Fractional CO2 for boxcar and ice-pick scars
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Acne Scarring Treatments sydney
Medical Aesthetics 360 | Chatswood and Hurstville
Acne Scarring Treatment in Sydney, Planned by Scar Type
Acne scarring is not a single concern. Narrow ice-pick scars, sharp-edged boxcar scars, tethered rolling scars and post-acne colour changes respond to different strategies.
An effective acne scarring consultation begins by separating true textural scars from redness, pigmentation, enlarged pores and active acne. Treatment can then be matched to scar depth, skin tone, recovery preferences and the amount of change that is realistically possible.
Related MA360 patient examples
RF microneedling for mixed scarring
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Fractional erbium for textural scars
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Individual outcomes vary. These photographs do not predict your result; lighting, angle, skin condition, treatment timing and healing can affect appearance.
First stepIdentify the scar pattern
PlanningMatch depth and skin type
ProgressUsually staged over time
Sydney clinicsChatswood and Hurstville
Scars, marks and active acne
Acne Scarring: Not Every Post-Acne Mark Is a Scar
A true atrophic acne scar changes the skin surface, leaving a pit, indentation or wave-like depression. Post-inflammatory redness and brown pigmentation change colour without necessarily changing texture. Many people have a mixture of both.
This difference affects treatment. A light or pigment pathway may soften red or brown marks but will not lift a tethered depression. Strong resurfacing may be unnecessary when the main concern is colour rather than structure.
What an Acne Scarring Assessment Checks
- Whether acne is still active or inflamed
- Scar depth, width, edges and tethering
- Post-inflammatory pigmentation or redness
- Skin sensitivity and previous treatment reactions
- History of keloid or raised scarring
- Recent medicines, procedures and isotretinoin use
Acne scar treatment rarely means complete removal. The aim is visible softening of texture and shadowing while protecting skin quality. The degree of improvement varies with scar type, depth and healing response.
Common acne scar types
How Acne Scarring Patterns Guide Treatment
Most atrophic acne scars are described as ice-pick, boxcar or rolling scars. Chicken pox scars can also leave depressed marks that need similar structural assessment.
Ice-Pick Acne Scarring
Narrow openings that extend more deeply into the skin. Surface-only treatments may not reach the full depth, so focused scar techniques or a combined plan may be needed.
Boxcar Acne Scarring
Round or oval depressions with clearer edges. Shallow boxcar scars may respond to resurfacing; deeper scars sometimes need focal treatment as well.
Rolling Acne Scarring
Broad, wave-like depressions caused partly by fibrous attachments beneath the skin. Releasing tethering may be relevant before or alongside collagen-remodelling treatment.
Raised scars
Hypertrophic and keloid scars sit above the skin rather than below it. They require a different pathway from laser resurfacing for atrophic scars.
Scar-first treatment matching
Why Acne Scarring Rarely Has a One-Device Answer
Deep ice-pick scars
Focused chemical reconstruction or punch techniques may be considered for selected scars, sometimes followed by resurfacing. Availability and suitability need clinical assessment.
Shallow boxcar scars
Fractional CO2 or erbium resurfacing may soften edges and improve the surrounding texture. Deeper boxcar scars can need a focal technique in addition to a device-based plan.
Tethered rolling scars
Subcision may be relevant when fibrous bands pull the skin downward. RF microneedling, microneedling or fractional laser may then support remodelling, depending on the skin and scar pattern.
Red or brown marks
Vascular, light-based or pigment-focused care may address colour, while skincare supports the barrier and reduces irritation. These options do not directly correct deep depressions.
Mixed scarring
Many faces contain several scar types plus pores, redness or pigmentation. A staged sequence can be more logical than repeating one procedure at increasing intensity.
Evidence in context
Balancing Acne Scarring Results and Recovery
Acne Scarring: Fractional CO2 Compared With RF Microneedling
A 2026 meta-analysis of eight randomised trials involving 249 patients found greater average scar improvement and satisfaction with fractional CO2 than with microneedling radiofrequency. However, fractional CO2 also produced more pain, a higher risk of post-inflammatory hyperpigmentation and longer-lasting redness.
The small evidence base and variation between studies mean there is no universal winner. Skin tone, scar type, recovery tolerance and treatment goals remain important. Read the acne-scar treatment meta-analysis on PubMed.
