[Key Summary: 3-Step Combined Reconstruction Protocol for Depressed Acne Scars in Cheongju] • Step 1: Release Fibrotic Adhesions: Three-dimensionally dissect the fibrotic bands pulling scars downward using manual needle subcision and high-pressure pneumatic AirJet 2 (air subcision). • Step 2: Autologous Collagen Regeneration: Inject Juvelook (PDLLA) into the dissected space to stimulate natural collagen synthesis and help the skin restore volume from the base up. • Step 3: Surface Refinement: Smooth the texture and boundary between scars and pores by combining Praxis CO2, Sellas Evo, and V-RO 49-pin microneedle RF according to individual skin condition.
Scar treatment is a process that examines the shape, depth, color, and adhesions under the skin. For pitted scars, fractional laser or needle radiofrequency is reviewed, and red or brown marks are evaluated separately. The goal of treatment is to help dents, margins, and color differences become less noticeable. The appropriate method and degree of improvement vary from person to person. 1
01. What is the difference between acne marks and scars?
It is easy to understand treatment goals by distinguishing between marks that only remain in color and scars with changes in skin height. Sometimes both remain in the same area.
| What you see in the mirror | What to check first | Directions to consider in treatment |
|---|---|---|
| Flat red/purple marks | Remaining inflammation and vascular changes | Inflammation control, progress monitoring, treatment of vascular marks when necessary |
| Flat brown/grey-brown marks | Post-inflammatory pigmentation | UV protection, irritation management, prescription/pigmentation treatment when necessary |
| A hollow visible when exposed to light from the side | Shape and depth of depression and adhesion below | Assessing the need for fractional laser, needle radiofrequency, local treatment, etc. |
| Hard and convex part | Hypertrophic scar or keloid | Separate treatment plan to control height, itchiness, and pain |
| Lines or spots that are whiter than the surrounding skin | Reduction of pigmentation and surface changes in scars | Evaluate color and skin texture separately |
Not all red marks turn into pitted scars. Conversely, even if redness is reduced, dents may remain. Lightening the color and evening out the skin surface are two different changes. 1 2
Guide to treating acne and marks · Guide to brown marks and pigmentation
02. The approach to pitted scars also varies depending on the shape.
In medical practice, pitted acne scars are classified as follows: There are many cases where multiple shapes are mixed into one face. 3
Rolling scar: Broad, gently sunken appearance.
The skin appears undulating, like rolling hills and valleys. The fibrous tissue beneath the skin pulls on the surface. adhesionThis may be involved. We first check for adhesions, and if necessary, we review treatment to loosen them and treatment to refine skin texture.
Boxcar scar: A depression with relatively distinct edges.
It looks like a small crater with a bottom and rim. The approach for shallow and deep dents is different. Consider fractional treatment, but check whether localized treatment is necessary for deep dents or areas with clear boundaries.
Ice pick scar: a deep hole with a narrow entrance
It looks narrow and deep as if it was cut with an awl. Repeating the same laser treatment over a large area may not be sufficient, so the need for methods targeting a single scar, such as CROSS or punch treatment, is evaluated separately. Whether it is actually implemented will be confirmed at the clinic.
Even if it looks like a pore, it could be a scar. Treatment goals become clear only when pore size, sebum, and scarring are distinguished. Rather than determining the type of scar on your own, it is better to check the shape and depth at a doctor's appointment.
03. Homepage What role does equipment play in scar treatment?
‘Fractional’ refers to a method of dividing the treatment into small treatment areas rather than treating the entire skin at once. Each device has different energy delivery methods and skin reactions, so skin color, scar type, and recovery schedule are all considered when selecting a device.
Praxis — CO₂ fractional laser
We review the process to smooth out pitted scars and surface irregularities.
It creates small treatment zones in the skin and uses the tissue's reaction to realign itself during the subsequent recovery process. Adjust coverage and intensity depending on the depth and boundaries of the indentation. CO₂ Fractional is a researched method for treating acne scars, but it does not solve all deep scar pits or strong adhesions. 4
Redness, swelling, oozing, scabs, and pigment changes may occur after the procedure. In rare cases, infection or additional scarring may occur, so wound care and follow-up are required.
