Acne scars are a frequent issue in medical consultations. They affect many patients, sometimes very young ones, but also adults whose acne has persisted or recurred over the years. Acne scars are often experienced as a lasting alteration of appearance and can lead to social discomfort or loss of self-confidence. Unlike post-inflammatory pigmentary marks, which can disappear spontaneously, true scars correspond to a structural modification of the skin and do not disappear without medical intervention.
The treatment of acne scars requires a precise understanding of pathophysiological mechanisms, skin thickness, acne history, any previous treatments (including isotretinoin), the level of fibrosis and the type of scar.
Acne scars usually appear after an inflammatory skin lesion, for example a pimple. When inflammation is significant or poorly managed, the integrity of the skin is altered. This trauma can be aggravated by mechanical manipulation, particularly when the pimple is squeezed, pierced or scratched.
Once the skin is damaged, the body sets up two mechanisms : an inflammatory reaction aimed at eliminating micro-organisms and a repair process intended to reconstruct the damaged skin tissues. Ideally, this healing phase allows the skin to regenerate properly.
However, it sometimes happens that the inflammatory response persists even after the imperfection has disappeared. In these situations, the skin heals irregularly, leaving a permanent mark : the acne scar. This phenomenon reflects a difficulty of the skin tissue to repair itself correctly, either through an excess of fibrous tissue or through loss of volume.
Acne scars do not all have the same appearance. They may be small, deep, raised, pigmented or simply red. Understanding their shape makes it possible to choose the most suitable treatment to improve the skin. Some are easy to reduce, while others require management by an experienced physician.
To avoid acne scars, it is important to adopt the right habits as soon as pimples appear. The most important thing is not to touch, squeeze or scratch the lesions. By manipulating them, you risk introducing bacteria present on the hands, which can cause an infection. An infected lesion leads to strong inflammation, which promotes the appearance of new pimples and prolongs irritation in the same area. The longer the skin remains inflamed, the more difficult the healing is, and the higher the risk of scarring becomes.
Sun exposure should also be limited. Even if UV rays temporarily improve acne, this effect is followed by its worsening. In addition, many acne treatments make the skin sensitive to the sun, which can cause pigment spots. Pimples that are in the process of healing are very sensitive. The sun can darken the skin and leave a mark that remains for a long time. It is therefore important to protect your skin and avoid staying in the sun for too long in order to limit visible scars.
To reduce or make acne scars disappear, several aesthetic medical treatments can be proposed depending on the type of scar and skin.
Medium or deep peels promote skin renewal and improve the appearance of scars by stimulating skin regeneration.
Continuous ablative laser smooths out scars by vaporizing the altered skin layers.
Fractional laser creates micro-areas of controlled ablation, which stimulates skin regeneration and collagen production and progressively improves skin quality.
Skinboosters are indicated to hydrate the skin and increase its density.
During an initial consultation, Dr. Romano evaluates the skin, the type of acne scars and proposes the most suitable treatment for each patient.
The medium peel is used to reduce acne scars by inducing controlled exfoliation of the layers of the skin. By removing part of the epidermis and dermis, this technique promotes skin renewal, stimulates collagen production and helps progressively improve atrophic scars. This treatment is particularly effective for superficial to moderate scars and can be repeated depending on skin thickness and individual tolerance. The concentration of the TCA peel is determined according to the desired depth, the phototype as well as the quality of the skin. Particular attention must be paid to post-peel care and strict sun protection in order to minimize the risk of hyperpigmentation. A prior medical assessment is essential to define the appropriate concentration and depth, while ensuring the safety of the procedure. A single session is generally sufficient, although a second may sometimes be considered.
The Skinboosters are injections of lightly cross-linked hyaluronic acid designed to improve the overall quality of the skin. In the case of atrophic acne scars, their role is not limited to filling depressions in the usual way. They deeply hydrate the dermis while strengthening skin elasticity and suppleness. This restructuring helps reduce the visibility of certain superficial scars and can also potentiate the effects of other treatments, such as laser or peeling.
This type of treatment is particularly indicated when the skin shows irregular density, persistent dryness or a lack of firmness. Performed in compliance with aseptic rules and appropriate injection techniques, the treatment is generally well tolerated and does not cause social downtime. A consultation with a physician is essential to assess the indications and determine the areas to be treated optimally.
Ablative lasers are used to improve atrophic acne scars by performing controlled ablation of skin tissues.
Continuous ablative lasers, such as CO₂ or Erbium lasers, uniformly remove a layer of skin on the treated area, with a depth adapted to the scar and the skin type. This technique softens the edges of scars, restructures the underlying tissues and stimulates the synthesis of new skin that is denser and better organized. This type of laser is particularly indicated for deep or extensive scars, but it entails a prolonged healing phase as well as an increased risk of erythema, crusting or pigmentary disorders.
The fractional ablative laser works differently : instead of treating the entire skin surface, it creates microcolumns of ablation or coagulation, interspersed with areas of intact skin. These untreated areas facilitate healing, also contribute to collagen production and reduce the risk of complications compared with continuous laser treatment. As a result, the fractional mode is most often used for moderate scars or when it is desirable to limit social downtime.
The choice of laser depends on several factors, such as the type of scar (rolling, ice-pick or boxcar), skin thickness, the patient’s phototype and the acceptable recovery time. Ablative lasers must be used with caution on higher phototypes because of an increased risk of post-inflammatory pigmentation. Strict photoprotection is essential throughout the healing process.
