Acne scars are not all the same. Rolling, boxcar, ice pick, and raised scars differ in shape and depth, so treatment needs to be matched to the scar rather than chosen as a one-size-fits-all solution.
For those considering acne scar treatment in Malaysia, options may include subcision, TCA CROSS, laser resurfacing, microneedling, radiofrequency-based treatments, chemical peels, and selected skin-quality treatments. The most suitable option depends on the scar pattern, skin condition, and whether active acne or post-acne pigmentation is also present.
At Dr Nazelia Clinic, acne scar treatment planning begins with an assessment to understand these factors before discussing suitable options.
Before comparing treatments, it helps to know whether you are dealing with a true acne scar or a mark left behind after a breakout.
Acne scars change the texture or shape of the skin. They may appear as shallow dips, deeper pits, or raised areas. These changes happen when the skin does not rebuild evenly after inflammation and tissue damage.
Acne marks are usually flat. For example, post-inflammatory hyperpigmentation, or PIH, can leave brown or darker patches where acne has healed.
In this case, the colour changes because pigment remains after inflammation, rather than because the skin itself has become indented or raised.
A simple way to tell the difference:
This distinction matters because pigmentation and structural acne scars need different treatment approaches. If you are unsure whether you have a scar, a post-acne mark, or both, a professional consultation can help identify the concern and guide the next step.
Acne scars are usually grouped by how they look and how deeply they affect the skin. Knowing the scar type makes it easier to understand why different treatments may be considered.
Rolling scars are broad, shallow depressions with smooth, sloping edges that give the skin a wave-like appearance. Some may be pulled down by fibrous bands beneath the skin.
Boxcar scars are round or oval depressions with more defined edges. They may be shallow or deeper and are often seen on the cheeks and jaw.
Ice pick scars are narrow, deep scars that look like small punctures in the skin. Because of their depth, they may need a more targeted treatment approach.
These are raised scars caused by excess collagen during healing. Hypertrophic scars stay within the original area, while keloid scars can grow beyond it.
It is common to have more than one scar type in the same area. When rolling, boxcar, ice pick, or raised scars appear together, a combination of treatments may be considered to address the different scar patterns.
Different acne scars respond to different approaches. The treatment considered will usually depend on the scar’s shape and depth, whether it is being pulled down by tissue underneath, and whether concerns such as active acne or pigmentation are also present.
Subcision uses a fine needle beneath the scar to release tight bands of scar tissue that are pulling the skin downward.
It may be considered for rolling or indented scars, especially when the scar is tethered underneath. This is why surface treatments alone may not fully address some rolling scars.
TCA CROSS applies a small amount of trichloroacetic acid directly into individual scars to trigger a controlled repair response.
It is commonly considered for selected narrow, deep ice pick scars because it targets the scar itself rather than treating a wide area of skin.
Laser treatment for acne scars may help improve uneven texture by resurfacing selected areas and supporting the skin’s natural renewal process.
Dr Nazelia offers CO2 Laser, Erbium Laser, and Pico Laser, with the approach depending on scar depth, skin tone, and other concerns. Pico Laser may also be considered when post-acne pigmentation or uneven skin tone is present alongside selected texture concerns.
Microneedling creates small, controlled channels in the skin to encourage its natural repair response and support smoother-looking texture over time.
It may be considered for milder indented scars or general uneven texture. Microneedling Therapy can also form part of a broader acne scar treatment plan when appropriate.
Radiofrequency-based treatments deliver controlled energy beneath the skin to support repair and improve uneven texture. Some treatments combine this with microneedling.
Treatments available at Dr Nazelia include Sylfirm X, which combines microneedling with radiofrequency, and Rejulax, a radiofrequency-based treatment used for selected acne scar concerns.
Chemical peels work on the skin’s surface to encourage renewal and may help with mild uneven texture and post-acne changes.
They are generally less suited to deep or strongly indented scars. Superficial and medium-depth chemical peels may be included in a treatment plan depending on the skin concern.
Skin boosters focus more on hydration and overall skin quality than on directly treating deep acne scars.
Treatments such as Juvelook and Rejuran Healer may be considered when hydration, skin quality, or texture are also part of the concern, often alongside other scar-focused treatments rather than replacing them.
It is common to have more than one type of acne scar in the same area. Rolling, boxcar, ice pick scars, and flat post-acne marks can appear together, but each affects the skin differently.
Because of this, one procedure may not address every concern. A treatment plan may combine different approaches, such as releasing deeper scars first and using resurfacing or collagen-focused treatments for remaining texture. Combination treatment is also supported in acne scar research, particularly when different scar patterns are present.
Dr Nazelia’s approach focuses on assessing the overall scar pattern and planning treatments according to the individual skin concern rather than relying on one treatment for every scar.
In many cases, active acne should be brought under control before focusing on existing scars. Ongoing breakouts can cause further inflammation and create new scars while older ones are being treated.
If both active acne and scarring are present, begin with a professional consultation. The treatment plan can then be arranged in the right order based on what your skin needs first.
Acne scar treatments can be considered for darker skin tones, but treatment needs to be planned carefully. One important concern is post-inflammatory hyperpigmentation (PIH), where the skin becomes darker after inflammation or irritation. PIH tends to be more noticeable and persistent in darker skin tones.
For this reason, factors such as skin tone, existing pigmentation, scar type, and treatment intensity should be considered before treatment. Research on lasers and radiofrequency treatments also highlights the importance of using appropriate settings for darker skin.
There is no fixed number of sessions that applies to everyone. Acne scar treatment is often gradual, and the treatment plan may change depending on how the skin responds over time.
The number of sessions may depend on:
Rather than focusing on a set number from the start, a consultation and follow-up reviews can help guide the treatment plan based on your progress.
An acne scar assessment helps identify what is contributing to the skin’s texture and what should be addressed first. This usually includes:
Dr Nazelia Clinic offers consultation-led treatment planning across TTDI, Wangsa Melawati, Shah Alam, and Alor Setar, with the focus on understanding the skin before discussing the next steps.
Acne scar treatment options may include subcision, TCA CROSS, laser resurfacing, microneedling, radiofrequency-based treatments, chemical peels, and selected skin-quality treatments. The right approach depends on the scar type and overall skin condition.
Acne scars cannot always be removed completely, especially when they are deep or longstanding. Treatment usually focuses on reducing their appearance and improving skin texture over time.
Neither is automatically better. Laser treatment may suit certain texture concerns, while microneedling may be considered for milder or mixed uneven texture, depending on the scar pattern and skin tone.
Subcision may be considered for rolling scars that are pulled down by tight bands of scar tissue beneath the skin. It works by releasing these bands so the scar is no longer held down as firmly.
Yes, TCA CROSS may be used for selected narrow, deep ice pick scars. It is applied directly to individual scars rather than across a large area of skin.
Yes. Mixed acne scars may need more than one treatment because rolling, boxcar, ice pick scars, and post-acne marks can respond differently. A combination plan can address these concerns in stages.
Acne scar treatment can be considered for darker skin tones, but extra care may be needed because post-inflammatory hyperpigmentation can occur after irritation. Skin tone, scar type, and treatment intensity should be considered when planning treatment.
In many cases, active acne is managed first because ongoing inflammation can lead to new scars. Once breakouts are better controlled, scar treatment can be planned more effectively.
There is no single acne scar treatment that suits everyone, and the most appropriate approach can vary from one person to another.
If you are unsure where to begin, book a consultation today to discuss your concerns and understand which acne scar treatment options may be worth considering for your skin.
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