Acne scars are not one problem. They are a mix of texture loss, tethering bands, uneven pigment, enlarged pores, and redness. One device rarely covers every layer. In real clinical practice, the best outcomes come from a plan that matches scar type, skin type, downtime tolerance, and risk profile—then uses the right tools in the right sequence.
At Dermablue, our highest-yield approach for most patients combines three categories: fractional CO2 resurfacing (eCO2), RF microneedling, and Lutronic ULTRA (1927 nm thulium) for texture + tone refinement. This combination targets collagen remodeling from multiple angles while helping us control downtime and pigment risk.
Start Here: What Kind of Acne Scars Do You Have?
Most acne scars fall into a few patterns:
- Ice pick scars: narrow, deep “punctures”
- Boxcar scars: wider, sharper edges
- Rolling scars: soft depressions from tethering
- Hypertrophic scars: raised scars (less common on face)
- Post-inflammatory hyperpigmentation (PIH): brown discoloration after acne
- Post-inflammatory erythema (PIE): persistent red marks
Your scar mix determines your best treatment mix.
Option 1: Fractional CO2 Laser (eCO2) — Best for Deep Texture Change
Fractional CO2 is an ablative resurfacing laser. It creates controlled micro-injuries and heat columns in skin, which drives collagen remodeling and scar edge softening. This remains one of the most effective tools for moderate-to-severe atrophic scars, especially boxcar and mixed atrophic patterns.
Why we use it:
- Strongest “texture reset” per treatment session for many patients
- Improves scar depth, pore appearance, and overall roughness
- Often becomes the anchor treatment when scars feel “etched in”
Typical course: 1–3 sessions for many patients, sometimes more for deep scarring
Downtime: commonly 5–10 days of visible recovery depending on intensity
Common short-term effects: redness, swelling, bronzing, peeling
Key risk to manage:
PIH risk rises in deeper skin tones or with sun exposure, so settings, priming, and aftercare matter. eCO2 is a Cynosure Lutronic platform designed for fractional CO2 resurfacing flexibility.
Option 2: RF Microneedling — Best for Rolling Scars and Collagen Remodeling With Less Surface Downtime
RF microneedling delivers heat through insulated or semi-insulated needles below the surface, targeting dermal remodeling while keeping more of the epidermis intact compared with ablative laser. Evidence supports meaningful improvement in atrophic acne scars with a favorable downtime profile for many patients.
Why we use it:
- Excellent for rolling scars and “soft valleys”
- Useful across many skin tones when performed thoughtfully
- Can be paired in a sequence with CO2 to improve total correction
Typical course: 3–6 sessions
Downtime: often 1–3 days of redness and mild swelling; varies by depth/energy
Key risk to manage:
RF microneedling is a medical procedure. The FDA issued a safety communication on potential serious complications reported with certain uses (burns, scarring, fat loss, nerve injury). Provider training, anatomy knowledge, device choice, and parameter discipline drive safety.
Our clinical takeaway:
RF microneedling can be high value when done by experienced medical teams using conservative, anatomically informed protocols.
Option 3: Lutronic ULTRA (1927 nm Thulium) — Best for “Finishing Work”: Tone, Texture Refinement, and Blending
ULTRA is a non-ablative fractional thulium laser (1927 nm). It creates microchannels and fractional heat zones that can improve fine texture, dyschromia, and overall skin quality with less downtime than ablative resurfacing. It is not the strongest tool for deep, tethered scars, but it is excellent for blending, tone correction, and incremental texture gains—especially when scars come with pigment issues.
Why we use it:
- Helps even tone and “polish” texture after deeper remodeling treatments
- Useful when PIH risk requires a less aggressive surface approach
- Strong option for patients wanting minimal downtime, gradual improvement
Typical course: 3–5 sessions
Downtime: usually mild redness and dryness for a few days
Best suited for: mild-to-moderate scarring, pigment issues, and refinement phases
Why Combination Therapy Usually Produces the Best Acne Scar Results
Acne scars live at different depths. CO2 addresses scar edges and surface architecture. RF microneedling targets deeper dermal collagen remodeling and tethering-related contour changes. ULTRA helps refine tone and micro-texture, which makes scars less noticeable even when depth improves modestly.