Treatment pathways at MA360
How Acne Scarring Technologies Differ
The device matters, but the treatment depth, settings, scar selection and aftercare matter just as much. These options are considered after the scar pattern and pigmentation risk are understood.
Fractional CO2 resurfacing
Ablative fractional resurfacing may be considered for established boxcar and mixed atrophic scars when a stronger texture-focused treatment is appropriate.
- Potential strength
- More intensive remodelling for selected deeper textural scars.
- Trade-off
- More visible recovery, pain, prolonged redness and pigmentation risk.
Fractional erbium resurfacing
Er:YAG resurfacing may be selected for superficial to moderate atrophic scars and uneven texture, with treatment intensity adjusted to the skin and recovery plan.
- Potential strength
- Controlled surface resurfacing with less residual heat than CO2.
- Trade-off
- Redness, peeling, pigment change and infection remain possible.
RF microneedling
Radiofrequency energy delivered through microneedles may support dermal remodelling in rolling, mixed or textural scars while limiting surface ablation.
- Potential strength
- Useful when dermal remodelling and a lower surface-recovery burden are priorities.
- Trade-off
- Deep ice-pick scars may need another technique; bruising, burns, track marks or pigment change can occur.
Non-ablative fractional laser
A gentler fractional pathway may support surface quality, fine texture and selected pigment concerns as part of a broader plan.
- Potential strength
- Lower surface disruption and a gradual approach to skin quality.
- Trade-off
- It is not a substitute for focused treatment of deep or tethered scars.
Light-based treatment
Broadband light may be relevant when lingering redness or brown marks are more prominent than textural indentation.
- Potential strength
- Targets colour rather than scar depth.
- Trade-off
- It does not lift pitted scars; burns, blistering and pigment change are possible.
Microneedling and skin texture care
Standard microneedling may support mild atrophic scarring, pores and overall texture over a series of sessions.
- Potential strength
- Progressive collagen support with less thermal injury.
- Trade-off
- Results are gradual and deep ice-pick or tethered scars may respond poorly on their own.
Pigmentation planning
Brown post-acne marks need a pigment-focused plan, sun protection and careful control of inflammation rather than automatic resurfacing.
- Potential strength
- Separates colour treatment from structural scar treatment.
- Trade-off
- Irritation and overly aggressive energy settings can worsen pigmentation.
Skincare and active-acne control
Skincare does not remove established depressions, but it can support the barrier, reduce inflammation and help prevent further acne-related damage.
- Potential strength
- Prepares the skin and supports recovery and maintenance.
- Trade-off
- Active acne may need medical management before intensive scar procedures begin.
From assessment to review
A Staged Acne Scarring Plan
- Classify. Map ice-pick, boxcar, rolling, raised scars, redness and pigmentation.
- Stabilise. Address active acne, irritation or an impaired skin barrier before intensive treatment where needed.
- Prioritise. Decide which scar types create the greatest shadowing and which treatment should come first.
- Treat and recover. Space procedures around healing, sun exposure and your tolerance for visible recovery.
- Review. Allow collagen remodelling to develop before deciding whether to repeat, combine or stop treatment.
Why combination plans are common
One person may have narrow ice-pick scars, broad rolling scars and post-acne pigmentation on the same cheek. Repeating one device may improve one layer while leaving another unchanged.
A combination plan does not mean doing everything at once. It means choosing a sequence, allowing recovery and reassessing after each stage. Sometimes a focused scar technique comes before resurfacing; in other cases, redness or active acne is the first priority.
Skin tone and pigmentation risk
A history of pigmentation changes the plan
Medium-to-deep skin tones and anyone with previous post-inflammatory hyperpigmentation may be more prone to dark marks after heat, inflammation or injury. This does not automatically rule out acne-scar procedures, but it may change the device, settings, preparation and recovery plan.
Recent tanning, sun exposure, melasma, active dermatitis and previous pigment reactions should be discussed. Consistent broad-spectrum sun protection and gentle barrier care are important before and after treatment.
Tell your practitioner about
- Current acne medicines and recent isotretinoin
- Cold sores or herpes infection around the treatment area
- Keloids, raised scars or delayed wound healing
- Melasma or previous post-inflammatory pigmentation
- Pregnancy, breastfeeding and relevant medical conditions
- Upcoming travel, events and unavoidable sun exposure
Recovery and possible complications
Downtime depends on treatment intensity
A lower-downtime option is not automatically better, and a stronger procedure is not automatically more suitable. Recovery needs to fit both the scar and the person.
