Acne Scar Treatment Los Angeles

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Los Angeles's Top Center for Acne Scar Treatment

Kare Plastic Surgery & Skin Health Center  ·  Santa Monica & Beverly Hills, Los Angeles

Acne Scar Treatment in Los Angeles

Precise scar diagnosis — ice pick, boxcar, rolling, atrophic & keloid — matched to the most effective evidence-based treatment: TCA Cross, fractional CO2 laser, subcision, Morpheus8, chemical peels & more. Board-certified dermatologist and plastic surgeon at Kare Plastic Surgery, Santa Monica

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BoardCertified Dermatologist
FACSBoard-Certified Plastic Surgeon
AllAcne Scar Types Treated
10+Treatment Modalities On-Site
Santa Monica804 7th Street

Precision Diagnosis. Multimodal Treatment.

 

Acne Scar Treatment in Los Angeles: The Right Treatment for Every Scar Type

Acne scars are the most psychologically impactful skin concern in dermatology — affecting more than 95% of individuals who experience moderate to severe acne and persisting for years or decades after the acne itself has resolved. Unlike active acne, which can be managed with topical and oral medications, acne scars represent permanent structural changes in the dermis: the destruction of collagen, the formation of fibrous tethering bands, the loss of dermal volume, or — in the case of hypertrophic and keloid scars — the excessive deposition of collagen that distorts the skin surface in the opposite direction.

The most important principle in acne scar treatment — and the one most frequently violated at non-physician laser chains and aesthetician-run clinics throughout Los Angeles — is that different scar types require fundamentally different treatments. Ice pick scars do not respond to the same interventions as rolling scars. Boxcar scars with sharply defined walls are not treated the same way as broad, shallow atrophic depressions. Keloid scars require the opposite approach from atrophic scars. Applying a single treatment modality to every acne scar type — as many Los Angeles providers do — produces mediocre results because the treatment is not matched to the morphology.

At Kare Plastic Surgery & Skin Health Center in Santa Monica, board-certified dermatologist Dr. Tiffany Sierro performs a precise morphologic assessment of every patient’s acne scars — characterizing each scar type, depth, and distribution before any treatment is initiated. Working in partnership with board-certified plastic surgeon Dr. Raffy Karamanoukian, MD, FACS, whose expertise in scar biology and wound healing science informs the surgical and combination aspects of complex scar revision, Kare provides a genuinely individualized, evidence-based acne scar treatment program that is simply unavailable at single-modality providers in the Los Angeles market.

Acne Scar Treatments Available at Kare

  • TCA Cross — precision chemical reconstruction for ice pick scars
  • Fractional CO2 Laser — gold standard for boxcar and rolling scars
  • Vbeam Pulsed-Dye Laser — erythematous and vascular scar components
  • Fractional Erbium Laser — medium-depth surface refinement
  • Morpheus8 RF Microneedling — subdermal collagen for all scar types
  • Microneedling with PRP — biological regeneration for diffuse atrophy
  • Subcision — mechanical release of rolling scar tethering bands
  • Obagi Blue Peel — physician-grade TCA medium-depth peel
  • Jessner’s + TCA Medium-Depth Chemical Peel
  • Punch Excision & Punch Grafting for deep boxcar and icepick scars
  • Intradermal Filler for volume restoration in atrophic depressions
  • Intralesional Kenalog + 5-FU for hypertrophic and keloid acne scars

Our Physician Team

 

Dermatologist & Plastic Surgeon: The Combination No Acne Scar Clinic in Santa Monica Can Match

Acne Diagnosis, Dermatology & Scar Assessment

Dr. Tiffany Sierro, MD
Board-Certified Dermatologist

Dr. Tiffany Sierro is a board-certified dermatologist whose formal training encompasses medical dermatology, surgical dermatology, dermatopathology, and laser medicine — the full clinical toolkit required for expert acne scar assessment and treatment. Her approach to every acne scar patient begins with the diagnostic precision that is the prerequisite for effective treatment: a systematic morphologic classification of every visible scar using dermoscopy and clinical assessment, establishing the exact mix of ice pick, boxcar, rolling, atrophic, and hypertrophic/keloid scars present before any treatment recommendation is made.

This classification directly determines the treatment plan. Dr. Sierro does not apply a single modality to all acne scar presentations — she designs individualized protocols that match TCA Cross to ice pick scars, subcision to rolling scars, fractional CO2 or Erbium laser to boxcar scars, Morpheus8 to diffuse atrophy in patients with darker skin tones, and intralesional treatment to hypertrophic components. Her medical dermatology background also allows her to address active acne simultaneously with scar treatment — critical because new breakouts continue to create new scars, and treating scars on a foundation of uncontrolled active acne is a losing strategy.