Sellas Evo — 1550nm non-ablative fractional laser
This is examined when looking at pitted scars and rough skin texture together.
Unlike methods that widely peel off the skin surface, it creates a small area of thermal stimulation and induces remodeling of tissue within the skin. The name ‘non-ablative’ does not mean there is no skin irritation or recovery period. 5
Redness, swelling, dryness and pigmentation may occur. In particular, please let us know during your consultation if you have experienced pigmentation remaining for a long time after a previous procedure.
VRO Advanced 49 pin needle radiofrequency — fine needle RF
It is a scar treatment option that delivers radiofrequency energy into the skin.
Energy is delivered to the target depth through a small needle and uses a reaction that reorganizes collagen, the supporting tissue in the skin. The method and purpose of use are different from ultrasonic lifting, which is introduced under the same equipment name. Depth and energy are determined according to the skin thickness and location of the scar area. 6
Pain, pinpoint bleeding, swelling, crusting and pigment changes may occur. Serious complications including burns, additional scarring, fat loss and nerve injury have also been reported with RF microneedling. It cannot be assumed to be less painful or safer than other methods in every case. 7
Piccolo Premium — DOE Fractional Picosecond Laser
This is explained in a fractional mode that examines scars and skin texture.
A special optical system is used to focus short laser energy into a small area. LIOB, as described in the study, is a phenomenon in which a subtle tissue response occurs due to strongly focused light. Methods of using this reaction to aid skin remodeling have been studied. General pigment toning and fractional scar treatment have different irradiation methods and goals. 8
Redness, swelling, petechiae, crusting, and pigmentation may occur. Just because it's picosecond doesn't guarantee better results or a shorter recovery period for all scars.
AirJet2 — Jet injection using air pressure
This is an auxiliary review method depending on the type of scar.
This method uses air pressure to deliver the solution to the skin. Related jet injection studies have observed changes in pitting scars, but the study size and observation period are limited. The cited study evaluated related technologies and did not directly verify the AirJet 2 model itself or our treatment combination. The delivered material and injection conditions also affect the results. 9
Although often described as “pneumatic subcision,” it is not equivalent to directly releasing adhesions with a needle or cannula. It should not be described as resolving every adhesion or treating deep scars on its own. Pain, bruising, swelling, bleeding, infection and reactions to the injected material must also be considered.
Auxiliary equipment for examining color and skin texture together
| Home page information equipment | Concerns we look at together | What to understand and distinguish |
|---|---|---|
| Element Vascular Laser | Remaining red marks and superficial vascular changes | This corresponds to the long pulse 532nm series information on the website. The goals of dealing with red tones and correcting dents are different. |
| Ravian | When there is both surface discoloration and rough skin texture | This corresponds to the 1927nm thulium series information on the website. It is not described as the main solution for deep adhesions or awl-shaped scars. |
These two devices are introductions to the counseling options provided on our website. The scar papers below do not directly prove the respective uses of each model and our treatment combination. Suitability is judged by considering the possibility of redness, burning, swelling, purpura, or pigment changes.
The thesis is a resource to help you choose treatment. Even within the same family, the devices, lenses, tips, settings, and research subjects are different. Research results obtained with other equipment may not be directly applicable to our equipment or to all patients.
Home page equipment introduction · Scar treatment information
04. Are there cases where treatment other than laser is needed?
yes. Pulling forces under the skin, narrow and deep scar pits, and large tissue volume loss are difficult to address in the same way. Rather than using multiple pieces of equipment, it is important to determine why you need each piece of equipment.
Adhesions and deep scar pits are evaluated separately
Subcision releases fibrous tissue pulling a scar down beneath the skin. CROSS involves applying a chemical peeling solution locally within selected scars to promote tissue remodeling, while punch treatment is a surgical approach for small scars. Suitability is assessed by scar shape; these methods are not applied to every depression. Risks include bruising, bleeding, infection, pigment changes and worsening scars. 3
This is a general guide to understanding treatment principles. The actual implementation and suitability of the method will be confirmed at the clinic, and should not be followed at home using medicine or needles.
Where is Collagen Booster/PRF located?
