As a skin restoration specialist based in Newport Beach, California, I’ve dedicated my career to helping patients overcome acne scars, pigmentation issues, and facial imbalances. My focus on collagen stimulation, volume restoration, and laser treatments has allowed me to develop a systematic approach that delivers long-lasting, natural results. In this article, I’ll walk you through how I analyze and treat different types of acne scars, the importance of combining advanced techniques like laser therapy , TCA cross, subcision, and fillers, and why consistency and experience are key to achieving optimal outcomes.
Understanding Acne Scars: The First Step
When a patient comes to me with acne scars, I begin by assessing their skin type, scar depth, and overall facial structure. There are several types of acne scars—boxcar, rolling, ice pick, and keloid —each requiring a tailored treatment plan. During consultations, I often ask patients to smile or animate so I can better understand how the scar tissue behaves under movement. This helps me determine whether the scarring is tethered (pulled down by fibrous bands) or simply atrophic (sunken due to loss of collagen or fat).
One of the most common types I see is boxcar scars. These are characterized by sharp edges and a crater-like appearance. Rolling scars, on the other hand, have a wave-like texture due to underlying fibrous bands pulling the skin down. Ice pick scars are narrow and deep, while keloid scars are raised and often inflamed.
How I Approach Scar Analysis
I start every consultation by examining high-quality photos submitted by patients. I look for signs of volume loss, oil production, and scar clustering. For instance, if there’s significant indentation in the mid-cheek area, it usually indicates fat destruction beneath the skin. This tells me that volume replacement will be part of the solution.
Next, I use tools like the CO2 laser , TCA cross, and subcision to address different layers of the scar. Each method plays a specific role:
TCA Cross : Trichloroacetic acid (TCA) is applied at the base of the scar to stimulate collagen production.
Subcision : This technique involves inserting a needle beneath the scar to break up fibrous bands, lifting the scar closer to the skin surface.
Laser Treatments : Fractionated and ablative lasers help smooth scar edges, promote collagen remodeling, and reduce textural irregularities.
The order of these treatments matters. I typically start with TCA cross and subcision first, followed by laser sessions, and finally volume restoration using fillers or fat transfer.
Why Laser Is Central to My Scar Treatment Protocol
Laser technology, especially CO2 laser , plays a pivotal role in my treatment plans. It allows me to target the outer layer of the skin while stimulating deeper collagen production. Unlike many practitioners who use a uniform approach, I customize the energy and depth of the laser depending on the scar's thickness and location.
For example, in cases where the scar edges are thickened or uneven, I use an ablative form of CO2 laser to “surgically” smooth them out. This step-by-step precision is what sets my approach apart and leads to more dramatic improvements.
I also combine laser with fractionated erbium lasers for blended resurfacing, which helps even out skin tone and texture. The result? Smoother, more youthful-looking skin with minimal downtime compared to older, more aggressive methods.
Combining Treatments for Maximum Results
One of the biggest misconceptions about acne scar treatment is that one modality can fix everything. The truth is, most patients need a combination of therapies to achieve real transformation. Let’s take a recent case where we treated a male patient with severe boxcar and rolling scars.
We started with TCA cross to stimulate collagen at the base of the scars. Then, I used subcision to release the tethered tissue. After that, I smoothed the scar edges with ablative CO2 laser , and finally, we added fat transfer to restore lost volume in the mid-face.
This layered strategy ensures that each component of the scar is addressed—depth, texture, volume, and inflammation—leading to a much smoother, more even complexion.
Addressing Oil Production and Active Acne
Before jumping into scar treatments, it’s crucial to control active acne and sebum (oil) production. Oil isn’t just a cosmetic issue—it’s inflammatory and can interfere with collagen remodeling. That’s why I often prescribe topical creams, spironolactone, or low-dose isotretinoin (Accutane) to regulate sebum levels before proceeding with laser or chemical treatments.
Some patients worry that drying out the skin will trigger increased oil production as a rebound effect. While that’s true in some cases, hormonal fluctuations and diet also play a role. By using targeted topicals like retinoids and salicylic acid, we can maintain balance without over-drying the skin.
The Role of Fillers and Volume Replacement
Volume loss is a major contributor to the aged, sunken appearance often seen in acne-scarred skin. Depending on the patient’s needs and available fat stores, I choose between autologous fat transfer , Sculptra , or Bellafill .
Fat transfer is ideal for patients with significant volume loss and enough donor fat. Bellafill, a semi-permanent filler, works well for those who want long-term support without surgery. Sculptra is great for gradual collagen stimulation over time.
Each filler has its strengths, and I tailor the choice based on the patient’s anatomy, lifestyle, and desired longevity of results.