Scar Science, Wound Healing & Complex Revision

Dr. Raffy Karamanoukian, MD, FACS
Board-Certified Plastic Surgeon

Dr. Raffy Karamanoukian is a UCLA-trained, double board-certified plastic and reconstructive surgeon with over 20 years of experience in scar management, wound healing science, and skin revision surgery — a background that uniquely qualifies him to manage the most complex acne scar presentations that exceed the scope of conventional dermatologic treatment alone. His expertise in the biology of scar formation — the phases of wound healing, the mechanical forces that determine scar geometry, the role of fibroblast activity and inflammatory mediators in scar maturation — informs the combination protocols he and Dr. Sierro design for patients with severe, recalcitrant, or surgically complex acne scar presentations.

For acne scars requiring punch excision, punch grafting, or surgical scar revision beyond what lasers and chemical agents can achieve, Dr. Karamanoukian performs these procedures in the fully equipped surgical suite at Kare Plastic Surgery. His nationally recognized expertise in keloid and hypertrophic scar management is particularly valuable for patients whose acne scars have evolved into raised, fibrotic lesions requiring the multimodal approach of intralesional treatment, vascular laser, compression, and surgical revision that is not available at standard dermatology practices.

“Acne scar treatment without precise morphologic diagnosis is like writing a prescription without examining the patient. The treatment must match the scar type exactly — and no single treatment addresses every scar type optimally. Our protocols are built scar by scar, not lesion category by category.”

— Dr. Tiffany Sierro, MD — Board-Certified Dermatologist, Kare Plastic Surgery

Scar Morphology & Diagnosis

 

Acne Scar Types: Precise Diagnosis Drives Treatment Selection

The five major categories of acne scarring have distinct morphologies, distinct pathophysiologies, and distinct treatment requirements. Dr. Sierro identifies the exact mix in each patient before designing a protocol.

Ice Pick Scars

The most distinctive and challenging atrophic acne scar subtype, ice pick scars are narrow, deep, sharply V-shaped channels that extend from the skin surface deep into the dermis — or even into the subcutaneous fat in the most severe cases. They are named for their resemblance to the wound left by an ice pick: small at the surface (typically <2mm), but extending much deeper than their surface opening suggests. The narrow channel geometry is precisely what makes ice pick scars so difficult to treat with surface lasers alone — the laser energy cannot reach the deep base of the channel without vaporizing the narrow walls, risking scarring of the channel itself.

First-Line Treatment: TCA Cross (Chemical Reconstruction of Skin Scars); punch excision for deep isolated lesions; combination with fractional CO2 for surrounding texture

Boxcar Scars

Boxcar scars are round to oval atrophic depressions with sharply defined, nearly vertical walls and a flat or gently concave base — resembling a box or crater viewed from above. They range from shallow (easily treated with 1–2 fractional CO2 sessions) to deep (requiring more aggressive treatment or combination approaches). Shallow boxcar scars represent a dermal volume deficit with relatively intact surrounding architecture; deep boxcar scars involve significant loss of the collagen scaffold that supports the overlying skin. The well-defined vertical walls that characterize boxcar scars make them among the most amenable to fractional CO2 laser treatment, which ablates the sloped wall and stimulates collagen from the scar base upward.

First-Line Treatment: Fractional CO2 laser; subcision if fibrous tethering is present; intradermal filler for deep volume deficit; punch excision for very deep isolated lesions

Rolling Scars (Valley Scars)

Rolling acne scars — also called valley scars — present as broad, undulating skin depressions with gradual, sloping edges that create a wave-like topographic irregularity across the skin surface. Unlike ice pick and boxcar scars, which represent loss of dermal volume, rolling scars are primarily caused by fibrous tethering bands that extend from the base of the scar downward into the subcutaneous tissue — anchoring the undersurface of the skin and pulling it downward relative to the surrounding unscarred skin. This anchoring mechanism makes rolling scars uniquely responsive to subcision — the one treatment that directly releases the tethering bands — and relatively less responsive to surface lasers alone, which cannot address the subdermal anchoring that creates the depression.

First-Line Treatment: Subcision (mechanical band release); combined with PRP or filler for volumetric fill of released space; followed by fractional CO2 or Morpheus8 for surface texture

Atrophic & Shallow Depressed Scars

Atrophic acne scars represent the broadest category of acne scarring — encompassing all depressions in the skin surface resulting from loss of collagen and dermal volume during the inflammatory phase of acne lesion resolution. They may be shallow enough to cast no shadow in direct lighting but become clearly visible in oblique (raking) light. Diffuse atrophic scarring across the cheeks, temples, and forehead produces an overall rough, irregular skin texture rather than isolated discrete pits, and responds well to global resurfacing approaches including medium-depth chemical peels and Morpheus8 RF microneedling. Shallow atrophic scars in patients with darker Fitzpatrick skin types are often best addressed with Morpheus8 rather than ablative CO2 laser to avoid post-inflammatory hyperpigmentation.

