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The Dermatology Institute of Boston
Physicians Caring For Your Skin -
The Dermatology Institute of Boston
Physicians Caring For Your Skin
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If stubborn marks, uneven texture, or lingering discoloration from past breakouts are weighing on you, you are not alone. At The Dermatology Institute of Boston, our board-certified dermatologists personalize every plan for acne scar treatment Boston patients trust, combining medical precision with refined, natural-looking results. Because no two scars behave the same way, we examine your skin carefully and recommend the approach, or combination of approaches, best suited to your scar type, skin tone, and goals.
Today, there are many types of acne scar treatments because there are so many types of acne scars. Two different kinds of discoloration can be left behind by acne. Post-inflammatory erythema, also known as macular erythema, is a type of red or pink skin discoloration, while post-inflammatory hyperpigmentation is a type of brown discoloration.
Acne can also leave depressions in the skin (known as atrophic scars) and thickening of the skin (known as hypertrophic or keloid scars). Because you may be experiencing multiple types of acne scarring, a combination of treatments is often necessary. During your consultation, we walk you through which options work best for your skin and explain how each one fits into a coordinated plan.
You should never shy away from the results you are looking for. Acne and scarring can have a real effect on self-esteem, but these concerns do not have to be permanent. The summaries below will help you recognize the scar types you may be noticing and understand what options we offer, including: pulsed dye laser, PicoWay laser, chemical peels, topical lightening agents, non-ablative laser resurfacing, TCA CROSS, dermal fillers, and microneedling with and without PRP therapy.
PIE, the same thing as macular erythema, is a type of acne scar that leaves small red marks on the skin in areas where there was previously an acne lesion. This redness is best treated with an acne scar laser treatment called the Pulsed Dye Laser (PDL), also known as the VBeam laser. Generally, a minimum of 2-3 treatments are needed for adequate results. Patients will notice that the treated areas are usually redder for a few hours to days before starting to fade.
This type of scarring is common, and for some people these lingering red marks can be more bothersome than the acne itself.
PIH is a type of discoloration after acne fades that leaves small brown marks on the skin in the areas where there was previously a pimple. It is more common in people of darker skin tones. Generally, PIH tends to fade on its own, but it could take over a year for some people. Often this type of discoloration is best treated with chemical peels, lightening agents and sometimes the PicoWay laser. It may also be treated with the diligent use of prescription or over-the-counter lightening creams.
For those who struggle with acne, this can become a compounding issue leading to substantial skin discoloration in extreme cases. It may not pose a health threat, but it is understandably very bothersome to some. Although PIH is more commonly found in those with darker skin types, it can happen to anyone, and the severity varies significantly from person to person.
Depressed acne scars (also known as atrophic scars) leave small indents in the skin after an acne lesion has run its course. A single spot may not concern most people, but others deal with uneven texture that is much more pronounced. TCA CROSS involves the precise application of trichloroacetic acid directly into individual scars to stimulate collagen remodeling while minimizing effects on the surrounding skin. As acne recurs, this type of scarring can worsen. Fractionated non-ablative lasers are a safe, reliable way to smooth these areas, and we often recommend these lasers as an acne scar removal option. Several treatments with this laser may be needed to improve the scars. Although the laser works well, it is nearly impossible to erase the scars or improve them 100%. The treated area will be red and swollen immediately after treatment, and on average, the skin will need 2-3 days to recover. Generally, 4-6 treatments spaced about a month apart are needed.
Microneedling is another method that can be used to treat depressed acne scars. During this procedure, the physician uses a device to create many tiny channels in the skin surface and then applies a serum that supports skin cell turnover and collagen production. Over time, this helps smooth the surface of the skin. Immediately after treatment, the area will look red and raw, healing in about 2-4 days. On average, patients require four or more treatments for full results.
Depending on the type of the atrophic acne scars, another option for treating depressed acne scars is dermal fillers. This options is usually best for rolling atrophic scars. Dermal fillers are gel-like substances injected just beneath the skin to lift depressed areas and help smooth the overall surface.
Ice pick atrophic scars and some boxcar atrophic scars may respond to a focal application of trichloroacetic acid (TCA). This type of localized application of TCA into a scar is known as the chemical reconstruction of skin scars (CROSS) method. This is a good option for narrow deep scars that a laser can’t reach the base of.
