Treating acne scars and scars: laser, RF microneedling and peels
Acne scars, surgical scars, burn scars or accident scars: which treatment helps depends on the type of scar. On this page you will find out how ice pick scars, boxcar scars and rolling scars differ, when a fractional CO2 laser, a non-ablative laser, RF microneedling or a peel is the right choice, and why keloids need a different therapy.
You will also find answers on the number of sessions, realistic results, dark skin and the right timing after acne, surgery or a caesarean section. For this, SIACSKIN offers the FRACO CO2 XL as an ablative fractional CO2 laser, the TULIX with 1927 and 1550 nm, and the EUPHEUS M8 and the EUPHEUS V for RF microneedling.
What types of acne scars are there and which treatment suits which type?
Acne scars are divided into three depressed forms: ice pick scars, boxcar scars and rolling scars. Ice pick scars are narrow and reach deep. Methods that treat a whole area reach their limit here, which is why highly concentrated acid or a small punch is often used first on individual scars. Boxcar scars have sharp edges and a flat base. They respond well to ablative fractional lasers, which ablate these edges. Rolling scars are soft undulations pulled downwards by strands of connective tissue. What helps here is releasing these strands (subcision) and heat at depth.
For boxcar scars, the FRACO CO2 XL is a good fit as an ablative fractional CO2 laser. For rolling scars, the EUPHEUS M8 and the EUPHEUS V deliver the radiofrequency via needles directly into the dermis. Most faces show all three forms, which is why treatments are almost always combined.
CO2 laser, RF microneedling or non-ablative laser: which has the strongest effect on acne scars?
Per session, the fractional CO2 laser has the strongest effect. RF microneedling and non-ablative lasers reach the goal over more sessions, but with considerably less downtime. The CO2 laser ablates tissue and smooths scar edges, but costs 1 to 2 weeks of healing. RF microneedling leaves the surface largely undisturbed and firms the tissue beneath the scar, which works well for undulating scars and dark skin. The non-ablative laser lies in between: intact skin, a few days of redness, but a longer course of treatment.
At SIACSKIN this means three devices: the FRACO CO2 XL for pronounced scars, the EUPHEUS M8 for RF microneedling with needle depths of up to 7 mm and the TULIX, whose erbium glass laser works in the dermis at 1550 nm. The deciding factors are scar type, skin type and the question of how much downtime is possible.
What is the difference between atrophic scars, hypertrophic scars and keloids?
Atrophic scars lie below the level of the skin, while hypertrophic scars and keloids rise above it. In atrophic scars tissue is missing, typically after acne or chickenpox. The aim is to build collagen, and that is exactly what fractional lasers and RF microneedling do. Hypertrophic scars are raised and thickened, but stay within the boundaries of the wound and often flatten by themselves over months. Keloids grow beyond the wound and tend to return after any irritation. They belong in medical hands, and the usual measures are cortisone injections, silicone sheets and pressure. Energy alone is not the answer here.
The FRACO CO2 XL, the TULIX and the EUPHEUS M8 are intended for depressed scars after acne or surgery. With raised scars, a doctor first decides whether a laser will be part of the treatment at all.
Are fresh red scars easier to treat than old white scars?
Yes, fresh red scars respond faster and need fewer sessions than old white scars. As long as a scar is red, it is still being remodelled: it has a good blood supply and the collagen is not yet firmly cross-linked. This remodelling takes 12 to 18 months and can be guided during this time. In old, pale scars the tissue is rigid and poorly vascularised. They can still be smoothed and softened, but require more energy and more appointments. The pale colour itself evens out only to a limited extent.
For young scars, the non-ablative TULIX with its short downtime is suitable. For old, hardened or depressed scars, the FRACO CO2 XL is the more powerful tool because it ablates scar tissue at individual points.
In what order should RF microneedling and laser be combined for acne scars?
The tried-and-tested order is from the bottom up: first the depth, then the surface. It starts with 2 to 3 sessions of RF microneedling, which loosen and build up the tissue beneath the scars. The fractional laser then smooths edges and skin texture. There are 4 to 6 weeks between two treatments, and more like 8 after an ablative laser. Both methods on the same day on the same area bring more inflammation but no better result. Individual very deep scars are treated beforehand one by one.
With devices from SIACSKIN, such a plan looks like this: the EUPHEUS M8 for the depth, the FRACO CO2 XL for the resurfacing and the TULIX as a gentle top-up when hardly any downtime is possible later on.
How much improvement is realistic for acne scars and do they go away completely?
A visible smoothing is realistic, but acne scars do not go away completely. How much improvement is achieved varies widely depending on the method and scar type, and no fixed percentage can be given in good faith. Shallow and undulating scars even out the most, while narrow deep scars are the most likely to remain visible. The age of the scars, the skin type and the individual tendency to heal also play a part. Many people judge too early: the skin continues to build collagen for 3 to 6 months after the last session. Photos under the same lighting and in raking light show the progress more honestly than a look in the mirror.
The Skin Analyzer Pro compares before and after and makes the development easy to follow. For pronounced scars, the FRACO CO2 XL comes in, with scars and resurfacing among its applications.
How many sessions does scar treatment take and when do you see the result?
Most scars need 3 to 6 sessions, and the final result only shows 3 to 6 months after the last appointment. With the ablative CO2 laser it is usually 3 to 5 sessions at intervals of 4 to 8 weeks, with a non-ablative laser likewise 3 to 5, and with RF microneedling 4 to 6 at intervals of 4 to 6 weeks. You will see the first changes after about 4 weeks, because collagen grows slowly. Old, deep scars and scars on the body lie at the upper end of the range.
