Which acne scars respond to CO₂ laser, and which need something else first?
Medically reviewed by
The LovMedSpa medical team, led by Dr. Ahmed Elsoury, MD and Mark Ennett, PhD, CRNA
Last reviewed: July 2026
Ice pick, boxcar and rolling scars have different geometry and respond to different tools. Rolling scars are tethered from below and will not lift with resurfacing alone. Assuming one laser clears a mixed scar field is the most common reason patients finish a series disappointed.
Three scar geometries, three different tools
Atrophic acne scars are not one condition. Ice pick scars are narrow, near-vertical tracts extending deep into the dermis. Fractional resurfacing softens their edges but rarely reaches the base, which is why they are typically addressed with focal chemical reconstruction or punch excision alongside a laser series rather than by laser alone.
Boxcar scars have sharp vertical walls and a flat floor. These respond well to fractional ablative resurfacing, because the goal is to blunt the wall edge and stimulate dermal collagen to raise the floor toward the surrounding surface.
Rolling scars are the ones misdiagnosed most often. The depression is caused by fibrous strands tethering the skin to deeper tissue. Resurfacing the surface of a tethered scar does very little, because the tether is still pulling. These require subcision to release the band, sometimes with volume support afterward, and only then does laser add meaningful value.
Raised scars and marks that aren't scars at all
Two further distinctions matter before anyone books a series. Raised scars are a separate pathway entirely. Hypertrophic and keloid scars are the result of excess collagen deposition rather than loss, and ablative resurfacing can aggravate them. They are managed with intralesional therapy instead.
Second, a significant amount of what patients call scarring is not scarring. Post-inflammatory erythema and post-inflammatory hyperpigmentation are flat color changes left behind by healed lesions, and both fade on their own over months. Treating them with an ablative laser is expensive, unnecessary, and in darker skin tones counterproductive.
Why a mixed scar field is sequenced, not lasered
Active acne also needs to be controlled first, and recent isotretinoin use requires a documented interval before resurfacing.
Most patients have several scar types at once. That is why an honest plan is sequenced and combined, and why a provider proposing a single modality for a mixed field is either not assessing carefully or not telling you. Realistic improvement across a full series is substantial, not total.
Common questions
Can a CO₂ laser fully remove my acne scars?
Realistic improvement across a full series is substantial, not total. Most patients have several scar types at once, which is why an honest plan is sequenced and combined rather than built on a single modality — a provider proposing one tool for a mixed scar field is either not assessing carefully or not telling you.
Do I need to stop acne treatment before laser resurfacing?
Active acne needs to be controlled first, and recent isotretinoin use requires a documented interval before resurfacing. Both are confirmed at consultation before a laser series is booked.
Are the dark marks left after acne actually scars?
Often not. Post-inflammatory erythema and post-inflammatory hyperpigmentation are flat color changes left behind by healed lesions, and both fade on their own over months. Treating them with an ablative laser is expensive, unnecessary, and in darker skin tones counterproductive.
At LovMedSpa, acne scar treatment planning is performed under the oversight of medical director Dr. Ahmed Elsoury, MD (New York and Connecticut) and Mark Ennett, PhD, CRNA (South Florida), available across our Brooklyn, Manhattan, Staten Island, Aventura, and West Farms locations. A consultation is the best way to map which scar types are present and in what order they should be treated.
This is general information, not medical advice; scar assessment and treatment sequencing are determined by a licensed provider at consultation.