What Are Acne Scars?

The pathogenesis of acne involves various factors, including the skin microbiome’s dysbiosis, characterized by the imbalance in cutaneous microorganisms. This dysbiosis can lead to the proliferation of virulent Cutibacterium species within the pilosebaceous unit, exacerbating the condition. Factors such as hyperkeratinization within the pilosebaceous duct, along with hyperseborrhea and dysseborrhea, contribute to the clogging of pores, fostering an ideal environment for acne development.

Moreover, alterations in the immune response and chronic inflammation further exacerbate acne. These multifaceted causes collectively influence the onset and persistence of acne lesions. While numerous treatments are available, each approach has its limitations in addressing the diverse aspects of acne pathogenesis, necessitating tailored strategies that encompass the varied etiological factors for more effective management of acne and its sequelae, such as scarring.



Icepick (narrow)
Deep and narrow pitting of the skin.

Rolling (wide)
Soft shoulders and rounded saucer-like shape.

Boxcar (narrow to wide)
Sharp vertical edges with a wide base.

1. Subcision for acne scars

Subcision is a medical procedure used to treat certain types of acne scars. It involves using a small needle or a microcannula to break up the fibrous bands of scar tissue that are pulling the skin down and causing depressions in the skin’s surface. This allows the skin to lift and fill in the depressed area, reducing the appearance of the acne scar. Dr. Shanthala uses microcannula for subcisions so that it is more comfortable and has less risk of bruising. Nokor needle or Taylors liberator is more invasive than microcannula can cause risk of bruising and more swelling.

During the procedure, local anesthetic is injected into the area, and the needle or microcannula is inserted beneath the skin’s surface to break up the scar tissue.  Subcision can be difficult in the temple and forehead areas where sometimes micro or hydro dissection is performed. The needle or microcannula is moved back and forth in a fanning motion to release the tethered scars and create a space for the tissue to heal without being pulled down by the scar. One may need several subcisions combined with energy-based treatments and other modalities. Subcision alone may not be sufficient to treat acne scars.

After the procedure, the skin may be red and bruised for a few days, and there may be some swelling and tenderness. It typically takes a few weeks or months for dermal remodeling, multiple treatments may be needed for optimal visible results.

Subcision is often used in combination with other acne scars treatments, such as Ultraclear laser, dermal fillers, 1550 or CO2 laser resurfacing, RF Microneedling, PRP, or Topical Exosomes depending on the type and severity of the acne scars. Dr. Shanthala will choose the most suitable treatment plan for an individual’s specific acne scars.

HA fillers such as Juvederm, Restylane, RHA, Versa,  Belotero are used to treat acne scars on some occasions. Bellafill is an FDA-approved long-lasting filler In addition to immediately adding volume to the skin to lift acne scars, Bellafill® helps your skin re-create its own firmer structure for a smoother appearance and lasting results. Bellafill is good for rolling and atrophic types of acne scars. A skin test is needed and performed by our physician. The rare risk of nodules or granulomas and accidental vascular occlusion should be kept in mind with dermal fillers. 

CO2RE  and FraxPro 1550 and 1940  is a fractional and are excellent for acne scars but may not be the BEST for all skin types. The CO2 laser may not be appropriate for deeper scars and it has a lot of limitations. Ultraclear laser offers a variety of treatment modalities with less pain, downtime, and safer for all skin types. The combination of laser treatments combined with PRP or Exosomes topical is a treatment that is fast, more comfortable and requires less downtime than traditional resurfacing – enabling you to get back to your daily routine much quicker. The CO2 laser is not meant for all skin types since it has a high risk for hyper or hypopigmentation in darker skin groups.

LaserCoring with UltraClear Laser exclusively performed by our board-certified physician, Dr. Shanthala. getting remarkable results for acne scars in all skin of color patients. 

