Acne & Acne Scar Revision in Charleston and Mt. Pleasant, SC

Reviewed by Ashley Harwyn, PA-C, ABAAHP  |  A4M Board Certified  |  Updated October 4, 2026

Acne scars come in different shapes, and each shape answers to different tools. Here is how to tell them apart, what fits each one, and what the research can honestly promise.

There is a second honest point worth knowing up front. Researchers who pooled the controlled trials found the overall quality of evidence low, and no single procedure has earned the title of best first choice.[3] If you are still breaking out, start with acne treatment first. New breakouts can mean new scars, and scar work usually waits until acne is under control.[2]

• Most acne scars are sunken (atrophic), and they come in three main shapes: ice pick, boxcar, and rolling. Raised scars and keloids are less common.[1][4]
• Each shape responds to different methods. The American Academy of Dermatology notes that ice pick scars need different treatment than rolling scars.[2]
• Active acne comes first. Scar treatment usually starts after breakouts are controlled with ongoing acne care.[2]
• A Cochrane review of 24 trials found a lack of high-quality evidence and did not support any one treatment as the first choice.[3]
• Darker skin can be treated, but some peels and lasers carry a higher risk of dark marks afterward, so the choice and settings matter.[3][4]
• Expect a series of visits, not one appointment, and expect improvement rather than erasure.[2][4]

Which kind of acne scar do you have?

A scar forms when a deep, inflamed breakout damages the collagen under the skin. In 80 to 90 percent of people with acne scars, the damage leaves a loss of tissue, which shows up as a dip.[4] A smaller group heals with too much collagen, which makes a raised scar. Deep, painful acne, a parent or sibling with acne scars, and picking or squeezing breakouts all raise the odds of scarring.[1]

Sunken scars are sorted by shape. Ice pick scars are narrow pits, under about 2 mm across, that run deep like a V. Boxcar scars are round or oval dips with steep edges and a flatter floor, most often 1.5 to 4 mm wide. Rolling scars are wider, usually over 4 to 5 mm, and give the skin a soft, wavy look because bands of tissue tether the surface down to deeper layers.[4] One cheek can hold all three types at once.[4]

Raised scars come in two forms. Hypertrophic scars are pink, firm, and stay within the spot where the breakout was. Keloids grow beyond that border, and they are more common on the chest and back and in people with darker skin.[4] Raised scars need different treatment than sunken ones, because the problem is extra collagen rather than missing collagen.[2]

One more thing is often mistaken for scarring. A flat brown or red spot left after a pimple heals is usually post-inflammatory hyperpigmentation, not a scar, and it often fades with time and the right care.[1] If flat color is your main concern, our hyperpigmentation page is the better fit. If you see texture you can feel, that is scarring.

Matching each scar to the right tools

Dermatologists build a scar plan around the type of scars, how many there are, your age, your skin tone, and your budget.[2] The table pairs each scar shape with the methods the evidence links to it.

Laser resurfacing removes or heats tiny areas of skin so the body rebuilds collagen as it heals, which can make scars less visible. Boxcar and rolling scars are the usual laser candidates.[2][4] Carbon dioxide and erbium (Er:YAG) lasers are the most common ablative lasers for acne scars.[4] A meta-analysis of five studies found the two gave similar improvement overall, with carbon dioxide slightly ahead on physician ratings, and suggested each suits different tasks.[7] Some lasers need more sessions than others.[2] Solcara uses a Fotona laser for post-acne scarring; see our laser facial page for how a session runs.

Microneedling uses fine needles to make tiny punctures that prompt new collagen.[2] A systematic review of nine randomized trials found it helped atrophic acne scars on its own or combined with other treatments, with no serious side effects reported.[6] It is often paired with a peel, radiofrequency, or platelet-rich plasma.[2] Read more on our microneedling page.

Chemical peels help the skin make collagen and elastin, which can make shallow dips less visible. A mild peel may take 3 to 5 sessions, spaced 2 to 4 weeks apart.[2] Our chemical peels page covers strengths. Fillers add volume under a dip, and most last from 3 months to 2 years.[2] In the Cochrane review, filler was the only comparison backed by moderate-quality evidence.[3] Ask which product is proposed and whether it is approved for acne scars, then see our dermal fillers page.

