Acne scars aren't permanent.
Texture is a collagen problem, not a pigment problem — which is why creams never fixed it. Our protocol rebuilds the skin from underneath, matching the tool to your scar type instead of running everyone through the same device.
A scar is missing structure, not a stubborn stain.
When inflammation goes deep enough, it destroys collagen in the dermis. The skin heals, but it heals short — and what's left is an indentation that no serum can reach.
This is the distinction that decides your entire treatment plan. Flat brown or red spots left behind by old breakouts are pigment, and they respond to laser, peels, and topicals. Indentations, rolling shadows, and rough texture are structural, and the only way to improve them is to trigger your skin into building new collagen where the old collagen was lost. Those two problems live on the same face and get talked about interchangeably, but they need entirely different treatments. Most patients arrive having spent a year treating the pigment and wondering why the texture never moved. The other thing worth knowing early: scar types respond differently. Rolling scars are the most rewarding to treat, boxcar scars respond well with enough sessions, and ice pick scars are genuinely stubborn and sometimes need a different approach altogether. We'll tell you which you have and what each one can realistically become.
Prep it. Rebuild it. Resurface it.
Scar revision is a construction project, not a cleanup, and it runs over a full year. Every plan moves through the same three phases — and the first one is the one people want to skip.
Prep the skin
Curated prescription topicals prepare the skin for the cellular turnover ahead and, just as importantly, prevent treatment-related PIE and PIH — the red and brown marks that a poorly prepared face will produce in response to resurfacing. This phase is why our results in richer skin tones hold. It is not filler, and it is not optional.
Rebuild the dermis
A series of Aerolase Neo laser and SkinPen microneedling sessions, combined with biostimulator injections — Sculptra and Radiesse. This step is critical: a damaged dermis cannot rebuild without the raw material to do it with, and biostimulators supply those building blocks. Neocollagenesis takes roughly sixteen weeks, which is why this phase is measured in months rather than appointments.
Resurface the texture
Erbium laser resurfacing combined with TCA CROSS, the technique that treats individual deep scars point by point rather than resurfacing the whole face to reach them. Repeated once more a couple of months later. This is the phase that takes the rebuilt dermis and makes the surface read smooth.
Not all scars respond the same way.
Identifying which scars you actually have is the difference between a plan that works and four sessions of the wrong device.
Rolling Scars
Broad, shallow depressions with soft edges that give skin a wavy look in side lighting. The most rewarding type to treat.
Boxcar Scars
Round or oval depressions with sharp, defined walls — like small craters. Responsive, but they need a full series.
Ice Pick Scars
Narrow, deep punctures that reach far into the dermis. Honest answer: these improve slowly and sometimes need a different technique.
Post-Acne Marks
Flat red or brown spots with no texture change. Different problem, different tools, much faster timeline.
Hypertrophic & Keloid
Scars that healed with too much tissue rather than too little — most common on the chest, shoulders, and jaw.
Chest & Back Scarring
Off-face scarring responds to the same logic, though it heals more slowly and needs a longer runway.
That's the consult.
Mixed scarring is the norm, not the exception, and it's exactly why one-device plans stall halfway. We map what's on your face and build the sequence around it.
Start with a free consultWe treat it. It just requires very specific preparation.
If you have a richer complexion, the risk in scar treatment isn't the scar. It's the dark mark a poorly prepared session can leave behind for months.
The answer is not to avoid resurfacing in Fitzpatrick IV-VI skin. It is to prepare the skin properly before you do it. That means a dedicated topical prep phase — pigment-suppressing agents running for weeks before the first energy-based treatment — so the skin is primed not to respond to injury with excess melanin. It also means moderate session intensity, more sessions rather than more aggression, and continued pigment suppression between visits. Done this way, deeper skin tones get the same structural improvement as anyone else. Done without the prep, resurfacing in richer skin is exactly how patients end up spending a year treating the treatment.
Smoother texture shouldn't cost you your even tone.
What's actually in the protocol.
Scar revision is the one area where sequence matters as much as device. These are the tools, roughly in the order they come in.
Curated Prescription Topicals
The prep phase, and the reason the rest of the plan is safe. Pigment-suppressing agents — hydroquinone, a retinoid, tranexamic acid, azelaic acid, and kojic acid — prime the skin for turnover and guard against treatment-related PIE and PIH.
Biostimulators: Sculptra & Radiesse
The building blocks. A damaged dermis cannot rebuild from nothing, and biostimulator injections supply the raw material your skin needs to lay down new collagen underneath the depressions.
Neo Laser, SkinPen & Erbium + TCA CROSS
The energy work. Aerolase Neo and SkinPen microneedling drive neocollagenesis through months two to four; erbium resurfacing with TCA CROSS finishes the surface and treats deep individual scars point by point at months five and seven.
Scar revision is cumulative and it is sequential. Neocollagenesis takes about sixteen weeks, which is why this is a twelve-month protocol rather than a package of appointments — and why skipping the prep phase or stopping halfway produces a fraction of the result.
A protocol versus a single session.
Almost everyone we see has had one microneedling appointment somewhere and concluded it doesn't work. Here's why a sequenced year is a different thing entirely.
Realistic framing: a well-run protocol typically produces substantial, visible improvement in texture. It does not produce skin that never had acne. Every provider promising the second one is counting on you not asking follow-up questions.
What twelve months looks like.
Consult and treatment mapping
We examine your scarring in raking light, identify which types you have and where, confirm your acne is stable, and map the full year — phases, devices, injection schedule, and cost.
Skin prep and priming
Prescription topicals begin preparing the skin for turnover and guarding against PIE and PIH. Biostimulator injections start in parallel to prime the dermis with the building blocks it will need.
