Acne Scar Types · Santa Monica Treatment
Understanding the Types of Acne Scars
Identifying the correct scar type is the essential first step in choosing effective treatment. Most patients have more than one type of scar, which is why combination treatment produces the best results.
Icepick Scars
Deep, narrow, V-shaped holes that extend into the dermis or deeper. They appear as small but very deep punctures in the skin surface and are notoriously difficult to treat with laser resurfacing alone. TCA Cross is the most effective specific treatment for icepick scars, and it is often combined with fractional CO2 laser to address the surrounding skin texture. Icepick scars commonly appear on the cheeks and temples and result most often from cystic or nodular acne.
Boxcar Scars
Round or oval depressions with sharply defined vertical edges, resembling the shape of a chicken pox scar. They are wider than icepick scars and more shallow, sitting in the mid or upper dermis. Boxcar scars respond well to fractional CO2 laser resurfacing and subcision, which releases the fibrous tissue anchoring the base of the scar to the underlying tissue. Filler injections can also temporarily raise individual boxcar scars to the level of the surrounding skin. They most commonly appear on the cheeks and temples.
Rolling Scars
Wide, wavy depressions with sloped edges that give the skin an undulating or rolling surface texture. They result from fibrous tissue bands beneath the skin that tether the surface down from below. Subcision is the most targeted treatment for rolling scars, as it severs these tethering bands and allows the depressed skin surface to rise. Fractional CO2 laser resurfacing and microneedling are used alongside subcision to stimulate collagen remodeling and improve the overall skin texture. Rolling scars are most common on the cheeks and lower face.
Hypertrophic and Keloid Acne Scars
Raised, firm scars that develop from inflammatory acne on the chest, shoulders, back, and jawline. Hypertrophic acne scars stay within the original blemish boundary, while keloid acne scars extend beyond it. Both are treated with steroid injections, pulsed dye laser, and silicone therapy. Keloid acne scars may require surgical excision combined with postoperative adjuvant treatment for lasting control. Learn more on our keloid scar removal page and our keloid treatment overview.
Kare Plastic Surgery · 804 7th Street, Santa Monica
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Acne Scar Treatments at Kare Plastic Surgery Santa Monica
Dr. Karamanoukian uses the full spectrum of evidence-based acne scar treatments and designs each patient's plan based on the combination of scar types present, the skin tone, and the degree of improvement the patient is seeking. No single treatment works for all scar types, which is why consultation with a physician who offers every modality is important for the best outcome.
Fractional CO2 Laser Resurfacing
Fractional CO2 laser is widely considered the gold standard for moderate to severe acne scarring. The laser creates thousands of tiny micro-columns of ablation in the skin, removing damaged collagen in the scar while leaving surrounding tissue intact. The surrounding skin responds by producing new collagen and elastin that fills in the treated columns and progressively smooths the scar surface. Downtime is approximately one week. Most patients see 25 to 50 percent improvement per session, with lighter skin types achieving results toward the higher end of that range. Multiple sessions may be recommended for more severe scarring. Fractional CO2 treats boxcar and rolling scars most effectively and significantly improves overall skin texture and tone.
TCA Cross for Icepick Scars
TCA Cross (Chemical Reconstruction of Skin Scars) is a precise technique in which a high concentration of trichloroacetic acid, typically 70 to 100 percent, is applied with a fine applicator to the base of individual icepick scars. The acid causes a localized frost reaction that triggers collagen production at the floor of the scar, gradually lifting and filling it from the bottom up over several weeks. TCA Cross requires multiple sessions spaced four to six weeks apart and is the most effective targeted treatment specifically for icepick scars. Patients with darker skin are advised to use a bleaching cream containing hydroquinone after each session to reduce the risk of post-inflammatory pigmentation. TCA Cross is often combined with fractional CO2 in the same course of treatment, with the two procedures performed on separate visits.
Chemical Peels
Chemical peels using alpha hydroxy acids, trichloroacetic acid at lower concentrations, Jessner solution, or other agents increase cell turnover, stimulate new collagen, and improve the texture and pigmentation of acne-scarred skin. They are particularly effective for post-inflammatory hyperpigmentation, surface texture irregularities, and mild to moderate acne scarring. Peels can be performed as standalone treatments or as part of a combination program with laser and TCA Cross. The depth of the peel is selected based on the severity of the scarring and the patient's skin tone, with deeper peels producing greater improvement at the cost of longer downtime.
