Acne is caused by a variety of reasons including genetics, lifestyle, humidity, menstruation, hormonal conditions, diet and more. Although acne is not a life-threatening disease, it has a huge impact on the patient’s life. Even after it has been controlled, acne leaves behind its footprints in the form of acne scars. At Castle Dermatology in Tarzana, we specialize in the comprehensive treatment of acne scars serving the entire Los Angeles area.

Acne scars are formed when the skin does not regenerate itself properly after the acne lesions are treated. The inflammation caused by acne can damage the skin tissue, hence leaving scars behind.

About 50 million Americans suffer from acne annually, making it the most common skin disease in the United States. What looks like a harmless pimple can conclude into a prominent lifetime scar, having a massive impact on the bearer. Acne scars play a vital role in lowering one’s self-esteem, especially teenagers. The person may heal physically, but the emotional damage can be long-lasting. Acne scars can be tough and stubborn, but there are different treatment options depending on the type of acne scars.

At Castle Dermatology in Tarzana, before treating the acne scars, we assess the individual scars to be able to recommend and customize the type of scar treatment needed for the individual.

Types of Acne Scars

Ice Pick Scars

The ice pick scars are deep but slim marks that go all the way into the second layer of the skin. They are the outcome of the deformation of skin tissues which were damaged due to an infection or pimple.

The skin with ice pick scars looks like it has been punctured by a needle. These tiny yet deep holes are one of the most difficult acne scars to treat.

Boxcar Scars

Boxcar scars are the remnants of high inflammatory acne. The scars are oval-shaped, shallow but visible depressions on the skin, mostly formed on the jaw line or lower cheeks portion of acne-prone face. The boxcar is atrophic scars with their intensity being dependent on the mass of tissue loss.

Rolling Scars

The rolling scars are quite similar to the boxcar scars, but their edges are smooth, rather than edgy or sharp. The skin texture may be rough and wavy. Rolling scars tend to become more intense and visible as the person ages.

During acne scar formation, fibrous tissue develops under the skin. These fibrous tissues pull down the skin at various levels, thus creating a wavy appearance of the skin, known as rolling scars. Typically the most common area of rolling scars appears on the cheek.

Hypertrophic and Keloid Scars

Contrary to the other types of scars, Keloids are not formed due to excess tissue formation after the healing of a wound. The skin does not stop the production of cells, which creates a mound above the healed skin.

These scars are more common in men than women, but due to hormonal conditions, some skin types are more likely to have hypertrophic scars than others.

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Types of Acne Scar Treatments

At Castle Dermatology, we are able to assess the type of acne scar that the patient is suffering from and customize the appropriate type of treatment.  It is common and more effective to use a combination of treatments for the individual since most patients have different types of acne scars at the same time.

The following are few of the many acne scars treatments offered by Dr. Ghasri at Castle Dermatology in Los Angeles:


The process consists of using a high-speed tool to reemerge the cells of the skin. This helps in making the atrophic scars shallower and less visible to the naked eye. With each session, the light trauma stimulates collagen production, thereby lessening the depth of the atrophic scar. Microneedling usually takes a few sessions for optimal results.

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Chemical Peeling

Chemical Peeling involves the use of concentrated acid to peel the outer damaged skin, reducing the depth of the scars and making the skin look smooth and balanced. The use of chemicals can cause redness and exfoliation for a few days after the treatment.  There are many different types of chemical peels available based on the skin type and sensitivity.  

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Soft-Tissue Fillers

The depressions of the skin are filled by collagen or fat to help make the deep scars less visible. This treatment helps in covering the scars for a short period of time. Tissue-filling must be repeated after intervals as the skin absorbs the additional fats fading the effect of the treatment. At Castle Dermatology, Dr. Ghasri prefers to use Juvederm as a filler in treating acne scars due to the ease of molding and longevity.

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Fractional CO2 Laser Resurfacing

A multi-session treatment involves the use of laser to reduce the damaged skin layer. The dermatologist applies professional judgment on the type of laser, depending on the intensity of the scars and skin type.

This procedure carries a risk of bleeding, infection, and soreness. The patient may take several days to recover depending on the depth of the treatment.

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TCA Cross

The gold standard in the treatment of icepick scars is the TCA Cross Technique. TCA Cross is a method where high concentrated TCA Chemical peel is applied deep into the scar and the area frosts up. The TCA chemical peel will induce collagen stimulation in the ice pick scar.

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Subcision is a preferred treatment option for rolling acne scars and is often combined with filler injection or TCA cross.  Subcision is a minor in-office surgical procedure that is performed by fanning a sharp needle under the skin. The act of fanning the needle will cut off the various fibrous tissues pulling down the skin surface, thus releasing the scar and allowing it to level with the rest of the skin. If needed, there is a dermal filler injected under the scar to maintain the results by keeping the scar elevated and preventing it from tacking down again.

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Intralesional Kenalog Injection

The standard of therapy for hypertrophic thicker scars is Kenalog injections. Kenalog injections will thin out the scar and make it softer over time.