First-Line Treatment: Fractional CO2 or Erbium for Fitzpatrick I–III; Morpheus8 for Fitzpatrick III–VI; medium-depth chemical peels; microneedling with PRP; multiple sessions required

Hypertrophic & Keloid Acne Scars

While most acne scars are atrophic (depressed), a subset of patients — particularly those with darker skin tones and a genetic predisposition to abnormal wound healing — develop hypertrophic or keloid scars at acne sites. Hypertrophic acne scars are raised, firm, erythematous papules and plaques that remain within the original wound boundary; keloid acne scars extend beyond the original acne lesion boundary and continue to grow over time. The most common locations for keloid acne scarring are the jawline, chest, and back. Treatment is the reverse of atrophic scar management: the goal is to flatten and soften the raised tissue rather than to stimulate new collagen.

First-Line Treatment: Intralesional triamcinolone + 5-FU (TAC/5-FU); Vbeam pulsed-dye laser for vascular and erythematous components; silicone gel sheeting; surgical excision with adjuvant treatment for recalcitrant keloids

Post-Inflammatory Hyperpigmentation

Post-inflammatory hyperpigmentation (PIH) — the dark brown or gray-brown discoloration that remains at healed acne sites — is technically not a true acne scar (it does not represent structural dermal change) but is the most visible and distressing reminder of prior acne for many patients, particularly those with darker skin tones. PIH results from excess melanin deposition in the epidermis and superficial dermis during the resolution of an inflammatory acne lesion. Unlike true acne scars, PIH typically fades over 6–24 months with sun protection alone, but can be significantly accelerated with topical depigmenting agents, chemical peels, and Lutronic Thulium laser treatment. Accurate differentiation between PIH and true atrophic scarring is essential before treatment, as they require entirely different management.

First-Line Treatment: Topical hydroquinone + tretinoin + vitamin C; Lutronic Thulium laser; medium-depth chemical peels; SPF 50+ strict sun avoidance; differentiate from true scarring before treatment

Treatment Selection Guide

 

Precision Matching Acne Scar Treatment to Scar Type

No single treatment optimally addresses every acne scar type. This evidence-based guide summarizes the primary and adjuvant treatment roles of each modality at Kare Plastic Surgery for each major scar category.

Treatment Ice Pick Boxcar Rolling Atrophic Hypertrophic/Keloid PIH
TCA Cross First-Line Adjuvant Not Used Not Used Not Used Not Used
Fractional CO2 Laser Adjuvant First-Line After Subcision First-Line Caution Risk PIH
Subcision Not Used If Tethered First-Line Adjuvant Not Used Not Used
Morpheus8 RF Adjuvant First-Line After Subcision First-Line Dark Skin Not Used Adjuvant
Vbeam Pulsed-Dye Not Used Not Used Not Used Erythema First-Line Adjuvant
Obagi Blue Peel / TCA Peel Adjuvant First-Line Adjuvant First-Line Not Used First-Line
Microneedling + PRP Adjuvant Adjuvant After Subcision First-Line Dark Skin Not Used Adjuvant
Intralesional TAC + 5-FU Not Used Not Used Not Used Not Used First-Line Not Used

Treatment Modalities

 

Acne Scar Treatments at Kare Plastic Surgery: Every Modality, Every Scar Type

01

TCA Cross for Ice Pick Acne Scars

TCA Cross (Trichloroacetic Acid Chemical Reconstruction of Skin Scars) is the definitive treatment for ice pick acne scars and deep narrow boxcar scars — the two scar subtypes that respond least well to surface laser resurfacing due to their narrow, deep channel geometry. The procedure applies a very high concentration of TCA (typically 70–100%) focally and precisely to the individual scar base using a sharpened wooden applicator or fine-gauge needle tip, delivering the acid exclusively to the interior of the scar channel without affecting the surrounding normal skin.

The concentrated acid causes immediate protein coagulation and full-thickness coagulative necrosis within the narrow scar channel, followed by a robust wound healing response over 4–6 weeks in which fibroblasts migrate into the channel and synthesize new collagen from the scar base upward — progressively elevating the scar floor toward the surrounding skin level with each session. Published data demonstrate 50–75% improvement in ice pick scar depth after 2–4 TCA Cross sessions spaced 6–8 weeks apart. TCA Cross leaves surrounding normal skin completely unaffected, making it the only focally precise chemical treatment capable of selectively improving deep, narrow scar channels without collateral damage to healthy skin.

