Why treating depressed acne scars hurts and how long recovery takes

"Doctor, I heard scar treatment hurts a lot and stays red for a long time?" This comes up often in acne scar consultations. Many people have been bothered by their scars yet kept putting treatment off for years, telling themselves they would do it when they had time.

It is true that it hurts. Whether it stays red for long depends on which treatment you have.

"I've had laser so many times, why does it look the same?" People who have had several laser sessions ask this often. A depressed scar looks like a hole from the outside, but underneath, the floor of the scar is often held down by the tissue below.

As acne inflammation heals, tough fibers form and pull the skin downward. Even after many sessions of laser that only smooth the surface, if the band holding it is still there, the scar stays too. So the tissue holding the scar is released first, and the skin is then allowed to fill in.

Even if you come in because a scar bothers you, whether that spot is really a depressed scar or a leftover colour mark has to be checked separately. So the light is moved to different angles to tell depressed scars from colour marks first. A colour mark is a surface colour problem, and treatment that releases tissue holding a scar does not suit it.

If acne is still coming up, scar treatment is put off and that is calmed first. If inflammation remains, new scars can form even while the old ones are being treated.

People who have put treatment off because they heard it hurts are not told it does not hurt. RF microneedling (Potenza type), often used for scars, tends to hurt more than laser. For scars an insulated tip is used, with the electrode exposed only at the needle tip. Instead of spreading heat widely, it gathers heat at one point at scar depth and coagulates strongly, so the stimulus is greater.

So numbing cream is applied well, and deep and shallow parts of the scar are separated with the strength set for each. Spreading stimulation within what the skin can recover from works better than one strong pass. The pain is reduced, not removed.

"Is one session enough?" This is the most common question. Collagen fills in slowly over months after treatment, so a scar does not come all the way up after one session. Somsei Clinic plans scar treatment as a set of three sessions.

A 2025 study from Thailand followed 397 people who had at least two scar treatments for six months. Their skin tones were similar to Koreans; 254 had fractional laser and 143 had RF microneedling. At six months, the share whose scars improved by a quarter or more was 88.1% with RF microneedling and 71.9% with laser (Life (Basel) 2025 · PMID 41010320).

These numbers do not mean the scars disappear. The threshold is a quarter or more improvement, so scars still visible count too. It looked back at past treatment records, and the difference between the two treatments was not large enough to be statistically certain. Pain scores were clearly higher with RF microneedling.

"What if people at work can tell?" This worry comes up a lot too. Potenza does not shave the skin surface, so there is no separate period of scabs forming and falling off. Afterwards there is sunburn-like redness, which mostly settles in a day or two.

Soothing care follows right after treatment, so you leave once the heat has calmed. On the day, please avoid saunas, hard exercise and alcohol. If redness and dryness remain when the next session date comes, that session is postponed. Layering stimulation on skin that has not recovered only leaves it sensitive for longer. If you are flying home, plan the next session date with this in mind.

"After laser my face actually got blotchier." People who have had dark pigmentation after scar treatment worry about this a lot.

RF microneedling does not target melanin, the pigment that gives skin its colour; it delivers heat to the dermis under the surface, so the burden is relatively low even for darker skin tones. In the Thai study above, pigmentation was also rare and did not differ much between laser and RF microneedling. Rare does not mean it never happens, so sun protection needs more care than usual during the treatment period.

Even a single scar has surface texture, a band holding it, and empty dermis together. So it is not handled with one device; the layers are taken in order and done one after another in a single visit.

• Plasma toning to smooth the skin surface
• Subcision to release the tissue holding the scar
• Potenza to help the dermis fill in
• PDRN and soothing care to support recovery

At each session, which scars have come up and by how much is checked one by one together with the patient.