Collagen boosters such as Juvelook Skin on the website can be consulted separately when looking at skin texture or volume loss. The equipment studies in this guide do not translate into evidence for the effectiveness of the injectable product.
obtained from autologous blood PRFThere is also a small study using it in combination with regular microneedling treatment. However, these results alone cannot confirm the effectiveness of a specific active PRF system, PRF treatment alone, or any combination of devices. It is best to understand it as a supplementary method to determine if additional help is needed. 10
Injection procedures must take into account pain, bruising, swelling, infection, and nodules/allergies depending on the product. Procedures using autologous blood also have the potential for side effects. Risks for each product will be confirmed through separate consultation.
Active PRF principle, administration method, and paper basis · Skin Booster/Collagen Booster Guide
05. Raised scars and white scars require different approaches.
Hypertrophic scars and keloids
Firmly raised scars are distinguished from sunken scars. Hypertrophic scars usually rise within the original wound, while keloids can grow beyond the wound boundaries. Don’t decide on your own based on the shape alone, but check the growth pattern and itchiness/pain as well. 11
In this case, planning to reduce height and discomfort and manage recurrence is important. Depending on the diagnosis, silicone preparations, intralesional injections, lasers, or surgery may be considered, but the description of equipment used for pitted acne scars does not apply as is. In particular, keloids can grow again even after surgery, so concurrent treatment and follow-up may be necessary. 12
Surgical methods and post-operative care for keloids in the ear Ear Keloid Surgery GuideYou can check details here.
White linear scars and hypopigmented scars
If the scar appears whiter than the surrounding area, examine the changes in the cells that produce the color and the texture of the surface. Treatment to smooth out irregularities does not improve white color to the same extent.
Depending on the skin condition and characteristics of the scar skin graftingYou can try to improve the color difference through . SST (Skin Seeding Technique, Microskin Grafting) is a method of harvesting small skin tissue from one's own normal skin and transplanting it to a hypopigmented scar. As the graft tissue engrafts and pigment forms, it can help reduce the color difference from the surrounding skin. However, the related study is a small retrospective study, and the same results cannot be expected for all white scars. 13
The decision to transplant is made after examining the cause, location, and skin condition of the scar. After observing the progress of engraftment and pigment stabilization, additional treatment for remaining irregularities can be considered. There are individual differences in the degree of pigment recovery and recovery process, and pain, bleeding, erythema, infection, poor engraftment, uneven color, petechial bumps (cobblestones), and scarring at the area where the skin was harvested or transplanted may occur.
Related comments: SST microskin graft treatment process for white linear scars · Description of white and shiny scars and skin transplant surgery. Individual treatment progress in the blog does not guarantee results for other patients.
For scars that appear after surgery, trauma, or burns, the location, time of occurrence, and limitations in pulling or movement are also important. The acne scar research on this page does not apply to all surgical or burn scars.
06. In what order is scar treatment performed?
First Step — Check for new sores and current skin condition
If new acne repeats, scars may continue to form, so control of inflammation should be considered first. There is no need to delay your consultation until all redness is gone. However, the actual timing of scar treatment is determined based on inflammation, wound recovery status, and medications being used. 2
Step 2 — Organize the changes that bother you the most
Look for the depth of the indentation, the shadow of the border, or the red or brown color difference. Your medical team will determine treatment goals by looking at scar type, skin color, adhesions, and response to previous treatment.
Step 3 — Choose the method you need
Don't set a schedule for using all the equipment at once. For example, if adhesion is suspected, the need for it can be assessed first, and surface irregularities or remaining shade can be dealt with separately depending on the response. The order and whether to do it in parallel varies from person to person. 1
Fourth step — Comparison under the same conditions after recovery
Swelling immediately after the procedure may make the dent temporarily less visible. After redness and swelling subside, check the progress under the same lighting, distance, and angle if possible. Photos are used to aid consultation and documentation and are not a substitute for diagnosis.
