions with sloping edges that can give the skin a wavy or uneven appearance.
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BOXCAR SCARS
Round or oval depressions with more clearly defined edges. They may be shallow or more deeply established.
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MOSTLY RED OR PINK MARKS
Flat red or pink marks remaining after acne, without a clear indentation in the skin.
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MOSTLY BROWN OR GREY MARKS
Flat brown or grey marks remaining after acne, without a clear change in skin texture.
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MIXED SCARS OR I’M NOT SURE
A combination of different depressions, marks or uneven texture that does not fit one clear pattern.
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Active acne should usually be controlled before beginning a scar-remodelling treatment plan. Continuing breakouts can create new marks and scars while older scars are being treated.
ICE-PICK SCARS
START HERE
TCA CROSS
Other focal scar-directed treatment
CONSIDER NEXT
Punch excision for selected deep scars
When it may fit
Fractional Laser Resurfacing
When it may fit
RF Microneedling as part of a combination plan
When it may fit
WHY THIS ORDER
Ice-pick scars are narrow and extend more deeply into the skin. Broad collagen-stimulating treatments alone may soften the surrounding texture without adequately treating the deepest part of the scar.
ROLLING SCARS
START HERE
Subcision
CONSIDER NEXT
RF Microneedling
When it may fit
Fractional Laser Resurfacing
When it may fit
Scar-specific combination treatment
When it may fit
WHY THIS ORDER
Rolling scars are often connected to deeper fibrous bands that pull the skin downward. Subcision is commonly considered first to release this tethering before or alongside treatments that stimulate collagen and improve surface texture.
BOXCAR SCARS
START HERE
RF Microneedling
Fractional Laser Resurfacing
CONSIDER NEXT
Fractional CO₂ Laser
When it may fit
Focal scar-directed treatment
When it may fit
Punch elevation or excision for selected deep, sharply defined scars
When it may fit
Combination treatment
When it may fit
WHY THIS ORDER
Shallow boxcar scars may respond to collagen remodelling and resurfacing. Deeper scars with sharply defined edges may require a more focal scar-directed approach rather than resurfacing alone.
MOSTLY RED OR PINK MARKS
START HERE
Allow time for natural fading where appropriate
Control any ongoing acne or inflammation
Redness or vascular-focused treatment
CONSIDER NEXT
Vascular laser
When it may fit
IPL
When it may fit
Selected gentle skin-renewal treatments
When it may fit
WHY THIS ORDER
Flat red or pink marks are generally post-inflammatory redness rather than true textural scars. They require a different pathway from depressed acne scarring.
MOSTLY BROWN OR GREY MARKS
START HERE
Control any ongoing acne or inflammation
Pigment-focused topical care
CONSIDER NEXT
Superficial chemical peels
When it may fit
Carefully selected pigment-targeting laser or light treatment
When it may fit
Combination treatment
When it may fit
WHY THIS ORDER
Flat brown or grey marks are generally post-inflammatory pigmentation rather than true textural scars. Skin type and the risk of further pigmentation are important when treatment is selected.
MIXED SCARS OR I’M NOT SURE
START HERE
Professional scar assessment
Identify which scar type should be treated first
CONSIDER NEXT
TCA CROSS for selected ice-pick scars
When it may fit
Subcision for tethered rolling scars
When it may fit
RF Microneedling or Fractional Laser Resurfacing for broader texture
When it may fit
Staged combination treatment
When it may fit
WHY THIS ORDER
Mixed scarring often requires more than one treatment category. The sequence should be based on scar structure—for example, treating focal or tethered scars before completing broader collagen remodelling or resurfacing.
STRUCTURE FIRST
Treat the physical structure of the scar, not only the surface texture.
STAGED TREATMENT
Focal and tethered scars may need to be addressed before broader resurfacing.
REALISTIC IMPROVEMENT
The goal is meaningful improvement rather than perfectly smooth or scar-free skin.
RF Microneedling and Fractional Laser Resurfacing can improve broader acne-scar texture, but they do not necessarily replace TCA CROSS for narrow ice-pick scars or Subcision for tethered rolling scars. The best treatment is determined by the scar structure—not by which device is currently popular.
Treat the Concern, Not the Device.
Answer a few questions about your scars, skin and treatment preferences to explore the treatment categories commonly considered.