Subcision
Subcision uses a fine needle or cannula inserted beneath the skin to release the fibrous tissue bands that tether rolling and boxcar scars down to the underlying tissue. Breaking these bands allows the depressed scar surface to rise to the level of the surrounding skin. Subcision is frequently combined with fractional CO2 laser in the same treatment program, and is often performed alongside filler injection into the treated area to prevent the bands from reattaching. It is the most mechanically targeted treatment for rolling scars and a valuable component of combination acne scar therapy for patients with significant surface undulation.
Microneedling
Microneedling uses a device with fine needles to create controlled micro-injuries across the skin surface, stimulating collagen production and remodeling. It improves skin texture, reduces pore size, and gradually diminishes superficial acne scars over a series of sessions. Microneedling is a lower-downtime option that is particularly well suited for patients who cannot tolerate the week of recovery associated with CO2 laser resurfacing, and for use in darker skin types where aggressive laser carries a higher risk of post-inflammatory pigmentation. Radiofrequency microneedling adds a thermal energy component for enhanced collagen stimulation.
Pulsed Dye Laser and Steroid Injections
Raised, red, or pink acne scars and post-acne erythema respond to pulsed dye laser, which targets the blood vessels that give these lesions their color and that supply the nutrients driving ongoing inflammation. Keloid and hypertrophic acne scars on the chest, shoulders, and back are treated with intralesional steroid injections to flatten and soften raised tissue. These treatments address the vascular and structural components of acne scarring that CO2 laser and TCA Cross do not specifically target, and are an important part of comprehensive acne scar management for patients with raised or pigmented scars.
Back and shoulder acne scars are also treated at Kare Plastic Surgery: Acne scarring is not limited to the face. Many patients experience significant scarring on the chest, back, and shoulders from inflammatory back acne. Dr. Karamanoukian evaluates and treats body acne scars with the same individualized approach used for facial acne, combining laser, peels, and injection therapy as appropriate. Call (310) 998-5533 for a same-week consultation at Kare Plastic Surgery in Santa Monica.
"Acne scars have a tremendous impact on how a person sees themselves and how confident they feel in everyday life. "
— Dr. Raffy Karamanoukian · Board-Certified Plastic Surgeon · Kare Plastic Surgery, Santa Monica
Frequently Asked Questions
What is the best treatment for acne scars in Santa Monica?
The best treatment depends on the type of scar. Icepick scars respond best to TCA Cross, while boxcar and rolling scars respond well to fractional CO2 laser combined with subcision. Raised or red acne scars respond to pulsed dye laser and steroid injections. Most patients benefit from a combination of treatments. Dr. Raffy Karamanoukian at Kare Plastic Surgery in Santa Monica evaluates each patient's scar types individually and designs a personalized plan. Call (310) 998-5533.
What is TCA Cross and how does it work?
TCA Cross stands for Chemical Reconstruction of Skin Scars. It uses a high concentration of trichloroacetic acid applied precisely to the base of individual icepick scars, stimulating collagen production in the floor of the scar and causing it to gradually fill in. Multiple sessions are typically needed. TCA Cross is the most effective treatment specifically for icepick scars. Dr. Karamanoukian performs TCA Cross at Kare Plastic Surgery in Santa Monica. Call (310) 998-5533.
How many CO2 laser sessions are needed for acne scars?
Most patients see 25 to 50 percent improvement after a single fractional CO2 laser session. Patients with more severe scarring or darker skin tones often benefit from additional sessions with adjusted settings. Each session stimulates collagen production that continues to improve the skin for three to six months after treatment. Dr. Karamanoukian advises on additional sessions based on each patient's response. Call (310) 998-5533.
Are acne scar treatments safe for darker skin tones?
Yes, when performed with the correct settings for each skin type. At Kare Plastic Surgery, Dr. Karamanoukian tailors every treatment to the patient's Fitzpatrick skin type. Darker skin tones typically respond best to non-ablative fractional lasers, erbium, TCA Cross with post-procedure hydroquinone, and carefully selected chemical peels. Call (310) 998-5533.
Can raised acne scars on the back and shoulders be treated?
Yes. Raised hypertrophic and keloid acne scars on the chest, shoulders, and back are treated with steroid injections, pulsed dye laser, and silicone therapy. Larger or previously recurrent keloid acne scars may benefit from surgical excision combined with postoperative adjuvant treatment. Dr. Karamanoukian evaluates body acne scars at Kare Plastic Surgery in Santa Monica and designs a treatment plan appropriate for each patient. See our keloid scar removal page for more detail. Call (310) 998-5533.
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