What Are Acne Scars?

As a result of cystic acne, scars can develop. Acne is now thought to be a chronic inflammatory disease of the skin in which the sebaceous glands become blocked resulting in an accumulation of sebum (oil) and debris. The p. acne bacterium grows inside, causing infection and leading to scarring.

Acne scars are a common dermatological condition that can significantly affect an individual’s physical and psychological well-being. Traditional treatments for acne scars, such as chemical peels, dermabrasion, and laser therapy, can be expensive, invasive, and may have significant side effects. Emerging research on exosomes, small extracellular vesicles, suggests that they have potential in regenerative medicine and could be a promising treatment option for 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. Additionally, energy-based treatments, such as radiofrequency, ultrasound, and microneedling, have also shown promising results in treating acne scars by stimulating collagen production and remodeling. Combining exosome therapy with energy-based treatments may offer a novel and effective approach to treating acne scars.


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 acne scars. It involves using a small needle 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.

During the procedure, a local anesthetic is applied to the area, and the needle is inserted beneath the skin’s surface to break up the scar tissue. The needle is moved back and forth in a fanning motion to create a space for the tissue to heal without being pulled down by the scar.

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 for the results of the subcision procedure to become visible, and multiple treatments may be needed for optimal results.

Subcision is often used in combination with other acne scar treatments, such as dermal fillers, laser resurfacing, or chemical peels, depending on the type and severity of the acne scars. It is important to consult a dermatologist or a cosmetic surgeon to determine the most suitable treatment plan for an individual’s specific acne scars.

HA fillers such as Juvederm, Restylane, and 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.

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. Your skin is treated with a matrix of laser light points that vary in intensity, depending on your skin type and desired treatment results. The result 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.

SkinPen medical micro-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. Acne scars require multiple sessions and combined treatment to see better results. Dr. Shanthala, often combines it with PRP or Exosomes and Subcision.

RF micro-needling for acne scars is very effective by stimulating new collagen and reduction of pore size. RF performed after subcision  has better results, combining RF micro-needling with PRPor Exosomes is shown to reduce the downtime and neocollagenesis.

RF Microneedling is our popular treatment for Acne Scars

A cutting-edge form of regenerative medicine using the body’s own plasma to restore collagen in the skin. Combining PRP or EXOSOMES with Micro-needling has shown to improve acne scars. We combine PRP and HA fillers for forehead scars and deep atrophic scars. A combination of Sculptra and PRP or Radiesse with PRP is also used for acne scars. Our latest treatment includes topical exosomes.

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.


Combination of lasers such as CO2 laser or Microneedling with Sculptra is also used by our physician based on the distribution and the type of acne scaring.

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.

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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