For ice pick pits and tethered rolling scars, focal techniques like TCA CROSS, punch elevation, and subcision work one scar at a time.[4] If a surgical method would serve your scars better than anything on this page, Ashley will tell you so plainly.

Why active acne comes first

Scar treatment builds new collagen, and new breakouts damage it. The American Academy of Dermatology advises that scar treatment typically begins once acne is under control and you are using acne medicine to prevent new breakouts.[2] Treating acne early also lowers the chance that deeper breakouts form in the first place.[1]

That is why the first visit often looks like acne care, not a laser. At Solcara, options for active acne include medical-grade ZO skin care, prescription creams, oral hormone blockers, and oral antibiotics, and that work is covered on our acne treatment page.

Medication history matters too. Tell your clinician about every acne treatment you have used in the past two years, because starting some scar procedures during or soon after certain acne medicines can cause side effects.[2] If you have taken isotretinoin, bring the dates you started and stopped. The right gap before a given procedure depends on the procedure and your history, so it is decided case by case.

What the research can and cannot promise

The best summary of the evidence is a Cochrane review that pooled 24 randomized trials with 789 adults.[3] The authors found a lack of high-quality evidence, mostly because trials were small, poorly designed, or measured improvement in different ways. They concluded that the results did not support the first-line use of any single intervention.[3] They also warned that when two active treatments look equal, it is possible that neither one works well.[3]

That does not make scar treatment useless. Later reviews describe improvement with microneedling and lasers.[6][7] It does mean results vary, improvement is the realistic goal, and long-term data is thin: the longest follow-up in the Cochrane trials was 48 weeks.[3] The microneedling review also called for larger trials with longer follow-up.[6]

The device label is a separate question from the research. Fotona's erbium (Er:YAG) lasers reach the market through FDA 510(k) clearance. The clearance we reviewed, for Fotona's Dynamis platform, covers soft tissue resurfacing, including with a fractional handpiece, and does not name acne scars as its own indication.[5] Clearance means the FDA found the device substantially equivalent to earlier devices. It is not a ruling that it fixes acne scars, so the scar evidence comes from the studies above.

Discomfort and downtime are real. In several of those trials, every participant reported pain.[3] Some treatments require downtime, and insurance does not cover the cost of acne scar treatment.[2]

Not sure whether your scars are ice pick, boxcar, or rolling? A close look in good light usually settles it, and the answer shapes everything after. Call 843-981-0870 to set up a scar consult with Ashley, and bring the names and dates of any acne medicines you have used.

Skin tone, timing, and what a plan looks like

Skin that tans easily or is naturally darker is more likely to develop dark patches after some procedures. People with higher skin phototypes face a higher risk of hyperpigmentation after laser resurfacing, and deeper TCA peels are not advised for dark skin for that reason.[4] In one small trial in the Cochrane review, 6 of 12 people developed dark marks after a chemical peel, compared with none of 15 after microneedling.[3] Microneedling carries a lower risk of these marks than peels or laser resurfacing.[4] That makes the choice and settings more important for darker skin, not off limits.

Sun protection is part of the treatment. Protecting your skin from the sun before a peel helps prevent discolored skin afterward.[2] Raised scars and keloids follow different rules. Steroid injections can flatten them, but can also thin or lighten the skin, and keloids sometimes return.[2][4]

Our approach starts with the least aggressive option that fits your scars. When the Fotona laser is part of the plan, numbing cream goes on first. A typical laser plan at Solcara is 3 to 5 sessions of about 10 to 30 minutes, though your number may differ based on your scars and skin. Ashley Harwyn, PA-C, who is board certified in anti-aging and functional medicine, reviews your scar types and history before suggesting anything.

You can see us at our Mount Pleasant office on Bramson Court or at The Longevity Club on Rutledge Avenue in downtown Charleston. Bring a list of your past acne treatments.