# Treating *acne scars.*

> Ice-pick, boxcar and rolling scars need different procedures. What microneedling, PRP, hyaluronic acid fillers, peels and subcision achieve

- Source: https://www.vivaderm.de/guide-acne-scars-en.html
- Language: en
- Publisher: VIVA DERM, Privatpraxis für ästhetische Medizin, Rosastraße 6a, 45130 Essen, Germany, +49 1520 8367711
- Responsible physician: Katayoun Mostaghimi (Fachärztin für Allgemeinmedizin)
- Updated: 2026-10-15

The acne is over, the scars remain. They cannot be magicked away but can be flattened noticeably – if the procedure matches the scar type.

## Scar type determines procedure.

**Three scar types:** *ice-pick scars* – narrow, deep, tapering; *boxcar scars* – wider, sharply defined, as if punched out; *rolling scars* – flat, wavy, from tethering in the depth. Add redness (fades on its own) and pigment spots (not true scar tissue). Most people have a mixture.

**Microneedling:** the basic procedure for rolling and shallow boxcar scars. Fine needles set controlled micro-injuries, the skin forms new collagen and levels out over months. Three to six sessions four to six weeks apart; first improvement after the second session, the result matures for up to a year. Combining with PRP enhances the effect and shortens redness.

**PRP:** own-blood growth factors, usually applied onto the needling or injected. Weaker as a single procedure, useful as a supplement.
**Hyaluronic acid fillers:** for individual deep rolling or boxcar scars: the gel lifts the scar base. Visible immediately, lasts six to twelve months. Unsuitable for many small scars.

**Subcision:** a cannula releases the tethering under rolling scars; often combined with filler or PRP. A medical procedure, very effective for this type.
**Peels (TCA):** for ice-pick scars in the CROSS technique, spot-applied at high concentration – several sessions, physician only.
**Laser (fractional, CO2):** effective but with longer downtime and pigment risk; not offered at VIVA DERM, referral if needed.

**Prerequisites:** the acne must have healed – active inflammation is a contraindication. After isotretinoin a six-month gap. Darker skin types need more conservative settings because of pigment risk.

**Realistic expectation:** an improvement of 30 to 60 percent is a good result; the skin becomes smoother, in side light scars usually remain recognisable. Anyone promising 'scar-free' promises too much.

## The essentials.

- **Rolling / shallow boxcar:** microneedling ± PRP
- **Deep single scars:** filler, subcision
- **Ice-pick:** TCA CROSS
- **Sessions:** 3–6, result matures 12 months

## Important note.

This text is general information. It replaces neither a medical examination nor the consultation required before any treatment under German law (§ 630e BGB). Whether and which treatment is suitable for you can only be said after examination and consultation. No treatment results are promised.

## Frequently asked questions.

**How long am I red after microneedling?**

One to three days like a sunburn, then mild flaking. Make-up from the second day.

**Does microneedling also help with pigment spots after acne?**

Partly, combined with sun protection and lightening agents. But the spots often fade on their own within a year.

## Related.

- [Microneedling](https://www.vivaderm.de/microneedling-en.html) – Treatment
- [PRP face](https://www.vivaderm.de/prp-face-en.html) – Treatment
- [Winter as treatment season](https://www.vivaderm.de/guide-winter-skin-en.html) – Guide

## Sources

- [German Society of Dermatology (DDG)](https://derma.de/)
- [DermNet – dermatology reference](https://dermnetnz.org/)
- [American Academy of Dermatology](https://www.aad.org/)
- [PubMed – biomedical literature database](https://pubmed.ncbi.nlm.nih.gov/)
- [NHS: acne](https://www.nhs.uk/conditions/acne/)
- [NHS: non-surgical cosmetic procedures](https://www.nhs.uk/conditions/cosmetic-procedures/non-surgical-cosmetic-procedures/)
- [Medical Association North Rhine – patient information](https://www.aekno.de/patienten)

---
This page is general information and does not replace medical consultation and informed consent (§ 630e BGB). No guarantee of results. Prices are guide prices per GOÄ. Quoting with attribution (VIVA DERM, Essen) is expressly permitted.