Acne scarring and uneven texture
Rolling and boxcar scars are tethered below the surface, so resurfacing alone rarely resolves them. Collagen induction over a course of treatments does more than any single session.
Acne scarring is a wound-healing problem rather than a surface problem, which is why it behaves so differently from the discolouration it is often confused with. When inflammation damages the dermis, healing either lays down too little collagen, leaving a depression, or too much, leaving a raised scar. Atrophic scars, the depressed kind, are the most common and fall into three types: ice pick scars, narrow and deep; boxcar scars, wider with sharply defined edges; and rolling scars, shallow undulations caused by fibrous bands tethering skin to the tissue beneath. That tethering is why resurfacing alone often disappoints on rolling scars, because sanding the surface does not release a band pulling from below. What is frequently mistaken for scarring is post-inflammatory hyperpigmentation or erythema, the brown or red marks left after a spot resolves. These are not scars, the skin’s contour is intact, and they fade on their own over months. Distinguishing the two at consultation changes the plan entirely.
How we treat it
Active acne is controlled first. Treating scars while new lesions are still forming produces new scars behind the ones being treated, so where acne is ongoing, dermatological management comes first, and that may mean a referral. Once the skin is quiet, microneedling is the workhorse: controlled micro-injuries trigger collagen induction, and new collagen gradually lifts depressed scars from below. It is explicitly a course, typically three to six sessions spaced four to six weeks apart, because each session builds on the last and a single treatment will not deliver meaningful change. PRP is often added to the same session, applied topically or injected, to support healing. Chemical peels address the surface component and any accompanying pigmentation, and are frequently alternated with needling. Rolling scars with strong tethering may need subcision, releasing the fibrous band mechanically, before resurfacing achieves much. Realistic expectation is part of the treatment: meaningful improvement in depth and texture is achievable, complete erasure generally is not.
Medically reviewed by Dr. Sherwin Hariri, MD, Medical Director & Chief Longevity Physician. Last reviewed August 2026.
This page is for information only and is not medical advice. Suitability for any treatment is determined at consultation.
Common questions
How many microneedling sessions will I need?
Most courses run to three to six sessions, four to six weeks apart, with the interval allowing collagen to remodel between treatments. Deeper boxcar and rolling scars need more than shallow texture irregularity does. Improvement continues for several months after the final session, so the result is assessed at around six months rather than immediately.
Will my acne scars disappear completely?
Substantial improvement is realistic; complete erasure usually is not. A reasonable expectation for a full course is a marked reduction in depth and shadowing, so that scarring becomes difficult to notice in normal light rather than absent under every light. Anyone promising total removal is overselling.
Are the red or brown marks left by spots scars?
Usually not. Flat marks with no change in skin contour are post-inflammatory pigmentation or erythema, and they fade over three to twelve months without collagen treatment. Diligent sun protection speeds this considerably. Only a change in the skin’s surface contour is a true scar.
Can I have this done while I still get breakouts?
Occasional spots are not a barrier, but active inflammatory acne should be controlled first. Needling through active lesions risks spreading inflammation and creating fresh scarring, which defeats the purpose. Where acne is still active, getting it under medical control is the first stage of scar treatment.
Other concerns
Start with a conversation