Best For: Ice pick scars (primary indication), narrow deep boxcar scars; 2–4 sessions; combined with fractional CO2 for surrounding texture improvement; suitable for all Fitzpatrick skin types with appropriate concentration adjustment
02

Fractional CO2 Laser for Acne Scars

Fractional CO2 laser resurfacing is the gold standard non-surgical treatment for boxcar acne scars and diffuse atrophic scarring — the most evidence-supported, most widely studied, and most consistently effective modality for the scar subtypes that constitute the majority of acne scar burden in most patients. By delivering thousands of microscopic ablative columns into the skin at precisely controlled depths (150–400 microns for most facial acne scar treatment), fractional CO2 physically vaporizes the sloped scar walls and stimulates a profound wound healing collagen cascade that fills the scar base from below as new fibroblast-produced collagen replaces the ablated tissue.

Published clinical studies consistently demonstrate 25–75% improvement in acne scar severity scores after a series of fractional CO2 sessions, with improvement rates dependent on scar morphology, energy density, and number of sessions. Boxcar scars with well-defined vertical walls show the greatest absolute improvement per session; diffuse shallow atrophic scarring requires more sessions for equivalent improvement due to the lower topographic prominence of each individual scar. Dr. Sierro performs fractional CO2 acne scar treatment at Kare with settings customized to the patient’s specific scar characteristics and Fitzpatrick skin type, and regularly combines CO2 with TCA Cross (for any ice pick scars present) and subcision (for any rolling scars present) in comprehensive single-session combination protocols.

Best For: Boxcar scars (primary indication), diffuse atrophic scarring, Fitzpatrick I–III; 1–4 sessions; combined with TCA Cross and subcision in combination protocols; 7–10 days downtime
03

Subcision for Rolling & Tethered Acne Scars

Subcision is the surgical procedure of choice for rolling (valley) acne scars and any boxcar scar with demonstrated subcutaneous tethering — scars whose depression is caused not by volume loss alone but by fibrous bands anchoring the scar base to the underlying dermis or subcutaneous fascia. Using a 23–27 gauge needle or specialized Nokor needle inserted through a small puncture point adjacent to the scar, Dr. Sierro and Dr. Karamanoukian pass the needle in a fan-like pattern beneath the scar base, mechanically severing the fibrous tethering bands in a controlled subcutaneous dissection. The released scar elevates immediately as the tethering force is eliminated.

The subcutaneous space created by band release is filled by hematoma — the collection of blood that organizes over 2–4 weeks and serves as a scaffold for new collagen deposition. Injecting PRP into the released space at the time of subcision significantly enhances this collagen induction, and performing intradermal filler placement (Sculptra or Radiesse) immediately post-subcision physically fills the released volume with a collagen-stimulating agent that sustains the structural correction. Most rolling scar patients require 2–4 subcision sessions at 4–6 week intervals, with each session progressively releasing additional tethered areas and building upon the collagen laid down in prior sessions.

Best For: Rolling/valley scars (primary indication), tethered boxcar scars; 2–4 sessions; combined with PRP or filler for maximum volumetric result; followed by fractional CO2 or Morpheus8 for surface refinement; minimal downtime
04

Morpheus8 RF Microneedling for Acne Scars

Morpheus8 radiofrequency microneedling is the preferred treatment modality for acne scars in patients with darker Fitzpatrick skin types (III–VI) — where the post-inflammatory hyperpigmentation risk of fractional CO2 laser prohibits aggressive ablative resurfacing — and as a complementary treatment to fractional CO2 for patients of all skin types seeking maximum dermal remodeling depth. By delivering bipolar radiofrequency energy through an array of gold-tipped microneedles at programmable depths (1–8mm), Morpheus8 bypasses the melanin-containing epidermis entirely and delivers collagen-stimulating thermal energy directly to the dermis and subdermal fat at the exact depth where atrophic acne scars exist.

The combination of microneedling-induced collagen induction (from the physical needle channels) and RF-induced thermal remodeling (from the delivered radiofrequency energy) produces improvements in scar depth, skin thickness, surface texture, and dermal density that are additive to surface laser treatment. For patients with extensive atrophic scarring across the cheeks and temples — the diffuse, rough, irregular texture pattern that acne leaves across large facial surface areas — Morpheus8 at 4–8mm depth addresses the structural dermal deficit that surface-only laser treatment cannot reach. Multiple sessions (3–5) are recommended for maximum improvement.

