Pitted acne scars form when inflammatory acne damages collagen in the dermis, creating depressions in the skin surface. These scars appear as indentations ranging from shallow, wave-like depressions to deep, narrow pits. Unlike hyperpigmentation that fades over time, pitted scars require active intervention to stimulate collagen remodeling and resurface the skin.
Three distinct types characterize pitted acne scars: ice pick scars present as narrow, deep holes extending into the dermis; boxcar scars show broader depressions with sharp vertical edges; rolling scars create wave-like undulations across the skin. Each type responds differently to treatment modalities, making accurate classification the foundation of effective scar revision.
Ice pick scars measure less than 2mm in diameter but penetrate deep into the skin layers. Their narrow opening and steep sides make them particularly challenging to treat with surface-level procedures. These scars commonly appear on the cheeks and resemble small puncture wounds.
Boxcar scars present as round or oval depressions with well-defined edges. Shallow boxcar scars (0.1-0.5mm depth) respond well to resurfacing treatments, while deeper variants (>0.5mm) often require combination approaches. The temporal area and cheeks show the highest incidence of boxcar scarring.
Rolling scars create a wave-like texture through fibrous bands that tether the epidermis to deeper structures. These scars typically measure 4-5mm across and produce shadows that accentuate their appearance. The abnormal fibrous anchoring distinguishes rolling scars from other atrophic scar types.
💡 Did You Know?
Pitted acne scars form through a complex inflammatory cascade where matrix metalloproteinases break down collagen faster than fibroblasts can produce new collagen, creating permanent structural deficits in the dermis.
Fractional CO2 laser treatment creates controlled micro-injuries in the dermis, triggering collagen production while leaving surrounding tissue intact. The laser penetrates 0.5-2mm deep, vaporizing scar tissue and stimulating fibroblast activity. Treatment sessions require topical anesthesia and result in 5-7 days of visible peeling and redness.
Non-ablative fractional lasers like Fraxel deliver thermal energy without removing the epidermis. These devices heat dermal collagen to 60-70°C, initiating remodeling while preserving the skin barrier. Patients experience 2-3 days of mild swelling and can resume normal activities within 24-48 hours.
Picosecond lasers utilize ultra-short pulses measured in trillionths of a second to create photoacoustic effects. This mechanical disruption breaks up scar tissue without significant heat generation, reducing downtime to 1-2 days. The technology particularly suits patients with darker skin types who face higher risks with traditional ablative lasers.
Treatment protocols typically involve 3-6 sessions spaced 4-6 weeks apart. Each session targets progressively deeper layers, allowing gradual collagen remodeling. Improvement continues for 3-6 months post-treatment as new collagen matures and organizes.
Microneedling creates controlled micro-channels using sterile needles ranging from 0.5-3mm in length. Professional devices penetrate at precise depths, triggering wound healing cascades that increase collagen and elastin production. The mechanical disruption also releases growth factors from platelets and keratinocytes.
Radiofrequency microneedling combines mechanical needling with thermal energy delivery. Insulated needles penetrate to predetermined depths before releasing radiofrequency energy at the needle tips. This dual-action approach heats dermal collagen to 65-75°C while protecting the epidermis, maximizing collagen remodeling with minimal surface damage.
⚠️ Important Note
Professional microneedling devices differ significantly from home rollers in needle quality, penetration depth, and sterility standards. Medical-grade treatments use single-use cartridges with surgical steel needles that maintain sharpness throughout the procedure.Treatment sessions require numbing cream application 30-45 minutes prior. The procedure itself takes 20-30 minutes, followed by immediate application of growth factor serums or platelet-rich plasma. Post-treatment redness resembles moderate sunburn and resolves within 24-72 hours.
TCA CROSS (Chemical Reconstruction of Skin Scars) applies high-concentration trichloroacetic acid (70-100%) directly into individual scars using a toothpick or fine applicator. The acid coagulates proteins within the scar, creating controlled inflammation that stimulates collagen production from the base upward. White frosting appears immediately, followed by scab formation lasting 7-10 days.
Medium-depth peels using 35-50% TCA or combination peels address superficial scarring across broader areas. These peels penetrate through the papillary dermis, removing damaged tissue while stimulating fibroblast activity. The controlled injury results in organized collagen deposition during the healing phase.
Glycolic acid peels at 50-70% concentration provide gentler resurfacing for mild scarring. Sequential treatments every 2-4 weeks gradually improve skin texture through accelerated cell turnover and mild collagen stimulation. This approach suits patients seeking minimal downtime between sessions.
✅ Quick Tip
Pre-treatment with tretinoin 0.025-0.05% for 2-4 weeks enhances peel penetration and promotes more uniform results by normalizing keratinization patterns.