Lasercoring is a new novel 2910 nm fiber laser technology which combines both laser enabled tissue coring and laser induced collagen synthesis and deep dermal remodeling results in exceptional scar treatments. The Lasercoring is unique and very different from mechanical tissue coring. In our office we combine Lasercoring, Ultra mode , Clear plus mode with Biostimulators, topical Exosomes or PRP and subcision for optimal results.


SkinPen medical micro-needling is a non thermal or cold needling for Acne scar treatment is by creating invisible micro-perforations into the skin to induce neo- collagenasis.  This can be used for any type of acne scar, all skin types, but requires several treatments. The skin uses its natural repair mechanism producing collagen and elastin to repair the micro-perforations. Your skin becomes firmer and regains its elasticity. Dr. Shanthala often combines after other energy-based treatments  such as 3DMIRACL by Ultraclear laser and PRP or Exosomes and Subcision.

RF micro-needling for acne scars is very effective by stimulating new collagen and reduction of pore size. FRF microneedling is very effective for all skin types with minimal risk of hypo or hyperpigmentation. Ultraclear LaserCoring  is  our #1 choice for treating acne scars at ShanthalaMD.  RFMN performed after subcision  has better results for some scar types.combining RF micro-needling with PRPor Exosomes is shown to reduce the downtime.

RF Microneedling combination with other fractional modalities are our popular treatment for Acne Scars

A cutting-edge form of regenerative medicine using PRP, the body’s growth factors to restore collagen in the skin. Combining PRP or EXOSOMES  after Laser or RF Micro-needling has been shown to improve acne scars further with minimal downtime.  We combine Lasers, and RF microneedling, PRP, or topical exosomes for forehead/ temple and difficult-to-treat acne scars and deep atrophic scars. 

Dr. Shanthala is passionate about treating scars, especially acne scars. Emerging research on exosomes, small extracellular vesicles, suggests that they have potential in regenerative medicine such as wound healing and scar remodeling, and could be a promising treatment option for acne scars when combined with other modalities. Dr. Shanthala has spoken at several international conferences sharing her extensive experience in treating acne scars. Exosomes have been shown to play a critical role in cell-to-cell communication and can modulate various biological processes, including tissue repair and regeneration.  Combining exosome therapy with energy-based treatments may offer a novel and effective approach to treating acne scars.

Although Exosomes can benefit as an adjuvant therapy but not as amonotherapy.

7. TCA CROSS Chemical Peels

TCA cross-hatch technique peels chemically exfoliates the top layer of skin.  TCA peels have to used carefully for darker skin types, require multiple sessions may be accompanied by prolonged erythema and downtime. This exfoliation signals the cells inside the skin to produce more rapidly, which can help skin turnover faster and prevent pores from clogging and stimulates collagen performed by our physician.

Dr. Shanthala combines several different procedures along with PDO smooth threads for acne scar treatments. PDO threads are absorbable sutures and stimulate the collagen production, offers subcision while inserting the threads.

9. Biostimulators: Sculptra And Radiesse

A combination of lasers such as CO2, Ultraclear or Frax Pro 1550 laser or RFMicroneedling with bio stimulators such as Sculptra or Hyper diluted Radiesse is also used by our physician based on the distribution and the type of acne scarring.

Acne scars can be devastating to many young and older people, it is very difficult to treat acne scars, multiple sessions and combination treatments are shown to improve scars. Dr. Shanthala uses her unique combination treatment approach to help improve your acne scars. Follow her social media to see the before and after photos.
For more information follow us on social media to see live videos and patients’ experiences.

Dr. Shanthala Shivananjappa MD

Dr. Shanthala is a board-certified, Harvard trained anesthesiologist, assistant professor at Yale University, and staff at Massachusetts General Hospital prior to opening her cosmetic medicine clinic. Her extensive experience working with plastic surgical patients in the operating room for more than 25 years, paired with years of training in non-surgical cosmetic procedures, has enabled Dr. Shanthala to have a unique perspective on Anti-aging treatments.

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