Best For: All atrophic scar types; Fitzpatrick III–VI (primary platform for darker skin tones); combination with fractional CO2 for maximum multimodal effect; 3–5 sessions; 24–72 hours downtime
05

Vbeam Pulsed-Dye Laser for Hypertrophic & Erythematous Acne Scars

The Vbeam pulsed-dye laser (595nm) is the first-line treatment for hypertrophic and early keloidal acne scars and for the persistent redness and erythema that accompanies active acne lesion resolution and early inflammatory scars. By selectively targeting the network of abnormal blood vessels within hypertrophic scar tissue, the Vbeam depletes the vascular supply that sustains the fibroproliferative scar activity — reducing the redness, flattening the elevation, and softening the texture of hypertrophic acne lesions. Vbeam is also highly effective for reducing the post-inflammatory erythema that remains at healing acne sites, and for addressing the vascular component within early atrophic acne scars that appear red and inflamed before they mature into established atrophic lesions.

For keloid acne scars, Vbeam is combined with intralesional triamcinolone acetonide (TAC) and 5-fluorouracil (5-FU) in a multimodal protocol that addresses the vascular, inflammatory, and fibroproliferative components of keloid pathophysiology simultaneously. This combination protocol — developed through published clinical research on keloid management — produces significantly better keloid flattening than either laser or injection alone.

Best For: Hypertrophic acne scars (primary indication with TAC + 5-FU), early erythematous lesions, post-inflammatory erythema, keloidal jawline and chest acne scars; 2–5 sessions
06

Obagi Blue Peel & Medium-Depth Chemical Peels

Chemical peels occupy a crucial position in the acne scar treatment spectrum — particularly for patients with diffuse shallow atrophic scarring, concurrent post-inflammatory hyperpigmentation, and uneven skin tone who want a single treatment that addresses texture, pigmentation, and surface quality simultaneously. The Obagi Blue Peel is a physician-grade trichloroacetic acid (TCA) peel developed by renowned dermatologist Dr. Zein Obagi that uses a blue-tinted base solution to control TCA penetration depth and ensure uniform, predictable, medium-depth exfoliation of the skin down to the papillary dermis.

The Jessner’s + TCA (35%) combination medium-depth peel is another cornerstone of Dr. Sierro’s chemical peel program for acne scars. Jessner’s solution (salicylic acid + lactic acid + resorcinol in ethanol) is first applied to thoroughly disrupt the epidermal barrier, after which TCA 35% penetrates more evenly and deeply than TCA alone — producing a medium-depth peel that reaches the upper reticular dermis and stimulates robust collagen remodeling. Both the Obagi Blue Peel and the Jessner’s + TCA combination peel require 5–7 days of peeling and healing, and produce improvements in skin texture, tone uniformity, and mild to moderate atrophic scar appearance that are durable and cumulative with repeat sessions.

Best For: Diffuse shallow atrophic scarring, post-inflammatory hyperpigmentation, uneven skin tone, concurrent photodamage; 1–3 sessions; 5–7 days downtime; suitable for Fitzpatrick I–IV with appropriate peel selection
07

Microneedling with PRP for Acne Scars

Microneedling — using a medical-grade device with fine needles (0.5–2.5mm) to create thousands of microscopic puncture wounds in the dermis — stimulates a natural wound healing cascade that drives new collagen and elastin production, improving scar depth, texture, and overall skin quality through biological regeneration rather than ablation. When combined with PRP (platelet-rich plasma) applied topically immediately after needling creates the micro-channels for deep dermal penetration, the growth factor payload of the PRP — PDGF, TGF-β, VEGF, EGF — amplifies the collagen induction response and accelerates tissue regeneration within the treated scars.

The published clinical evidence supporting microneedling with PRP for acne scars includes several randomized controlled trials demonstrating superiority over microneedling alone, with improvements in scar severity scores, skin thickness by ultrasound, and patient satisfaction. Microneedling with PRP is Dr. Sierro’s preferred approach for patients with diffuse atrophic scarring and darker Fitzpatrick skin types who want a no-ablation treatment with zero risk of post-inflammatory hyperpigmentation. Most patients require 3–5 sessions at 4–6 week intervals, with collagen remodeling continuing for 3–6 months after the final session.

Best For: Diffuse atrophic scarring, all Fitzpatrick skin types, patients who cannot accept ablative downtime; 3–5 sessions; 24–48 hours mild redness; excellent safety profile for darker skin tones
08

Fractional Erbium Laser for Moderate Acne Scars

The fractional Erbium:YAG laser (2,940nm) provides a medium-depth ablative resurfacing option that sits between the no-ablation approach of microneedling and the full power of fractional CO2 — offering meaningful improvement in boxcar and shallow atrophic scars with 3–7 days of downtime rather than the 7–10 days required by CO2. The Erbium wavelength is absorbed more precisely by water than CO2 and produces less collateral thermal damage to surrounding tissue, resulting in faster healing and a wider safety margin for patients with Fitzpatrick skin type III–IV who may not be appropriate candidates for full-power fractional CO2.