Recovery and Realistic Expectations
Recovery time varies depending on the intensity of the treatment. Mild procedures like TCA cross or microneedling may only require a few days of downtime, while ablative laser or subcision can take up to two weeks. However, thanks to years of refining my protocols, recovery times have significantly improved.
Patients should also understand that acne scar correction is a journey , not a quick fix. Most patients need 4–6 TCA cross sessions , spaced 4–6 weeks apart, along with multiple laser and subcision sessions. Forehead scars, for example, respond beautifully to this protocol, but they still require patience and consistency.
Frequently Asked Questions About Acne Scar Treatments
Below are answers to some of the most commonly asked questions during my live sessions. These insights reflect years of clinical experience and patient feedback.
- Question: Could you do punch excision for these scars?
- Dr. Qazi: Punch excision can work for isolated, deep scars like icepick scars. However, in areas with widespread scarring or poor skin elasticity, excision can lead to worse scarring due to tension. Instead, I prefer smoothing the edges with CO2 laser and lifting the scar via subcision for safer, more predictable results.
- Question: Why are you interested in acne scars?
- Dr. Qazi: Acne scars dramatically impact self-esteem and quality of life. I believe focusing deeply on one specialty allows for mastery. Like athletes or artists, repetition builds skill—and treating acne scars has become both my passion and expertise.
- Question: Which topicals decrease oil production?
- Dr. Qazi: Topicals like retinoids (tretinoin, adapalene) , niacinamide , and salicylic acid help regulate sebum production. They also exfoliate and unclog pores, reducing future breakouts and supporting clearer skin.
- Question: Just got off Accutane but have some scars and uneven skin. What is the most effective treatment?
- Dr. Qazi: Post-Accutane skin is often thinner and more sensitive. I recommend starting with gentle laser resurfacing , TCA cross , and subcision to rebuild collagen safely. Topical retinoids can also help speed healing.
- Question: Do you think over the years you've gotten better at scar procedures?
- Dr. Qazi: Absolutely. With thousands of hours of hands-on experience, I’ve refined my technique, reduced recovery times, and improved outcomes. The process has become almost intuitive—like solving a puzzle with every patient.
- Question: Does insurance cover this?
- Dr. Qazi: Unfortunately, most insurance companies don't cover acne scar treatments since they’re considered cosmetic. However, I always encourage patients to check with their provider, as coverage policies can vary.
- Question: Does Volufiline work?
- Dr. Qazi: Volufiline may offer slight volumizing effects, but it’s not sufficient for complex acne scars. True improvement requires structural changes through subcision , laser , and fillers .
- Question: Can you still do subcision after getting CO2 or is that suboptimal?
- Dr. Qazi: Ideally, subcision should come first to release scar tissue before laser. However, if done afterward, it can still improve results—just not as effectively as the ideal sequence.
- Question: Is this from subcision?
- Dr. Qazi: Yes, many of the visible lifts and smoothing effects in before-and-after photos are due to subcision , especially when combined with TCA cross and laser .
- Question: Is CO2 laser good?
- Dr. Qazi: Yes, CO2 laser is highly effective for acne scars, especially when used ablative-style to smooth thickened scar edges. It stimulates strong collagen remodeling and can be customized for each patient.
- Question: What do you think is the most rewarding part of being an acne scar and skin specialist?
- Dr. Qazi: Changing lives. Seeing patients regain confidence, feel comfortable in their own skin, and reclaim joy—it’s incredibly fulfilling. I wish I had access to these treatments growing up, so being able to offer them now is deeply meaningful.
- Question: How many TCA cross sessions are needed on average?
- Dr. Qazi: Most patients need 4–6 sessions , spaced 4–6 weeks apart. Some may need more depending on severity, but consistent treatment yields noticeable improvement.
- Question: What do you think of the LaserAway lawsuit?
- Dr. Qazi: I’m not familiar with the specifics, but I know that not all laser clinics prioritize safety or customization. Many patients come to me after ineffective or harmful treatments elsewhere.
- Question: What are your thoughts on Skin Laundry laser resurfacing?
- Dr. Qazi: I’m not familiar with their protocols, but from what I’ve heard, they focus more on superficial treatments rather than addressing deeper scar structures. Their services may be limited in scope for complex acne scars.
- Question: How do you decide which filler is best for each patient?
- Dr. Qazi: It depends on the degree of volume loss, the patient’s body type, and availability of fat for transfer. I consider Bellafill for long-term support, Sculptra for collagen stimulation, and fat transfer for larger volume deficits.
- Question: Do you ever choose Bellafill rather than HA filler?