Laser and microneedling
Aerolase Neo laser combined with SkinPen microneedling sessions, layered over the biostimulator work. Collagen laid down here takes about sixteen weeks to mature, so the visible change trails the treatment.
Erbium laser + TCA CROSS
The first resurfacing pass. Erbium laser addresses overall texture while TCA CROSS treats individual deep scars point by point rather than resurfacing the whole face to reach them.
Second erbium + TCA CROSS
A repeat pass, now working on a dermis that has already rebuilt. This is where deep boxcar and ice pick scars make their biggest jump.
Full result
Collagen from the final phase has fully matured. We photograph against your baseline and decide whether anything is worth another pass or whether you move to maintenance.
Before & after, in our chair.
Real Skin! patients on real scar protocols. Individual results vary — scar type and how completely the protocol is finished drive most of the difference.
I stopped editing — every photo.
“My acne cleared up in my twenties and left me with scarring I spent the next decade trying to light my way around. I had one microneedling session somewhere else years ago, saw a bit of a glow and nothing else, and wrote the whole category off.
What I did not understand was that it is a sequence, not an appointment. The first month here was all skin prep and the biostimulator injections, and it was explained to me that my skin needed the raw material before it could rebuild anything. Then the laser and microneedling, then the erbium and TCA later in the year.
It is a long protocol and I will not pretend otherwise. But somewhere around month eight I noticed I had stopped checking how my face looked in overhead lighting, and I do not edit photos anymore.”
The short list of big reasons.
Biostimulators first
The dermis gets what it needs to rebuild.
Safe on every skin tone
Weeks of topical prep before any energy.
Acne cleared first
We don't resurface skin that's still breaking out.
A sequenced year
Prep, rebuild, resurface — in that order.
Pigment handled too
Texture and tone are treated as separate jobs.
Honest expectations
You'll know what each scar type can become.
Pricing, made personal.
Scar protocols vary by scar type, surface area, and how much of the twelve-month sequence your skin needs.
Scar revision runs over twelve months, so we quote the full year at your consultation — every phase, device, and injection included — rather than a per-session price that wouldn't tell you what it actually costs to finish. You can pay for the plan up front or pay as you go.
Members save 10% on treatments and topicals. Across a twelve-month protocol with prescription skincare running throughout, that adds up well before the year is out.
Your virtual consult is completely free — including the part where we tell you a scar type won't respond the way you're hoping, or that you're not ready to start.
Book a Free Virtual ConsultEverything you're wondering.
A full protocol runs twelve months. That is not padding. Neocollagenesis, the process of laying down new collagen where the old collagen was lost, takes roughly sixteen weeks on its own, and our protocol runs three distinct phases that each need that time to mature. Month one is skin prep and biostimulator priming, months two through four are laser and microneedling, month five and month seven are erbium resurfacing with TCA CROSS, and the full result is assessed at twelve months.
Because unprepared skin responds to resurfacing by producing pigment, and that is how patients end up with post-inflammatory erythema or hyperpigmentation that outlasts the scars they came in to treat. The prep phase uses a curated combination of hydroquinone, a retinoid, tranexamic acid, azelaic acid, and kojic acid to suppress pigment production and prime the skin for the cellular turnover ahead. Skipping it does not save time. It costs you the result.
Because a damaged dermis cannot rebuild out of nothing. Sculptra and Radiesse supply the raw material your skin needs to produce new collagen, and injecting them alongside the laser and microneedling work means the energy-based treatments have something to build with. Energy alone stimulates a rebuild your skin may not have the building blocks to complete, which is a large part of why single-modality plans underperform.
TCA CROSS is a technique for treating deep individual scars, particularly ice pick and narrow boxcar scars, by applying a high concentration of trichloroacetic acid precisely into the scar itself rather than resurfacing the entire face to reach it. It remodels the scar from the inside while leaving the surrounding skin untouched. We pair it with erbium laser resurfacing at months five and seven, once the dermis has already been rebuilt underneath.
Substantially improved, yes. Completely erased, no, and we would rather say that plainly than sell you a fantasy. A completed twelve-month protocol commonly produces a large, visible reduction in depth and shadow, to the point that most patients stop noticing the scars in daily life. Rolling scars improve the most, boxcar scars respond well, and ice pick scars are the most resistant, which is exactly why TCA CROSS is in the plan.
Yes, and we do treat richer complexions with resurfacing — it simply requires very specific preparation. Fitzpatrick IV-VI skin needs weeks of pigment-suppressing topical prep before any energy-based treatment, moderate session intensity rather than aggressive settings, and continued suppression between visits. Done that way the structural improvement is the same as in any other skin type. Done without the prep, resurfacing in richer skin reliably produces dark marks.
No, and this is one of the few places we will hold you back from booking. Resurfacing actively inflamed skin produces poorer collagen results, prolongs healing, and can create new scarring while you are paying to treat the old kind. If you are still active, we will get you clear first. It feels like a delay and it is actually the fastest route to a good result.
We quote a full one-year plan at your consultation rather than a per-session rate, because the protocol is a sequence and a single session price would not tell you what it costs to finish. The plan covers every phase — topical prep, biostimulator injections, laser and microneedling, and the erbium and TCA CROSS resurfacing — and you can pay for it up front or pay as you go. Your virtual consult is free, and members save 10 percent on treatments and topicals.
Let's rebuild it.
Book a free virtual consult at Skin! Medical Aesthetics in Denver. Send a few photos in side lighting, tell us what you've already tried, and we'll come back with a real scar plan — device, session count, timeline, and cost.