For patients with mild to moderate boxcar and atrophic acne scarring who want visible improvement with moderate downtime, fractional Erbium is Dr. Sierro’s preferred alternative to CO2. Multiple sessions (typically 2–4) are needed to achieve improvement comparable to 1–2 CO2 sessions, but the reduced thermal injury profile and wider skin-type applicability make it the pragmatic choice for many Los Angeles patients whose lifestyle or Fitzpatrick type limits their CO2 candidacy.

Best For: Moderate boxcar and atrophic scars, Fitzpatrick I–IV; 2–4 sessions; 3–7 days downtime; preferred for darker skin types not suitable for full CO2 settings; combination with TCA Cross for mixed presentations

Who We Treat

 

Who Should Seek Acne Scar Treatment at Kare Plastic Surgery in Los Angeles?

✓   Ideal Candidates for Acne Scar Treatment at Kare Plastic Surgery

  • Adults with ice pick, boxcar, rolling, or atrophic acne scars who have had their active acne controlled for a minimum of 3–6 months before scar treatment — treating scars on a foundation of uncontrolled active acne is counterproductive, as new breakouts continue to produce new scars while treatment is underway
  • Patients who have not taken isotretinoin (Accutane) within the past 6–12 months — isotretinoin significantly impairs wound healing and increases the risk of abnormal healing and hypertrophic scar formation after ablative laser procedures during the washout period
  • Those with realistic expectations about acne scar improvement — most treatment programs achieve 25–75% improvement in scar severity rather than complete elimination, and multiple sessions are required for significant correction of established scarring
  • Patients of all Fitzpatrick skin types — darker skin tones are appropriately redirected to Morpheus8 RF microneedling, microneedling with PRP, fractional Erbium, and chemical peels rather than aggressive CO2 laser, ensuring safe and effective treatment for the full ethnic diversity of the Los Angeles patient population
  • Individuals with mixed acne scar presentations — the majority of patients have a combination of ice pick, boxcar, and rolling scars simultaneously — who benefit most from the multimodal combination protocols that Kare’s dual-physician team uniquely provides in a single treatment session
  • Patients who have previously received laser or chemical peel treatment elsewhere with incomplete results, and who want access to the full multimodal protocol — including TCA Cross, subcision, and combination approaches — that was not available at their prior provider
  • Those with hypertrophic or keloid acne scars on the jawline, chest, or back who need the combined expertise of Dr. Sierro’s intralesional injection protocols and Dr. Karamanoukian’s reconstructive scar surgery background for complex, recalcitrant lesions
  • Adults who want to actively manage active acne and prevent future scar formation simultaneously with treating existing scars — Dr. Sierro’s dermatology practice provides both functions in one comprehensive skin health program
  • Patients with post-inflammatory hyperpigmentation who need accurate differentiation between true scarring and transient pigmentary change before committing to invasive treatments that would be unnecessary and potentially harmful for pure PIH
  • Individuals in the Los Angeles area whose outdoor, beach, and social lifestyle makes acne scarring particularly impactful on self-confidence and quality of life, and who are motivated to complete a full treatment series with appropriate sun protection and skincare compliance throughout the program

Active acne must be controlled before scar treatment begins: Initiating laser resurfacing, TCA Cross, or chemical peels on skin with active inflammatory acne lesions increases the risk of post-treatment PIH, worsened scarring from disrupted active papules, and bacterial superinfection of the healing skin. Dr. Sierro evaluates active acne status at every consultation and, when active disease is present, initiates appropriate acne management before scheduling any scar treatment procedure. The investment in controlling the acne first is the prerequisite for the investment in treating the scars it has left behind.

Your Treatment Experience

 

What to Expect: Acne Scar Treatment at Kare Plastic Surgery

 

Comprehensive Acne Scar Assessment & Classification

Dr. Sierro performs a systematic dermoscopic and clinical examination of all acne scars under standardized direct and oblique (raking) lighting — the latter essential for revealing shallow atrophic scars that are invisible in direct light. She characterizes the morphology, depth, and proportion of each scar subtype (ice pick, boxcar, rolling, atrophic, hypertrophic) and the distribution of any post-inflammatory hyperpigmentation. Active acne status is assessed and graded. Fitzpatrick skin type is established. Medical history — including recent isotretinoin use, herpes history, keloid tendency, and medications — is reviewed for contraindications. Clinical photographs are taken under standardized conditions for baseline documentation.

