How acne scars form
When a pimple is deep or badly inflamed, the inflammation damages the collagen that supports the skin from below. As the skin heals, it does not always rebuild that support evenly. Where too little collagen forms, the surface sinks into a dip or pit: these are atrophic scars, the most common kind after acne. Less often, too much collagen forms and the scar is raised, which is treated differently.
Scars are not the same as acne marks. Marks are flat patches of brown, red or purple colour left after a pimple heals, and they usually fade with sun protection and the right creams. Scars change the texture of the skin, so they need treatments that rebuild collagen. Many people have both, and a good plan treats both.
Three kinds of scar, three approaches
Rolling
Soft, wave-like dips, pulled down by fibrous bands under the skin.
- RF subcision
- MNRF
- Fractional CO2
Boxcar
Broad depressions with sharp, steep edges, like a small crater.
- Fractional CO2
- Erbium glass
- MNRF
Ice-pick
Narrow, deep pits that look like large open pores.
- Fractional CO2
- Planned case by case
Telling these types apart is the first step, because each responds to a different method. In the consultation room, the dermatologist examines your skin under angled light, notes which types you have and where, and checks for active acne, marks and your skin’s tendency to darken after injury.
The treatments we use
Acne scar treatment works by controlled injury: creating tiny, precise zones of damage that the skin repairs with new collagen. Each method does this at a different depth and with a different recovery.
- Laser or fine needles make microscopic channels, leaving the skin between them intact.
- The skin repairs each channel and lays down new collagen.
- Over months the new collagen helps lift and soften depressed scars.
- Fractional CO2 laser (FRx). The Dolphin fractional CO2 laser makes thousands of microscopic columns through the surface into the dermis. The skin heals from the untouched skin around each column, resurfacing the edges of scars and tightening the base. It tends to give a noticeable change per session, in return for a few days of recovery.
- Microneedling radiofrequency (MNRF). Fine insulated needles on the Intensif probe of our EndyMed PURE deliver radiofrequency heat beneath the surface, remodelling collagen deeper with less effect on the top layer. It suits people who cannot take much downtime and is often combined with laser.
- RF subcision. For rolling scars, a fine probe releases the fibrous bands that pull the skin down, so the scar can lift. Laser and MNRF then smooth the surface.
- Fractional erbium glass laser (1550 nm). A non-ablative laser that heats columns of skin without breaking the surface. Recovery is usually a day or two of redness, and it helps with texture and shallow scars.
- PRP (platelet-rich plasma). Concentrated platelets from your own blood are applied or injected after laser or MNRF to support healing. Our plans combine it with FRx where it helps.
Most people need a combination. A typical plan might begin with RF subcision for rolling scars, followed by a course of fractional laser or MNRF sessions a few weeks apart, with PRP added to some of them.
Who it suits
Acne scar treatment suits adults and older teenagers whose acne is under control and who have scars that bother them. It works on all Indian skin types when the settings and preparation are right. It is not started while acne is active, during pregnancy, over skin infections or cold sores, or if you tend to form raised (keloid) scars, which need a different approach.
Before, during and after
Before
- Get active acne under control first; your dermatologist may treat both together.
- Avoid sun tanning for two weeks. You may be given creams to prepare the skin and lower the risk of darkening.
- Tell us about recent isotretinoin, a history of cold sores, keloids or pigment problems, and any medicines you take.
During
A numbing cream is applied for about 45 minutes. The treatment itself usually takes 15 to 30 minutes for the face. With laser you feel heat and prickling; with MNRF, a series of warm pricks. Cooling is used throughout.
After
- Fractional CO2: redness, swelling and a fine sandpaper-like crust for about three to seven days. Do not pick; the crust protects new skin.
- MNRF and erbium glass: redness for a day or two, sometimes small grid marks that fade quickly.
- RF subcision: swelling and bruising for several days.
- Use the soothing cream and sunscreen you are given, avoid the sun, and skip make-up until the skin has settled. We review you before the next session.
What results to expect
Collagen takes months to remodel, so improvement continues for three to six months after each session. Scars become shallower, their edges soften, and the skin looks smoother in daylight. Results vary with scar type, depth, skin type and how many sessions you have; deep or widespread scarring improves but rarely disappears completely. Photographs taken at your first visit help you see the change.
How we photograph progress and share results, only with written consent, is explained on our results page.
Risks and how we minimise them
- Temporary darkening (post-inflammatory hyperpigmentation) is the most common concern on Indian skin. We lower it with conservative settings, preparing the skin where needed, and strict sun protection, and treat it promptly if it appears.
- Prolonged redness can last a few weeks after laser in sensitive skin.
- Infection or a cold sore flare is uncommon; preventive medicine may be given if you are prone to cold sores.
- Grid marks, bruising or swelling settle with time.
Choosing the right method for each scar type, and spacing sessions so the skin fully recovers, matters as much as the machine.