These scars are caused by thickened skin in the area of previous acne lesions. The difference between a hypertrophic scar and keloid scar depends on how much the scar has spread beyond the size of the original acne lesion or pimple. If the scar is wider than the original size of the acne lesion, it is a keloid scar. Otherwise, it is a hypertrophic scar. Regardless, these thickened scars are often treated with injections of a steroid solution, which can help thin the scar. Multiple injections spaced over time are typically needed to fully flatten the lesion. Microneedling is another method used to treat thickened acne scars. The provider creates many tiny channels in the skin and applies a serum that supports cell turnover and collagen production. Over time, this helps smooth the surface of the skin. Immediately after treatment, the area looks red and raw, and typically heals in about 2-4 days. On average, patients require 4 or more treatments for complete results. Some hypertrophic or keloid scars may respond to a surgical procedure known as scar revision. Some hypertrophic and keloid scars are also red or pink colored. Oftentimes, a laser, known as the pulsed dye laser can be used to reduce the red color of the scar. Your dermatologist will recommend the regimen best matched to your scar type and history.
Most adults and older teens with healed acne scarring are good candidates, particularly when active breakouts are under control. If acne is still flaring, we may coordinate treatment alongside medical options, including AviClear acne laser therapy, before starting resurfacing. Candidacy for specific devices also depends on your skin tone, tendency to pigment, and the depth of your scars. During your visit, we assess these factors and align on a plan that prioritizes safety, predictable recovery, and natural-looking improvement.
Some cases of acne are more damaging than others, and even with over-the-counter or medicated acne treatments, scarring can still develop. Many scars, however, are caused or worsened by picking at the skin or squeezing lesions before they fully resolve.
This increases the amount of damage done and, in many cases, makes scarring more likely. Facial scars may be difficult to avoid entirely with more severe acne, but you can do a great deal to minimize them. Consistent facial hygiene and doing your best not to pick at your acne, no matter how frustrating a breakout feels, remain the most reliable preventive steps. If you are still struggling with recurrent breakouts, we can address both the active acne and the resulting scarring during the same course of care.
If you have struggled with acne to the point of noticing scarring on the skin, we welcome the opportunity to evaluate your concerns and outline your next step. With the range of acne scar removal dermatologist options we offer, you can feel confident that your skin has real pathways to improvement over time.
We have a thorough understanding of how scarring occurs, and if you schedule a consultation with us, we will share the details you need to make an informed decision about the health and appearance of your skin. Our Back Bay office is easy to reach from across the greater Boston area, and we also offer online appointment booking for added convenience.
What is the most difficult acne scar to treat?
Generally, a type of depressed acne scar known as an ice pick scar is considered the most difficult acne scar to treat. Ice pick scars are very narrow, with v-shaped holes that look similar to oversized pores, or puncture wounds. They typically appear on the cheeks.
Because they reach deep below the epidermis and into the dermis, ice pick acne scar treatment in Boston is more complex. Damaged skin must be addressed, the deep scar must be filled, and any discoloration must also be treated. This process can involve microneedling, laser treatments, TCA chemical peels to support collagen production, and other approaches used in combination.
How does microneedling help treat acne scars?
Microneedling is an effective option for depressed and thickened acne scars. The treatment creates controlled microinjuries into the skin layers, with depth adjusted to the scar being treated. This controlled stimulation triggers the skin’s healing response, encouraging new collagen and elastin in the area. Stiff scar tissue is broken down, and newer skin cells form at a faster rate as cell turnover improves.
A healing serum applied to the skin after the channels are created penetrates more deeply, enhancing its effect. As new collagen and elastin develop, the scar gradually softens and the skin looks smoother. Typically, patients complete at least four sessions for optimal acne scar reduction.
Can you get rid of indented acne scars?
You can improve your indented scars but it may be difficult to get rid of them completely. We offer several acne scar treatments in Boston for reducing indented scars. Our options include fractionated laser treatments, TCA CROSS, microneedling, dermal fillers that lift the skin, and chemical peels. The three main types of indented acne scars are boxcar, ice pick, and rolling, and each responds best to specific treatments. The most reliable way to learn which approach is right for your skin is to arrange a consultation with our board-certified dermatologist.