This layered strategy often produces a more natural result than overusing one modality. It also lets us dial downtime up or down across a treatment series, instead of forcing every session to be a major recovery event. Evidence supports fractional CO2 benefits for atrophic scars, and published reviews support RF microneedling as an effective modality for acne scarring.
What a Smart Treatment Plan Looks Like
Most patients do best with a phased plan:
Phase 1: control acne and inflammation (active breakouts reduce results and raise risk)
Phase 2: deeper remodeling (eCO2 and/or RF microneedling depending on scar type and skin type)
Phase 3: refinement and blending (ULTRA, targeted touch-ups, pigment-focused care)
If scars include significant tethering, we may also discuss scar release techniques as appropriate, since lasers alone cannot fully lift scars anchored by fibrous bands.
How Many Treatments Will You Need for Acne Scar Reduction?
Most patients see meaningful improvement over 3–6 months, with continued collagen remodeling for months after the final session.
General guide:
Mild scars: often 3–4 total sessions (ULTRA and/or RF microneedling)
Moderate scars: often 4–6 sessions, usually mixed modalities
Severe scars: often 6+ sessions across a longer plan, usually including fractional CO2
We set expectations around improvement, not perfection. A realistic goal for many patients sits in the 30–70% improvement range, depending on scar depth, scar age, skin biology, and plan adherence.
Downtime and “Social Recovery”
ULTRA: typically minimal, often a few days of mild redness/dryness
RF microneedling: usually a few days, sometimes longer depending on depth/energy
Fractional CO2: most downtime, commonly about 1 week or more depending on intensity
If you need low downtime, we build a plan around RF microneedling + ULTRA, then reserve CO2 for a single higher-impact session when timing works.
Who is a good candidate for acne scar treatments?
You are a strong candidate if you have stable acne control, can protect skin from sun, and can follow a structured aftercare plan.
We proceed more carefully (or choose different settings/modalities) if you have:
- Recent isotretinoin use (timing depends on dose, duration, and planned procedure)
- History of keloids or poor wound healing
- Melasma tendency or high PIH risk without capacity for strict sun avoidance
- Uncontrolled acne, picking behavior, or active dermatitis
For RF microneedling specifically, device selection and provider expertise matter because FDA has reported serious complications with certain uses.
How much does acne scar reduction cost?
Pricing varies for acne scar treatments based on device, treatment area, intensity, and number of sessions. In most markets, fractional CO2 sessions tend to cost more than ULTRA, with RF microneedling often in between.
Come in for a free consultation so we can assess your acne scarring, determine the right approach for you, and provide a pricing quote and treatment timeline.
To recap: Acne scar reduction often requires a multi-pronged approach.
If you want the best laser treatment for acne scars, do not chase a single “best device.” Chase the best plan.
Acne scarring is multi-layered, so results improve most when we combine modalities: eCO2 for deep texture remodeling, RF microneedling for dermal collagen and contour change, and ULTRA for refinement and blending.
When we match the tool to the scar type—and keep safety, skin tone, and downtime in view—patients usually get smoother texture, better tone, and a more confident look without unnecessary risk.
Dr. David LaMond
Medical Director, Dermablue
Frequently Asked Questions About Treatments for Acne Scarring
Which treatment works fastest for acne scars?
Fractional CO2 often produces the biggest single-step change in texture for treating acne scarring, with the most downtime.
Which acne scar treatment has the least downtime?
ULTRA usually wins for minimal downtime while still improving tone and fine texture.
Is RF microneedling safe?
It can be safe and effective when performed by well-trained medical professionals using appropriate devices and parameters. The FDA safety communication highlights potential serious risks reported with certain uses, so provider selection is not optional.)
Can lasers fix ice pick scars?
Ice pick scars often need targeted approaches. Lasers can soften their appearance, but deep narrow scars may need additional techniques for best correction.