- Dr. Qazi: Yes, especially around the cheeks and temples. Bellafill is semi-permanent and supports scar elevation better than hyaluronic acid (HA), which tends to dissipate faster.
- Question: Did you change your live times?
- Dr. Qazi: No, I haven’t changed my live session schedule. However, I may adjust Mondays slightly due to personal commitments, including the upcoming arrival of my baby.
- Question: Do people typically see results after the first sessions?
- Dr. Qazi: Results depend on the scar type. Rolling scars with volume loss often show early improvement after subcision and filler , while boxcar or icepick scars take longer and require multiple sessions.
- Question: Do scars go away on their own over time?
- Dr. Qazi: Mild scars might fade slightly, but deep scars rarely resolve completely without intervention. Early treatment with silicone tape, hydrocolloid patches, or laser can prevent worsening.
- Question: For the photo on the screen, how many sessions has been done for her and is this the final result?
- Dr. Qazi: She’s had several sessions already, including TCA cross , laser , and Bellafill , but she’s not yet at the final stage. We’ll continue with additional sessions for optimal smoothing.
- Question: Do you use ultrasound to inject filler?
- Dr. Qazi: Not routinely. Moving the needle carefully and understanding facial anatomy is usually enough. Ultrasound may add complexity without clear benefits for most patients.
- Question: What about forehead scars—can those be done? Is it realistic to get good results on them?
- Dr. Qazi: Yes, forehead scars respond very well to subcision , TCA cross , and volume replacement . The forehead has good blood flow, making it an ideal area for collagen stimulation.
- Question: Can you just use a bunch of retinol or retinoids creams to make this look better?
- Dr. Qazi: Retinoids help with mild textural improvements and pore size, but they won’t fix deep scars. They can support healing post-treatment, though, and are often included in maintenance routines.
- Question: Is it easy to solve the underlying appearance of shallow rolling scars without subcision?
- Dr. Qazi: Possibly, but it’s a slow process. Without subcision, you rely solely on collagen stimulation, which takes longer and may not fully lift the scar.
- Question: Does beef tallow help with this?
- Dr. Qazi: Beef tallow feels like a retinoid and improves skin texture, but it doesn’t penetrate deeply enough to affect scar tissue. It’s great for general skincare, though!
- Question: I'm on Accutane—I'm not purging anymore. What scar treatment can I safely do?
- Dr. Qazi: As long as your dose is low and your skin isn’t overly dry, most treatments—including laser , TCA cross , and subcision —are safe. I avoid aggressive heat-based treatments until your skin stabilizes.
- Question: Keloid scarring from acne. What do you recommend?
- Dr. Qazi: Keloids are tricky. I often use steroid injections , VBeam laser , or pulse dye laser to reduce redness and inflammation. Prevention is key, so early treatment is best.
- Question: In the future, will I need to do CO2 laser for smoother results, or will it just continue to be the fractionated laser?
- Dr. Qazi: You can absolutely benefit from ablative CO2 laser for smoother results, especially if you have thicker scar edges. However, Asian skin types may experience more downtime and pigment changes.
- Question: Will acne scars 100% go away?
- Dr. Qazi: While complete removal isn’t guaranteed, the goal is to make scars less visible and boost confidence. Focusing on percentages can be misleading—what matters is how you feel in your skin.
- Question: Will an ablated CO2 laser with subcision give good results for a moderate case of rolling scars?
- Dr. Qazi: Yes, this combination is highly effective. Subcision releases the tethered tissue, while ablative CO2 promotes collagen and evens the skin texture.
- Question: Is Botox for men too?
- Dr. Qazi: Absolutely! Men benefit from Botox just like women. Whether it’s smoothing expression lines or reducing tension headaches caused by frowning, Botox is gender-neutral and effective.
- Question: I'm one month post-op rhinoplasty (ultrasonic). Is there a timeframe I need to wait before booking an appointment for scar treatment?
- Dr. Qazi: No waiting necessary. We can safely perform non-invasive treatments around the nose without affecting your surgical results.
- Question: Is the procedure safe for people with Type 2 diabetes?
- Dr. Qazi: Yes, as long as their A1C is under 6.0 . Good blood sugar control is essential for optimal healing and collagen production.
- Question: If my acne scars look like the after, should I still consider treatments?
- Dr. Qazi: Definitely. Even subtle improvements can make a big difference in how you feel. Every patient’s journey is unique, and we can always enhance results further with additional sessions.
Final Thoughts
If you're struggling with acne scars and want to explore personalized treatment options, I invite you to reach out. Together, we can create a tailored plan that addresses your unique concerns and helps you achieve the smooth, confident skin you deserve.
To learn more or book your consultation, visit DoctorQazi.com .