 

Individualized Multimodal Treatment Protocol Design

Based on the scar classification and patient-specific factors, Dr. Sierro designs a personalized combination treatment protocol. For a typical patient with mixed ice pick, boxcar, and rolling scars, this might include: TCA Cross for ice pick scars + subcision for rolling scars + fractional CO2 for boxcar scars and diffuse texture — all performed in a single combination session. For a patient with darker Fitzpatrick skin and diffuse atrophic scarring, the protocol might be: Morpheus8 for deep dermal remodeling + microneedling with PRP for collagen induction + a medium-depth chemical peel for surface improvement and PIH management. The protocol specifies each treatment, the sequencing of combination procedures within and between sessions, and the expected number of sessions and timeline.

 

Pre-Treatment Preparation

For fractional CO2 laser sessions, patients with Fitzpatrick III–IV skin are placed on topical hydroquinone (4%) and tretinoin for 4–6 weeks before treatment. Antiviral prophylaxis is prescribed for any patient with a history of perioral herpes. TCA Cross and subcision require no specific pre-treatment preparation beyond sun avoidance and SPF 50+ use in the weeks before the procedure. Chemical peel patients discontinue retinoids for 5–7 days before the scheduled peel appointment. All patients are counseled on post-treatment sun avoidance requirements and the critical importance of SPF 50+ compliance throughout the treatment series.

 

Treatment Session: Combination Protocol Execution

Combination acne scar sessions at Kare follow a logical sequencing: subcision is performed first (releasing tethering bands before surface ablation), followed by TCA Cross on ice pick scars (precise focal application), then fractional CO2 or Erbium laser for overall surface texture, and finally topical application of PRP or exosomes if included in the protocol. Topical anesthesia is applied 45–60 minutes before any laser or needling procedure. For full-face combination sessions, the total procedure time is typically 60–90 minutes. Patients are monitored for comfort throughout and supplemental local anesthesia is administered as needed.

 

Post-Treatment Care & Series Progression

Post-treatment wound care protocols are provided in writing for each specific procedure performed. After combination laser + subcision + TCA Cross sessions, patients experience 5–10 days of healing with redness, micro-peeling, and occasional bruising at subcision sites. Petrolatum-based ointment is applied continuously for the first 48 hours. Follow-up appointments are scheduled at 4–6 weeks to assess the healing response and improvement in scar morphology before the next session. Dr. Sierro adjusts the treatment parameters based on the observed response — escalating settings if improvement is slower than expected, or modifying the protocol if new concerns emerge. Most acne scar programs at Kare are completed in 3–6 sessions over 4–8 months, with results continuing to improve for up to 6 months after the final session.

25–75%Improvement in scar severity scores with multimodal treatment
3–6Sessions in most comprehensive acne scar protocols
6 moCollagen remodeling continues after final treatment session
AllFitzpatrick skin types treated with protocol customization

Common Questions

 

Frequently Asked Questions About Acne Scar Treatment in Los Angeles

What is TCA Cross and how many sessions does it take for ice pick scars?

TCA Cross (Trichloroacetic Acid Chemical Reconstruction of Skin Scars) applies a high concentration of TCA (70–100%) precisely to the base of individual ice pick scars using a sharpened applicator. The concentrated acid causes full-thickness coagulation within the scar channel and triggers a wound healing response that produces new collagen from the scar base upward, progressively elevating the scar floor toward surrounding skin level. Most patients require 2–4 TCA Cross sessions spaced 6–8 weeks apart, with 50–75% improvement in ice pick scar depth reported in published clinical series. TCA Cross is the treatment of choice for ice pick scars precisely because their narrow geometry makes laser resurfacing of the scar channel technically ineffective without risk of channel wall damage.

Is subcision better than laser for rolling acne scars?

For true rolling (valley) acne scars caused by fibrous tethering bands, subcision is the essential first-line treatment — and laser without subcision produces significantly inferior results for this specific scar type. The reason is mechanistic: rolling scars are depressed not primarily because of volume loss, but because fibrous bands anchor the scar base to the underlying tissue, pulling the skin downward. Laser resurfacing cannot release these bands; only mechanical subcision can sever them and release the tethering. After subcision releases the bands, laser (CO2 or Erbium) or Morpheus8 is added in subsequent sessions to refine the surface texture and stimulate additional collagen in the corrected scar area. The correct protocol for rolling scars is subcision first, surface refinement second.

Can acne scars be completely removed?

