Acne scars are one of the hardest dermatological conditions to treat — but the most rewarding when treated correctly. The reason most patients are unhappy with their scar-removal results is simple: they got the wrong treatment for their scar type. This page explains the four main types of acne scars, the right treatment for each, and what realistic 4 to 6 month results look like at Derma Essence.
First, identify your scar type
Most patients have a mix of these. Treatment depends on which dominate.
Ice-pick scars
Narrow, deep, V-shaped pits. Look like the skin was punctured with a needle. Best treatment: TCA CROSS (chemical reconstruction of skin scars) — concentrated TCA spot-applied to the scar floor. Less commonly, punch elevation surgery for very deep scars.
Boxcar scars
Wider, sharply-defined depressions with vertical edges (like chickenpox scars). Best treatment: MNRF with PRP layering. Sometimes combined with subcision for deeper boxcars.
Rolling scars
Shallow, wave-like depressions caused by fibrous bands tethering the skin. Best treatment: subcision (a needle is used to release the fibrous band beneath the scar) followed by MNRF for surface texture.
Hypertrophic / keloid scars
Raised, red, sometimes painful or itchy scars. Best treatment: intralesional corticosteroid injections, sometimes combined with cryotherapy or pulsed dye laser. Different protocol entirely from atrophic scars — wrong treatment makes keloids bigger.
Step 0: Get the acne under control first
This is non-negotiable. There is no point treating scars while new ones are forming. If you have active acne (more than 5 active lesions), we treat that first with topicals, peels, or oral medications. Scar treatment starts only after acne is stable for at least 1 to 2 months.
Our combination protocol
Detailed scar mapping 20 min
We photograph each face zone in standardised lighting, identify scar types in each region, and design a treatment sequence. You leave the consultation knowing exactly which procedures will hit which scars.
Subcision (if rolling scars present) 30 min
A specialised needle is inserted under each rolling scar to release the fibrous band tethering it. Performed under topical anaesthesia. Some bruising for 5 to 7 days. Often the most-impactful single procedure for patients with rolling scars.
MNRF + PRP (4 to 6 sessions) 60 min each
Workhorse of the protocol. MNRF remodels collagen at depth; PRP layered immediately after accelerates healing and amplifies results. Sessions 4 to 6 weeks apart.
TCA CROSS (for ice-pick scars) 20 min
Concentrated TCA acid is precisely deposited at the bottom of each ice-pick scar using a wooden applicator. Triggers controlled scar-base remodelling. 4 to 6 sessions, 6 to 8 weeks apart.
Filler / final touch-ups 30 min
For specific stubborn atrophic scars, hyaluronic acid filler raises the depression to skin level. Lasts 9 to 12 months. Used as a finishing touch, not a primary treatment.