Subcision physically releases fibrous bands tethering scars to underlying tissue. A specialized needle or cannula inserted parallel to the skin surface sweeps beneath scars, severing adhesions. The mechanical disruption creates a controlled hematoma that organizes into new collagen, elevating the depressed area.
Hyaluronic acid fillers provide immediate volume replacement for suitable scars. The filler integrates with surrounding tissue water, creating natural-looking elevation that lasts 6-12 months. Injection technique requires precise placement at the dermal-subcutaneous junction to avoid superficial irregularities.
Poly-L-lactic acid stimulates endogenous collagen production over several months. This biostimulator requires 2-3 treatment sessions spaced 4-6 weeks apart, with results developing gradually as fibroblasts respond to the implanted microspheres. The collagen response continues for 12-24 months post-treatment.
Combined subcision with filler placement addresses both tethering and volume loss simultaneously. The subcision creates space for filler distribution while the filler prevents re-adhesion during healing.
Sequential combination protocols maximize results by addressing different aspects of scarring. A typical approach begins with subcision to release tethered scars, followed by fractional laser resurfacing 4-6 weeks later to smooth surface irregularities. Final refinement with superficial peels or microneedling addresses residual textural concerns.
Simultaneous combinations leverage synergistic effects. Fractional laser treatment immediately followed by platelet-rich plasma application enhances healing and collagen production. The growth factors in PRP accelerate tissue repair while the laser-created channels facilitate deeper penetration.
Treatment spacing follows tissue healing timelines. Major interventions like deep laser resurfacing require 4-6 week intervals for complete re-epithelialization and initial collagen remodeling. Gentler treatments like superficial peels or light microneedling can occur at 2-3 week intervals.
“Successful pitted acne scar treatment requires matching the intervention to scar morphology. Ice pick scars often need TCA CROSS or punch excision before resurfacing, while rolling scars respond well to subcision combined with energy-based devices. I photograph scars under different lighting angles to reveal subtle contours that guide treatment selection.
Patient skin type influences device settings and treatment intervals significantly. Darker skin requires conservative parameters with extended healing times between sessions to minimize post-inflammatory hyperpigmentation risk. Pre-treatment with hydroquinone or tranexamic acid helps optimize outcomes in susceptible individuals.
Most patients achieve 50-70% improvement with comprehensive treatment plans. Complete scar elimination rarely occurs, but significant textural improvement transforms how light interacts with the skin surface, creating smoother appearance even with residual depth variations.”
How long before I see results from pitted acne scar treatment?
Initial improvements appear 2-4 weeks post-treatment as inflammation subsides and early collagen formation begins. Significant changes develop over 3-6 months as collagen remodeling progresses. Final results from a complete treatment series become apparent 6-12 months after the last session.
Can pitted acne scars return after successful treatment?
Treated scars don’t return, but new acne lesions can create fresh scarring. Maintaining clear skin through appropriate acne management prevents new scar formation. Collagen continues aging naturally, so some textural changes may develop over years, though not specifically scar recurrence.
Which treatment hurts the most?
Fractional CO2 laser and deep TCA peels cause the most discomfort despite numbing. Radiofrequency microneedling produces moderate sensation described as hot pinpricks. Non-ablative lasers and superficial peels create mild warming or tingling. All medical treatments include appropriate anesthesia options.
Do home devices work for pitted acne scars?
Home devices lack the power and precision to create significant collagen remodeling in established scars. LED devices and derma rollers may improve overall skin quality but won’t substantially reduce scar depth. Professional treatments deliver controlled injury at specific depths necessary for scar revision.
What’s the total cost for complete scar treatment?
Treatment costs vary based on scar severity, chosen modalities, and required session numbers. Most patients need multiple sessions of different treatments. Initial consultation determines the specific protocol and associated investment for your individual scarring pattern and treatment goals.
Effective pitted acne scar treatment combines appropriate technology selection with realistic expectations and commitment to the full treatment course. Professional assessment ensures safe, targeted interventions that progressively improve skin texture and appearance as part of acne scar treatment in Singapore.
If you’re experiencing deep scars affecting daily confidence, scarring with active acne, or multiple scar types requiring different approaches, our MOH-accredited aesthetic doctors can provide comprehensive evaluation and treatment options.
Every patient is important to me! The most delightful aspect of my profession is to see the satisfaction of my patients and the biggest earning in my career is the patients trust on me.
Dr. Sam has many years of experience in the aesthetic medicine and has worked with industry professionals for more than a decade.
After obtaining his Bachelor of Medicine and Bachelor of Surgery (MBBS), his experience in Anaesthesia, ICU management, Chronic pain management have laid a solid foundation in understanding & managing the pain during aesthetic procedures in a safe and effective manner.
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