Next Steps — Report Responses and Adjust Frequency and Interval
Changes in skin tissue are evaluated over time. The number of treatments and observation periods vary from paper to paper, so it is not possible to set a fixed number that applies to all. We check the degree of improvement, recovery burden, and satisfaction, and discuss whether to continue, change, or discontinue it. 1
07. What should I think about the recovery period and side effects?
The time taken for the external redness to subside and the time to evaluate changes in the scar may vary. The same equipment performs differently depending on its strength, treatment range, skin color and recovery. It is difficult to make a blanket promise that you will be able to apply makeup on the same day or go to work the next day.
| steps after treatment | What to check |
|---|---|
| Immediately after the procedure | Check the degree of heat, redness, swelling, pain, and petechiae. |
| early recovery | Depending on the presence of scabs, dryness, or oozing, you will be notified when to resume face washing, moisturizing, dressing, and makeup. |
| Afterwards | Check for persistent erythema, pigmentation/hypopigmentation changes, and new irregularities. |
| Before next treatment | Adjust treatment intervals and intensity based on recovery level and previous response. |
After the procedure, do not forcefully remove scabs or dead skin cells, but follow the wound care and moisturizing instructions. UV protection begins according to the recovery state of the skin surface, and even before that, exposure is reduced by using a hat or shade. Also check with your medical staff when to stop or resume retinoids or exfoliants. 2
If pain or swelling gets worse, or you experience blisters, pus, spreading redness, fever, dark or pale skin color, or persistent paresthesia, do not wait until your scheduled visit to contact your medical institution.
Please let us know during your consultation: Previous scar procedures and side effects, history of keloids, recent tanning, history of dermatitis, infection, and cold sores, medications being taken/applied, pregnancy/nursing status, bleeding-related diseases, and important schedules. Prescription medications should not be stopped arbitrarily.
08. Frequently Asked Questions About Scar Treatment
Although we aim to improve the depth and edges of scars to make them less noticeable, we cannot guarantee that your skin will return to its original condition. It is a good idea to first discuss possible changes and realistic goals.
There is no set answer. It depends on the type, depth, and extent of the scar, the method used, and the degree of recovery. Check for one reaction and decide on the next treatment.
Your consultation can begin now. Acne control is considered first to reduce new scars, and the timing of deep scar procedures is determined based on inflammation and skin condition.
There is no need to delay consultation just because there is redness. Check whether it is active inflammation or remaining vascular marks, and plan treatment for redness and pitting separately. Not all red marks turn into scars.
Lasers use light energy, and needle radiofrequency uses radiofrequency energy through microneedles. Both can target tissue remodeling, but their delivery methods and recovery responses are different, so the choice is tailored to the scar and skin condition.
A distinction must be made between regular pigment toning and fractional pico scar treatment using special optical systems. Even if the equipment name is the same, the mode used and treatment goals may be different.
That cannot be assumed. Pneumatic jet injection and subcision with a needle or cannula are different methods. The location and extent of adhesions help determine whether additional treatment is needed.
The role of topical medication or injection treatment is different. Changes in skin texture or tone do not equate to correction of deep structural dents. If there are deep holes or adhesions, the need for appropriate treatment is evaluated separately.
Just because it's old doesn't mean it's curable. Check the remaining dents, adhesions, color, and skin condition. However, the speed and extent of improvement varies from person to person.
It varies depending on the type and intensity of the procedure and the presence or absence of bleeding, oozing, or scabs. If you have an important schedule, please let us know during your consultation, and receive guidance on when to resume makeup and face washing based on your actual skin condition.
Pitched acne scars and treatment goals are different. A separate treatment plan is created by evaluating the height of the scar, its symptoms, and its propensity for regrowth.
It depends on the extent and depth of the scar and the method and concurrent treatments used. Please refer to the procedure information on the website and check the actual cost according to the plan during the consultation.
In everyday conversation, “Fraxel” usually refers broadly to fractional laser resurfacing that delivers microscopic thermal treatment zones. At our clinic, we differentiate ablative Fraxis (CO₂ fractional) for edge softening and surface remodeling, non-ablative Sellas Evo (1550nm Er:Glass fractional) for dermal collagen remodeling with less epidermal disruption, V-Ro 49-pin microneedle RF for targeted deep dermal radiofrequency delivery, and Piccolo Premium fractional mode according to scar cross-section and skin thickness.
Around the cheeks and nose, sebaceous-driven enlarged pores often coexist with icepick, boxcar, and rolling depressed scars. We first evaluate whether tethered zones require subcision or AirJet2 pneumatic jet delivery, and then plan staged combinations of 49-pin microneedle RF, fractional lasers, and collagen biostimulator injections (such as Juvelook) for pore elasticity and surface irregularity according to your recovery schedule.
