Why are acne scars so hard to treat?
Scarring forms when inflammation damages the skin's deeper support structure. The result is usually a mix of scar types — rolling, boxcar and icepick — each with different shapes and depths, plus sometimes leftover marks (which are pigmentation, not true scars). Because they're not all the same, they don't all respond to the same treatment — which is why assessment comes first.
The main treatments, and what each does
Subcision releases the tethered bands that pull rolling scars down from beneath the skin. Consultant dermatologist Dr. Barikbin specialises in minimally invasive subcision techniques. RF microneedling stimulates collagen remodelling to improve texture and shallower scars. Laser resurfacing / scar-remodelling protocols (e.g. Fotona) help refine surface and texture. PRP uses your own growth factors to support skin regeneration, often combined with microneedling. These are frequently used together across a course of sessions.
How is a treatment plan chosen?
Your dermatologist first identifies your scar types and skin tone, then sequences treatments accordingly — for example, subcision for tethered rolling scars, microneedling or laser for texture, and PRP to support healing. On darker skin, settings are kept conservative to avoid triggering pigmentation. The plan is staged over time, letting the skin remodel between sessions. See our full acne scar treatment approach.
What results are realistic?
The honest answer is meaningful improvement, not complete erasure. Scars can be made substantially less visible and the skin's texture smoother, but expecting perfectly scar-free skin sets you up for disappointment. Results develop gradually over months as collagen remodels, and individual results vary. Treating any active acne and protecting from the sun are part of the plan.
Should you treat scars or active acne first?
Generally, active acne is brought under control first — otherwise new breakouts can create new scars. Once the skin is settled, scar treatment begins. Leftover dark marks (post-inflammatory pigmentation) are also addressed, often separately, as they're pigment rather than true scars.