"Acne scars won't go away…" The reason may be that your skin type and treatment method don't match.
- Optimal treatment methods for each type of acne scar (redness, hyperpigmentation, crater)
- Thorough comparison of Dermapen, CO2 laser, RF microneedling
- How to choose "effective treatment" by type based on paper evidence
"Every time I look in the mirror, the uneven acne scars and redness bother me and my mood sinks…"
"I've tried expensive skincare products and clinic treatments, but I can't seem to achieve my ideal skin"
There are many women in their 20s to 40s struggling with such concerns. In fact, depending on the type and depth of acne scars, the treatment method that becomes the "correct answer" differs. There are cases where the treatment you continue with good intentions actually becomes a longer route.
Overturning Common Knowledge About Acne Scar Treatment? Why Dermapen Alone Cannot Fix All Irregularities
Many people think, "When it comes to acne scar treatment, first try Dermapen." Certainly, Dermapen is an extremely excellent treatment method,but it's not the case that "doing this alone will make any acne scar beautiful."There is a trap that many people tend to fall into here.
"Microneedling" such as Dermapen is a treatment that creates numerous tiny holes in the skin with fine needles and promotes collagen production by utilizing the skin's natural healing ability. In technical terms, it is called "percutaneous collagen induction therapy (PCI)," and is characterized by promoting the reconstruction of the dermal layer without causing major damage to the epidermis [1].
Since the downtime (the period until redness and other conditions subside after the procedure) is relatively short and the risk of post-inflammatory hyperpigmentation (PIH), which often occurs with laser treatment, is low, it is considered a safe treatment suitable for the skin of people of color, including Japanese people [2].
In fact, in a study of patients, treatment over 3 months (a total of 6 sessions every 2 weeks) resulted in an improvement in appearance of 51-60%, an improvement in skin texture of 40-50%, and a high patient satisfaction rate of 80-85% [3]. Skin tissue biopsy also proved that type I, III, and VII collagen increased significantly [4].
However, in fact, there are acne scars that microneedling is good at treating and acne scars that it is not good at treating. According to paper data, it is effective for rolling type (shallow wavy depressions) and boxcar type (depressions with vertical steps), but has low effectiveness on ice pick type (point-shaped deep craters) [5].
In other words, if you repeat only Dermapen on deep ice pick-type acne scars, you may not achieve the change you expect. So which treatment should be applied to your acne scars? Let me explain in detail next.
What Type of Acne Scar Do You Have? Comparison of Optimal Treatment Approaches That Vary by Type
The greatest key to success in acne scar treatment is"correctly understanding the type of your acne scars"It is. Acne scars are broadly classified into three types: redness, hyperpigmentation, and textural irregularities (crater-like depressions). It is extremely important to select the optimal treatment method according to each condition.
- Acne scars with redness:A condition in which prolonged inflammation causes capillaries to dilate, allowing blood to show through the skin.
- Hyperpigmentation (age spots):A condition in which inflammation from acne causes excessive melanin production, which then deposits in the skin and leaves a brown discoloration.
- Textural irregularities and crater-like depressions:Inflammation has reached the dermal layer deep within the skin, destroying normal collagen tissue and causing the skin to become depressed.
For example, craters (atrophic scars) are further classified into 3 types based on their shape. The first is the "boxcar type," which has a wide opening and a flat bottom. The second is the "rolling type," which has gentle wave-like depressions. And the third is the "icepick type," which has deep, sharp point-like indentations as if pierced by an ice pick [6][7].
For redness and pigmentation, chemical exfoliation promotes skin cell turnoverPeelingand mild laser treatments that react to melanin and capillaries are often effective. However, in the case of craters where dermal tissue has been destroyed, treatment limited to the skin surface will not resolve the issue.
To smooth out crater skin, powerful treatments that forcibly rebuild collagen deep within the skin (such as Dermapen, CO2 laser, RF microneedling, etc.) are necessary. Furthermore, it is essential to determine which device to use based on the depth and shape of the craters.
Remarkable improvement rate of 85.4%! The power of Dermapen combined with other active ingredients
If your acne scars are the type suitable for Dermapen (microneedling), there is a method to dramatically enhance its effectiveness even further. That is "combination therapy" with active ingredients. You can regenerate your skin far more efficiently than with treatment alone.
The latest research shows that when combined with ingredients such asPRP (platelet-rich plasma)higher results are achieved compared to Dermapen alone. PRP is a component extracted from the patient's own blood, rich in growth factors that accelerate cellular repair. By performing Dermapen while allowing this to penetrate the skin, powerful wound healing is promoted[8].
Let us introduce actual research data from 41 patients. After 4 treatments performed at one-month intervals,on the side of the face treated with the combination of Dermapen and PRP, acne scar improvement was confirmed in 85.4% of patients[9][10]. Additionally, when Dermapen is combined with non-crosslinked hyaluronic acid (an ingredient with moisturizing and anti-inflammatory properties), a high improvement rate of 82.9% has been reported[11].