Things to check together during consultation
Please let us know the location and appearance of the scar you are most concerned about, your experience with previous procedures, and the time available for recovery. You can distinguish between dents, discoloration, and adhesions and receive an explanation of the necessary treatment and expected discomfort.
This page provides general medical information to help you understand scar treatment. The actual diagnosis and treatment will be determined after a medical consultation. The effectiveness, number of treatments required, and recovery period vary from person to person. Depending on the procedure, pain, erythema, swelling, bruising, bleeding, scabs, infection, pigmentation/hypopigmentation, burns, and additional scarring may occur. No specific device or combination treatment guarantees the same results for all scars.
Evidence and further reading
The literature below was used to understand treatment principles and selection criteria. The subjects, devices, and settings vary for each study, so we do not directly guarantee the results of specific equipment or treatment combinations at our center.
- 1.Salameh et al. 2022. International expert consensus on energy device treatment of acne scars. Lasers in Surgery and Medicine. DOI: 10.1002/lsm.23484. View source
- 2.American Academy of Dermatology. Patient guidance on acne scar counseling and treatment. View source
- 3.Vempati et al. 2023. Review of subcision and combination approaches for atrophic acne scars. Clinical, Cosmetic and Investigational Dermatology. DOI: 10.2147/CCID.S397888. View source
- 4.Liu et al. 2024. Meta-analysis comparing CO₂ and Er:YAG fractional lasers for acne scars. Journal of Cosmetic Dermatology. DOI: 10.1111/jocd.16348. View source
- 5.Alexis et al. 2016. Efficacy and safety study of 1550 nm non-ablative fractional laser in patients with skin tone IV–VI. Dermatologic Surgery. DOI: 10.1097/DSS.0000000000000640. View source
- 6.Hendel et al. 2023. Randomized bifacial comparative study of CO₂ fractional and microneedle RF. Lasers in Surgery and Medicine. DOI: 10.1002/lsm.23655. View source
- 7.FDA. 2025-10-15. Safety notice regarding certain uses of RF microneedling. View source
- 8.Li et al. 2023. Meta-analysis on fractional picosecond laser treatment for acne scars. Journal of Cosmetic Dermatology. DOI: 10.1111/jocd.15862. View source
- 9.Kim et al. 2019. Prospective study of high-pressure pneumatic injection of atrophic acne scars. Dermatologic Surgery. DOI: 10.1097/DSS.0000000000001708. View source
- 10.Krishnegowda et al. 2023. Bifacial comparative study of combined injectable PRF and regular microneedle treatment. Dermatologic Surgery. DOI: 10.1097/DSS.0000000000003893. View source
- 11.Limandjaja et al. 2021. A review of the literature on the similarities and differences between hypertrophic scars and keloids. Experimental Dermatology. DOI: 10.1111/exd.14121. View source
- 12.American Academy of Dermatology. Patient guidance on keloid diagnosis and treatment. View source
- 13.Kim DS, Kim JC, Baek DJ, Kang HY. Successful repigmentation of hypopigmented scars with micropunch grafting with a skin-seeding technique. J Dermatol. 2024;51(11):1496–1499. DOI: 10.1111/1346-8138.17216. View source
Continue reading on the hospital blog
- Why Do Depressed Acne Scars Remain After Multiple Fractional Lasers? 3-Step Manual Subcision, AirJet 2, and Collagen Booster — Explains releasing fibrotic tethering combined with pneumatic air-subcision and collagen regeneration.
- Why Do Red Marks Persist After Acne Clears? The Golden Time for Post-Inflammatory Erythema (PIE) Before Scars Settle — Covers early red mark and scar prevention principles using a long-pulse 532nm vascular laser.
- Why acne scar treatment is difficult to complete in one session and the LIOB principle — This article is about understanding scar structure and fractional pico treatment.
- The role of PRF in acne and scar treatment and limitations of evidence — Explains the meaning of basic research, research on patients, and auxiliary treatment.
A good guide to check out together
pimple · melasma·pigmented spots·pigmentation · Skin booster/Collagen booster · lifting