Acne scars can appear on various parts of the body : the face, the neck, the back, the chest or the shoulders. Among these, the face and neck are the areas most often affected due to the high concentration of sebaceous glands that lead to increased sebum production and the appearance of inflammatory imperfections. Laser treatment is possible on all of these regions without any limitation. This method makes it possible to treat different types of scars : atrophic, raised or pigmented. The laser stimulates collagen production and the natural and progressive regeneration of the skin. The treatment is adjusted to the specific characteristics of each area, thanks to precise modulation of the intensity according to the depth of the scars and the sensitivity of the skin.
Laser significantly improves skin quality. By removing damaged tissues and stimulating collagen production, it helps increase skin firmness, elasticity and homogeneity. Scars fade, while the skin texture becomes visibly more even. The results obtained are long-lasting, with a significant reduction in scars and much smoother skin. Each treatment is fully adapted to individual needs : the intensity, depth of action and duration of the sessions are adjusted according to the characteristics of the scars, their severity and the skin type. Before any procedure, a detailed analysis is carried out to define the most appropriate strategy and configure the laser optimally, while minimizing the risk of side effects. Afterwards, personalized follow-up and skincare advice are provided.
Medium or deep peels, as well as continuous ablative laser, are the most effective solutions for treating acne scars.
However, these treatments are not suitable for all patients. Darker skin tones, from phototype IV upwards, present an increased risk of post-inflammatory hyperpigmentation, which makes this type of procedure contraindicated.
Recovery time must also be taken into account : deep peels and ablative laser cause social downtime of 7 to 10 days, which may be difficult to accept for some patients who have significant professional or social activity.
Atrophic acne scars do not disappear completely, but current treatments make it possible to obtain significant improvement. Studies published in Dermatologic Surgery, JAAD or Lasers in Surgery and Medicine indicate that resurfacing techniques – in particular ablative lasers, fractional lasers and certain medium to deep peels – offer on average a partial but clinically noticeable reduction in the depth and visibility of scars. Improvement varies according to the type of scar, skin quality and the chosen treatment : boxcar and rolling scars respond better than ice-pick scars, which are recognized as the most difficult to treat. The literature also shows that the best results are obtained with combined protocols, which associate resurfacing and optimization of skin quality (such as Skinboosters). Thus, it is generally possible to obtain smoother and more even skin, but not to completely erase scars.
The improvement of acne scars is a progressive process that generally extends over several months. After a resurfacing treatment (ablative laser, fractional laser or medium/deep peel), skin regeneration and collagen production continue for 3 to 6 months, which explains why the results are not immediate. Depending on the depth of the scars and the technique used, several sessions may be necessary. The interval between sessions is 4 to 8 weeks. Superficial scars improve more quickly, while deep scars often require combined protocols to obtain a satisfactory result. Thus, the management of acne scars should be considered as a medium-term treatment, the evolution of which depends on skin biology, the type of scar and the chosen therapeutic plan.
Treatments for acne scars have been the subject of numerous publications in medical journals such as Dermatologic Surgery, Lasers in Surgery and Medicine, Journal of the American Academy of Dermatology (JAAD) and Aesthetic Surgery Journal. The available data indicate that resurfacing techniques — in particular ablative laser, fractional laser and medium to deep peels — are those that achieve the most significant improvements in atrophic scars.
Articles published in these journals generally show a reduction in the depth and visibility of scars ranging from moderate to major, with clinical improvement observed after a single treatment, then enhanced by additional sessions when indicated. Fractional ablative lasers are particularly well documented : studies report progressive improvement in skin quality and collagen production over several months, thanks to skin regeneration.
Medium or deep TCA-based peels, long described in the dermatological literature, have also demonstrated their effectiveness in reducing superficial to moderate scars. Their ability to smooth the skin surface and even out the complexion is well described, but their use requires rigorous selection of phototype due to pigmentary risks.
Skinbooster injections, for their part, do not directly modify the structure of deep scars, but several studies published in aesthetic medicine show a measurable improvement in hydration, elasticity and skin quality, which can make certain superficial scars less visible and optimize the results of another treatment (laser or peel).
The medical literature finally emphasizes that the choice of treatment must be personalized, taking into account the type of scar, skin thickness, phototype and recovery time. The best improvements are generally obtained through a combined approach, integrating resurfacing and optimization of skin quality.
The cost of treatment for acne scars varies depending on the complexity of the case and the extent of the area to be treated. For a medium peel or a continuous ablative laser, a single session is generally necessary, with a price starting at 500 CHF. Fractional ablative laser requires several sessions – on average 4 to 6 sessions spaced about two months apart – with a price starting from 350 CHF per session. Skinboosters can be used in addition to improve skin quality : the syringe is billed 400 CHF, and on average two to three syringes per year are needed, injected during the same session.
In Switzerland, laser used to treat acne scars is considered an aesthetic-oriented medicine procedure. It is therefore not reimbursed by basic insurance (LAMal), because it is not a medically necessary treatment but an aesthetic procedure. Supplementary insurance rarely covers this type of intervention, except in very specific cases linked to post-traumatic scars or a reconstructive indication. For most patients, the treatment is therefore entirely at their expense.
Medium peels and continuous ablative lasers are contraindicated on higher phototypes (from phototype IV onwards).
Yes, for medium peels and continuous ablative lasers (7 to 10 days). Fractional laser leads to a faster recovery, often in a few days.
Yes, they improve hydration, elasticity and skin quality, making superficial scars less visible and enhancing the results of other treatments.