In another evaluation comparing patient satisfaction, the group combining both treatments showed significantly higher satisfaction and reduction in acne scars compared to Dermapen alone or PRP injection alone[12][13]. Dermapen functions as a "pathway" to deliver growth factors and hyaluronic acid deep into the skin, maximizing the effect of smoothing out crater skin to the limit.
Furthermore, research is being conducted combining not only PRP but also skin-brightening and anti-inflammatory ingredients such as vitamin C with microneedling. High satisfaction has been achieved even when vitamin C is combined, and it is extremely effective for those with both acne scars and hyperpigmentation (dark spots) present simultaneously[14].
CO2 laser and RF microneedling: comparison and optimal solution for stubborn crater skin?
So, for "deep craters (ice-pick type)" that are difficult to improve with microneedling, or severe uneven texture that requires more powerful treatment, how should we address this? Here, we would like to compare and consider"CO2 laser" and "RF microneedling"as two approaches.
Fractional CO2 laseris a powerful "ablative" type of treatment (removing/vaporizing the skin surface). It emits microscopic laser beams to the skin, using heat energy to ablate the skin pointwise. Since powerful heat penetrates deep into the dermis, it powerfully promotes collagen production and demonstrates extremely high effectiveness in improving deep uneven texture[15].
On the other hand, there are drawbacks to this high efficacy. Since the surface skin is ablated, downtime is long, with redness and scabbing remaining conspicuous for several days to a week. Additionally, for people of color (including Japanese), it is important to note that there is a somewhat elevated risk of post-treatment hyperpigmentation (PIH) due to thermal damage[16].
Meanwhile,RF microneedlingis a treatment in which ultrafine needles are inserted into the skin, and RF (radiofrequency) heat energy is delivered directly from the needle tip into the dermal layer. It enables a "non-ablative" approach that minimizes thermal damage to the skin surface (epidermis) while powerfully tightening the deep skin layers and promoting collagen production[17].
Research on RF microneedling has confirmed that it shows equivalent or superior effectiveness compared to fractional laser, with lower post-treatment hyperpigmentation risk, and faster resolution of pain and redness (shorter downtime)[17]. In one study targeting aged skin, RF microneedling was found to reduce aged cells and increase collagen quantity more than conventional microneedling[18].
In other words,"If you can tolerate longer downtime and want to powerfully treat deep uneven texture above all else," CO2 laseris the choice; if "you want to treat deep uneven texture thoroughly while reducing hyperpigmentation risk without affecting work or daily life," RF microneedlingwould be considered one optimal solution.How does research data prove the "fail-proof" way to choose acne scar treatment?
So far, we have compared three treatment methods: microneedling, CO2 laser, and RF microneedling. In fact, to absolutely avoid failure in choosing a treatment, there is something that must be considered. What is it?
The answer is
"combining multiple treatment methods (multimodality approach)"this way of thinking. As research data shown earlier demonstrated, in acne scar treatment, achieving perfect results with "just a single treatment method" is extremely difficult[19][20].For example, performing downtime-short microneedling or RF microneedling across the entire face, and combining TCA peeling (peeling using high-concentration acid) or CO2 laser pinpoint only on particularly deep ice-pick type craters is most effective[2].
Additionally, in severe acne scar cases, fibrous tissue may become adhered underneath the skin, pulling the surface strongly. In such cases, combining "subcision (treatment that physically cuts adhesions under the skin using medical needles)" with laser or RF microneedling makes depressions easier to lift and plump up[21].
Treatment interval and number of sessions are also important. In many clinical trials, acne scar treatment showed that
"performing sessions at 3-4 week intervals with a minimum of 4-6 sessions"achieves visible significant improvement[22][23][24]. Continuing treatment patiently and systematically in line with skin turnover is the shortest route to ideal skin.If you're thinking "I wonder what would be right for me?"
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Summary of this article
Identify the type of acne scar:
- Redness, hyperpigmentation, and uneven texture (craters) are categorized separately, and the optimal treatment further varies depending on crater shape.The true value of microneedling:
- Effective for shallow to moderate uneven texture. Combining with PRP (platelet-rich plasma) can provide an expected high improvement rate of 85.4%.Comparison of deep craters:
- For maximum effectiveness, "CO2 laser" is recommended; for treating deep layers while reducing hyperpigmentation risk and downtime, "RF microneedling" is recommended.Optimal treatment is combination:
- "Customization" that combines multiple treatments tailored to skin condition and downtime tolerance is the key to success.Even acne scars that have troubled you for years can be significantly improved to smooth, beautiful skin through the latest medical technology and appropriate approach. The best treatment method varies depending on your individual skin condition and acne scar type.
Rather than self-diagnosing based solely on internet information that "this treatment should be good," the first step is to have a specialist doctor properly diagnose your skin condition. At Zetith Beauty Clinic, we propose optimal customized treatment plans tailored to each patient's acne scar depth and lifestyle. Please feel free to contact us first.