Complete elimination of established atrophic acne scars is not achievable with any currently available treatment — including surgery, laser, or any combination protocol. However, “complete removal” is the wrong goal. The correct expectation is significant improvement: 25–75% reduction in scar depth, width, and visibility with a well-designed multimodal treatment series. At this level of improvement, scars that previously required heavy foundation coverage become inconspicuous in natural lighting; scars that were clearly visible become subtly visible only under raking light. This is a profoundly meaningful cosmetic improvement that significantly impacts self-confidence and quality of life, even if it is not perfect elimination. Realistic expectations and a commitment to completing the full treatment series are the two most important factors in achieving the best possible result.

What acne scar treatment is best for darker skin tones?

Patients with Fitzpatrick skin types IV–VI require a modified approach to acne scar treatment that avoids the post-inflammatory hyperpigmentation risk of aggressive ablative lasers. Dr. Sierro’s preferred protocols for darker skin tones include: Morpheus8 RF microneedling (bypasses the epidermis entirely, minimal PIH risk), microneedling with PRP (zero ablation, safe for all skin types), subcision for rolling scars (no laser energy, minimal PIH risk), TCA Cross at lower concentrations for ice pick scars, and carefully selected medium-depth chemical peels. Fractional Erbium at conservative settings can be considered for Fitzpatrick IV patients with appropriate pre-treatment melanocyte suppression. The diversity of the Los Angeles patient population makes this expertise in darker skin treatment a core clinical competency at Kare Plastic Surgery.

What is the Obagi Blue Peel and how is it used for acne scars?

The Obagi Blue Peel is a physician-grade TCA chemical peel developed by Dr. Zein Obagi that uses a proprietary blue base solution to control TCA penetration depth and produce uniform, predictable medium-depth exfoliation. The blue base allows the treating physician to monitor the application coverage and ensure even penetration, while slowing the TCA’s absorption rate to provide more controlled depth of injury than straight TCA alone. The Obagi Blue Peel reaches the upper reticular dermis, stimulating significant collagen remodeling and improving diffuse atrophic acne scarring, skin texture, pigmentation, and overall skin quality. It is particularly effective for patients with both acne scarring and concurrent sun damage who want a single treatment addressing both concerns. Most patients achieve meaningful improvement with 1–3 Obagi Blue Peel sessions, with 5–7 days of active peeling and healing after each.

How long does it take to see results from acne scar treatment?

The timeline to visible results varies by treatment modality. TCA Cross produces visible scar elevation beginning at 4–6 weeks after each session as new collagen fills the treated channel. Subcision produces immediate visible improvement in rolling scars as the tethering bands are released, with further improvement over 4–8 weeks as the released space fills with new collagen. Fractional CO2 laser and Morpheus8 produce progressive improvement over 3–6 months after each session as the collagen remodeling cascade matures — the full extent of improvement is typically not visible until 6 months after the last session. Chemical peels show initial improvement immediately as the treated skin resurfaces, with collagen-stimulating effects continuing for 2–3 months. Planning the treatment timeline with these improvement windows in mind allows Dr. Sierro to optimize the sequencing of combination sessions for maximum cumulative benefit.

How much does acne scar treatment cost in Los Angeles?

Acne scar treatment at Kare Plastic Surgery & Skin Health Center in Santa Monica is priced per treatment session and per modality — with the exact cost dependent on the combination of treatments performed at each session, the number of sessions in the prescribed protocol, and the extent of the treatment area. Combination sessions that include TCA Cross, subcision, and fractional CO2 in the same appointment have different pricing than a single-modality treatment. Package pricing for complete multimodal treatment series is available. All acne scar treatments are cosmetic procedures and are not covered by health insurance. Transparent pricing is provided at consultation once Dr. Sierro has assessed the specific scar presentation and designed the appropriate treatment plan. Financing options are available for qualified patients through CareCredit and other patient financing programs.

Schedule Your Acne Scar Consultation in Los Angeles

Whether you have ice pick, boxcar, rolling, or mixed acne scars, Dr. Tiffany Sierro and Dr. Raffy Karamanoukian at Kare Plastic Surgery & Skin Health Center provide the most complete, most precise, and most physician-directed acne scar treatment program in Santa Monica and the greater Los Angeles area. Contact our office to schedule your consultation today.

(310) 998-5533 Request a Consultation

Kare Plastic Surgery & Skin Health Center  ·  804 7th Street, Santa Monica, CA 90403  ·  (310) 998-5533

Dr. Tiffany Sierro, MD — Board-Certified Dermatologist  ·  Dr. Raffy Karamanoukian, MD, FACS — Board-Certified Plastic Surgeon  ·  TCA Cross  ·  CO2 Laser  ·  Subcision  ·  RealSelf 100