As an ablative laser, the FRACO CO2 XL achieves the most per appointment but requires the longest healing. The TULIX and the EUPHEUS M8 spread the effect over more sessions, between which you have hardly any downtime.
How are acne scars treated on dark skin without risking new pigment spots?
On dark skin, the safest way to treat acne scars is with methods that spare the epidermis: RF microneedling and conservatively set non-ablative lasers. The risk lies not in the scar but in the reaction afterwards. Skin types IV to VI respond quickly to inflammation with dark marks. The rule is therefore: lower density, longer intervals between sessions, a test patch and daily sun protection. Ablative lasers are possible, but require experience and cautious parameters.
The EUPHEUS V works with gold-plated, insulated needles, so the energy is delivered below the epidermis. The TULIX is specified for all skin types and leaves the surface intact. SIACSKIN also specifies the FRACO CO2 XL for all skin types, although on dark skin it is more the second step than the first.
Can burn scars and accident scars be treated with a laser?
Yes, burn scars and accident scars can be made softer, flatter and more mobile with fractional lasers. For burn scars, the fractional CO2 laser is well studied: the fine channels loosen the rigid tissue, tightness and itching often ease, and the surface becomes more even. Extensive scars, scars under tension or scars close to joints belong in medical care, usually together with scar care, compression and physiotherapy. Small accident scars after cuts or grazes, on the other hand, are a frequent request in everyday aesthetic practice and easy to plan.
Scar treatment is a core application of the FRACO CO2 XL. For shallower scars and sensitive areas, the non-ablative TULIX is a good option. Deeper-lying hardened tissue is reached by the EUPHEUS M8 with needle depths of up to 7 mm.
How soon can a caesarean scar be treated with a laser?
You can have a caesarean scar treated with a laser as soon as it is fully closed and free of irritation, at the earliest 6 to 8 weeks after the birth. Many wait 3 months. Starting early is worthwhile, because the scar is still being remodelled during the first year. Treatment begins gently with a non-ablative laser and becomes more intensive only once the scar is stable. Speak to your doctor or midwife beforehand, also because of the numbing cream while breastfeeding. A fold of skin over the scar or an inward pull is caused by adhesions, and a laser will not change that.
The TULIX lists surgical scars as an application and works with little downtime. For older, hardened caesarean scars, the FRACO CO2 XL or RF microneedling with the EUPHEUS V are options.
How are acne scars on the back, shoulders and décolleté treated?
You treat acne scars on the body with the same methods as on the face, but with lower density and more patience. The back, shoulders and décolleté heal more slowly than the face. In addition, on the shoulders, breastbone and upper back acne scars are often raised rather than depressed, and that is exactly where keloids form most frequently. Raised scars are treated differently from depressed ones. For depressed scars, RF microneedling and non-ablative lasers are the safe starting point on the body, with ablative lasers only at a cautious dose.
On large areas the working field counts: the TULIX has a scan field of up to 20 × 20 mm, the FRACO CO2 XL a spot of up to 20 × 20 mm. For areas such as the back, the EUPHEUS M8 comes with a 40-pin tip.
Can acne scars be lasered while the acne is still active?
No, as long as the acne is actively inflamed, you hold off on scar treatment. Every new spot can leave a new scar, and lasers or needles on inflamed skin can spread germs and fuel the inflammation. First the acne is brought under control, dermatologically and with suitable skincare. Individual blemishes are no obstacle, they are simply left out. After a course of isotretinoin, the doctor determines when which method is possible again.
Light can help during the waiting period: the DERMAFORCE BBL PRO names acne and redness as applications and is intended for skin types I to IV. Once the skin is calm, the actual scar treatment follows, for instance with the TULIX or the FRACO CO2 XL.
Does a chemical peel or a carbon peel help with acne scars?
Peels improve the complexion, pores and marks after acne, but superficial peels change little about true depressed scars. Fruit acid and salicylic acid renew only the epidermis. Scars sit in the dermis, and only medium-depth peels, which involve a marked peeling phase, reach that far. Highly concentrated trichloroacetic acid has a special role: it is dabbed precisely into individual ice pick scars. The carbon peel works with laser instead of acid: it clears pores, reduces shine and smooths the texture. That makes it suitable as a starting point and between more intensive sessions.
The carbon peel is one of the applications of the PICOLO S and the PICOLO L, both of which also list acne scars as an area of use. For deeper scars, the FRACO CO2 XL and RF microneedling are the more effective routes.
Are large pores after acne actually scars and what refines them?
No, enlarged pores are not scars, even though the two often occur side by side after acne and look similar. A pore is the opening of a sebaceous gland. It appears large when a lot of sebum widens it and the connective tissue around it slackens. An ice pick scar, by contrast, is a tissue defect that extends into the dermis. The difference matters for treatment: pores already respond to mild methods that release sebum and firm the tissue, whereas scars need more depth. Pores do not disappear, they look finer.
The PICOLO L names pores and acne scars as applications and offers the carbon peel and a dedicated skin rejuvenation mode for them. The TULIX also lists pores and combines 1927 nm for the epidermis with 1550 nm for the dermis.
How does a studio or practice build a scar treatment offering?
A viable scar offering consists of three building blocks: an honest analysis, one method for the depth and one for the surface. People with scars have often already tried a great deal. They stay if you explain the scar type, take photos under the same lighting and offer a course of treatment with a clear goal rather than individual appointments. Who may carry out which treatment is regulated differently from country to country, and that also determines the choice of device.
A common starting point is RF microneedling with the EUPHEUS M8, because it covers acne scars, surgical scars, pores and tightening. The TULIX complements it as a non-ablative laser without consumables. Medical practices often add the FRACO CO2 XL for pronounced scars. We will clarify which combination suits your business in the free consultation.