Expected short-term effects
Redness, swelling, tenderness, dryness, peeling, crusting, pinpoint bleeding or bruising may occur, depending on the procedure.
Problems that may need review
Acne flare, prolonged redness, infection, cold-sore reactivation, pigment darkening or lightening and delayed healing can occur.
Less common complications
Burns, persistent track marks, unwanted texture change or additional scarring are possible. Seek prompt advice for worsening pain, spreading redness, blistering or discharge.
Acne scar treatment cost Sydney
Pricing follows the treatment plan
Cost depends on the scar types present, treatment area, procedure selected, intensity, number of stages and whether redness or pigmentation also needs attention. A shallow texture concern will not have the same plan as deep mixed scarring.
A written estimate should explain the proposed sequence, expected recovery and likely review points, so you can consider the overall time and financial commitment before deciding.
How many sessions might be needed?
There is no reliable standard number. Some focal scars may be addressed with a small number of targeted procedures, while widespread mixed scarring may need several stages. Collagen remodelling continues after the visible surface has healed, so treatment should not be repeated too quickly.
The aim is to stop when the additional benefit no longer justifies the recovery, risk or cost, rather than continuing a preset package regardless of response.
Medical Aesthetics 360 Sydney
Acne scar consultations in Chatswood and Hurstville
Chatswood
Suite 203/38B Albert AvenueChatswood NSW 2067
Hurstville
41-43 Dora StreetHurstville NSW 2220
Questions patients ask
Acne Scarring FAQs
What causes acne scars?
Scars form when inflammation damages skin structure and healing produces too little or too much collagen. Deeper, longer-lasting inflammatory acne carries a greater risk, although scarring can occur even when acne has been treated carefully.
Which treatments are considered for pitted acne scars?
That depends on the pit. Ice-pick scars may need a focused chemical or punch technique, boxcar scars may respond to fractional resurfacing, and rolling scars may need release of tethering before collagen-remodelling procedures. Mixed scars often need a staged combination.
Can chicken pox scars be treated like acne scars?
Some chicken pox scars behave like other depressed scars, but their depth, edges and location still need assessment. Fractional resurfacing, focused scar techniques or collagen-remodelling procedures may be considered where suitable.
Are red or brown acne marks permanent scars?
Not necessarily. Redness and post-inflammatory pigmentation can remain after acne without creating an indentation. They may fade gradually or need colour-focused treatment, while true scars involve a structural texture change.
Can acne scars be completely removed?
Complete removal cannot be promised. Treatment aims to soften depth, edges and shadowing so scars are less noticeable. The achievable change depends on scar type, severity, skin response and the risks you are willing to accept.
How many sessions will I need?
The number varies with scar type, treatment intensity and response. A focal technique may need a different schedule from full-face fractional resurfacing or RF microneedling. Review after healing is more useful than committing to a fixed number before treatment begins.
Is laser or RF microneedling better for acne scars?
Neither is better for everyone. Fractional CO2 may create greater average improvement in selected atrophic scars but also more pain, redness and pigmentation risk. RF microneedling may suit people prioritising dermal remodelling with less surface ablation. Scar type and skin tone guide the choice.
Can medium-to-deep skin tones have acne scar treatment?
Yes, but pigmentation risk needs careful planning. A history of post-inflammatory hyperpigmentation, melasma, recent tanning and previous laser reactions may influence the technology, settings, preparation and aftercare.
What downtime should I expect?
Downtime ranges from short-lived redness and swelling to a more visible period of peeling, crusting and erythema after stronger resurfacing. Your practitioner should explain both the likely recovery and less common complications for the proposed procedure.
Can pigmentation treatment be combined with scar treatment?
It can be, but usually in a planned sequence. Treating texture and colour too aggressively at the same time may increase inflammation and pigmentation risk. The order depends on active acne, skin tone and which concern is most prominent.
Should active acne be controlled first?
Often, yes. Ongoing inflammatory acne can create new scars and may increase irritation or infection risk during some procedures. The acne and scar plan should be coordinated rather than treated as unrelated concerns.
How much does acne scar treatment cost in Sydney?
Pricing depends on scar pattern, treatment area, procedure, intensity and number of stages. An individual quote can be provided after assessment, together with expected recovery and review points.
Will the improvement last?
Structural remodelling can be long-lasting, but skin continues to age and new acne can cause new scars. Ongoing acne control, sun protection and appropriate skincare help protect the result.