Do steroids help acne scars?
Triamcinolone acetonide, a type of corticosteroid, is frequently used for acne scar removal. The brand name for this corticosteroid is Kenalog. Intralesional Kenalog injections are a popular method for treating thick, raised acne scars such as hypertrophic or keloid scars.
Thick acne scars typically form on the back, jawline, shoulders, and chest, and people with darker skin tones may be more prone to them. These raised lesions are built-up lumps of scar tissue, often building on earlier scar tissue in the area. Hypertrophic scars stay within the boundary of the original lesion, while keloid scars grow past it.
Thick acne scars are made of dense, stiff collagen fibers, the result of the body overproducing fibrous collagen during healing. When corticosteroids are injected into thick scars, they break bonds between collagen fibers and slow further overproduction. This reduces the thickness of the scar and the volume of tissue beneath the skin, making scars thinner, softer, and smaller on average. They gradually take on a more natural appearance.
By reducing inflammation, steroid injections also ease itching, swelling, and tenderness in thick scars. As vasoconstriction occurs, redness fades and the scar blends more naturally with surrounding skin. The treatment itself typically takes less than 5 minutes.
How long does a steroid injection take to flatten a scar?
The time required varies based on several factors, including how long you have had the scar, its thickness, and its size. In most cases, multiple intralesional Kenalog injections are needed to achieve optimal reduction. Patients often notice less itching, tenderness, redness, and swelling after the first injection. Injections are typically delivered every four to eight weeks, and we generally limit each case to a maximum of five. At each visit, we evaluate the scar’s response and may combine injections with other scar-reduction treatments for the most effective plan.
How is acne scar laser treatment different from laser acne treatment?
Laser acne treatment targets the sebaceous glands and active breakouts, while acne scar laser treatment focuses on remodeling skin texture, tone, and pigment left behind after breakouts resolve. Many patients benefit from both, sequenced thoughtfully so active acne is stabilized before resurfacing begins. During your visit, we clarify which stage you are in and which device pairing makes sense for your skin.
Is there downtime with acne scar laser treatment?
Yes, there is usually some degree of redness, possible bruising or possible crusting depending on the treatment plan that you choose. We review expected recovery in detail at your visit so you can plan around work, travel, and events in the Boston area.
Can acne scar treatment be combined with other services?
Yes. Combination care is one of the most common approaches to acne scar treatment in Boston, and for good reason. Most patients do not have just one kind of scar. Depressed, raised, red, and brown marks frequently appear together on the same patch of skin, and each responds best to a different tool. A carefully sequenced plan allows us to address each component without over-treating any single area.
Depending on what we see at your visit, a plan may blend fractionated laser acne scar removal, microneedling, chemical peels, dermal fillers for deeper indentations, steroid injections for thickened scars, and medical acne management to keep new breakouts from interfering with your progress. We space treatments so the skin has time to respond between sessions, and we adjust the plan as your skin evolves. The result is a coordinated course of care, not a series of disconnected procedures.
Should active acne be treated before acne scars?
In most cases, yes. Ongoing breakouts continue to create new inflammation, and that inflammation is what drives fresh scarring, redness, and pigment change. Resurfacing or remodeling the skin while active acne is still flaring tends to chase a moving target, and the new marks can undo the gains from earlier sessions. For this reason, we usually stabilize active acne first, either alongside or just before cosmetic scar work begins.
How aggressively we manage active breakouts depends on severity. Some cases may respond to prescription topicals or oral medications such as antibiotics or spironolactone, while other cases may benefit from oral isotretinoin or in-office options such as chemical peels or AviClear acne laser therapy. Once your skin is calmer and new lesions are under control, we move forward with the scar-focused portion of your plan. This sequencing protects the improvements you invest in and helps deliver the smoother, more even result you are working toward.
Dear Patients,
Our goal here at The Dermatology of Institute of Boston is protect the health of our patients and staff. To continue caring for our patients during these uncertain times, while strictly adhering to the guidelines set by the CDC, we will be only offering virtual consultations. For some patients, an in person visit is best, but if you feel that your concern could be addressed online, this may be a convenient option for you.
