Acne scars: is resurfacing enough? Why I also focus on rebuilding
"Wouldn't resurfacing the scar make it flat?" "I've had several laser sessions, but it looks the same."
These are questions from people seeking help for depressed acne scars.
First, removing the surface does not fill a depressed scar, because the problem is in the dermis. Treatment also takes months. It is difficult to promise a quick finish.
When starting scar treatment, I discuss the time commitment first. This is treatment that needs the same observer over several months; without readiness for that, it is better not to start.
Why is the core problem of a depressed scar in the dermis?
Deep acne inflammation damages the collagen framework in the dermis. When the site heals without replacing that lost tissue, the surface remains depressed, forming an atrophic scar. It is like a house with a sunken floor. Just as repairing the roof does not raise the floor, resurfacing alone does not resolve the dermal deficit responsible for the depression. Some people ask, "But won't removing the surface make it look less deep?" Surface refinement can help some shallow scars. However, with deeper tissue loss, the skin can become thinner by the amount removed while the depression remains. I therefore explain that the essence of scar treatment is to stimulate dermal regeneration and rebuild the damaged framework.
I am also often asked, "Won't it fill itself in over time?" Unfortunately, old depressed scars rarely fill spontaneously. Scar tissue has already completed the healing process; it is like construction that was finished despite a faulty result. From the body's perspective, repair is complete, so there is no reason to revisit it. Treatment therefore deliberately restarts regeneration by applying controlled stimulation at that site.
Why divide treatment into sessions with intervals?
Some people ask, "Wouldn't closer, concentrated sessions improve it faster?" The answer is no. Remodeling, during which new collagen forms and settles, happens gradually over weeks to months rather than immediately after a procedure. Treatment sends a signal for regeneration; the skin does the actual building afterward. Ignoring intervals and piling on stimulation may increase the recovery burden and risk of adverse effects rather than speed regeneration. This is why scar treatment is usually planned over several sessions separated by several weeks. It is also why you do not need to be disappointed if the mirror shows no change the next day. Changes often emerge step by step as sessions accumulate.
Why can the approach differ even within the same face?
Not all depressed scars are alike. Broad, gently sloping depressions, sharply edged scars and narrow, deep pits have different patterns of dermal loss and respond differently to the same procedure. I plan by layer and scar type. Depending on depth and type, I consider combining PicoWay's fractional picosecond mode, which creates small regenerative signals in the dermis, with scar-regeneration procedures and skin boosters such as Rejuran and Juvelook to support the regenerative environment. Different areas of the same face may require different approaches. There is no universal answer for which combination suits which scar; it requires direct examination. If red acne marks and pigmentation are also present, sequencing becomes even more important. If inflammatory acne is still appearing, acne control comes before scar treatment. Repairing old scars while new ones continue to develop is like wallpapering while the roof is still leaking.
Following progress with the same eyes over several months
Scar treatment is a process we go through together over months. At our clinic, I therefore personally handle consultation, treatment and follow-up, checking changes at every session and adjusting the next plan. I believe the person who made the initial plan should also judge progress, so the direction can be changed promptly if the response differs from expectations. For example, if the second session produces a weaker response than expected, I adjust the intensity or combination next time; if redness lasts longer, I allow a longer interval. These fine adjustments are most accurate when made by someone who directly observed the previous session. Consultations take place in private rooms, so even long-standing concerns about scars can be discussed comfortably. When comparing scar-treatment clinics near Cheongdam or Apgujeong, I recommend checking who plans and oversees the months of treatment before comparing the price per session. I believe that is what makes a difference to outcomes in scar treatment.
In closing
Acne-scar treatment can focus on removing tissue or rebuilding it. Whichever approach is chosen, I recommend starting at a practice that explains in advance that it will take several months.
Related column: Red acne marks: scars or pigmentation? How we distinguish three types Related treatment information: Pores and scars
