Can Laser Really Fix Acne Scars? A Dermatologist’s Honest Answer – by Dr Anjali Mahto, London Dermatologist
Acne scarring is not superficial. While its visible effects lie at the skin’s surface, its emotional impact often runs far deeper. Many of the patients we see at Self London are not driven by vanity or perfectionism. They are seeking to draw a line under an era, to make peace with their skin after years of inflammation, breakouts, and the psychological toll of acne.
Most have already tried multiple treatments. Some were told their scars were “not bad enough” for laser, others underwent resurfacing with limited results. Many arrive with the same question: can anything actually help?
This guide exists to answer that question with honesty, science, and strategy. Because the right laser, in the right hands, can transform not only the skin’s surface, but the way a person feels in it.
What Are Acne Scars and Why Are They Difficult to Treat?
Acne scars are not all the same. This is where most treatment failures begin. Unlike pigmentation or redness, acne scarring refers to structural damage within the dermis, the second, deeper layer of skin. When inflammation from acne is severe, particularly with nodules or cysts, it can destroy the normal collagen architecture. The result is disorganised healing: fibrotic bands, dermal thinning, and uneven skin texture.
The most common scar types include ice pick scars, which are narrow, deep, and often resistant to superficial treatments. Boxcar scars present as wide, sharply defined depressions that catch the light and create shadowing. Rolling scars are soft, undulating, and caused by fibrous tethering. Macular atrophy is a form of diffuse thinning often described as porous or papery skin. Treating these requires more than just resurfacing the surface. It demands a layered, strategic approach, one that addresses both the depth and character of the scarring, as well as the biology of the skin it affects.
What Can Laser Actually Do?
Laser treatment for acne scarring works by stimulating controlled injury in the dermis, not to damage, but to encourage remodelling and repair. Ablative lasers, such as the erbium:YAG and UltraClear, remove precise columns of damaged skin, triggering fibroblasts to produce new collagen and elastin.
Over time, this process can lead to smoother skin texture, shallower scars, more even light reflection, and a general improvement in tone and pore appearance. Importantly, this is not instant. Collagen takes three to six months to remodel after treatment, and sometimes longer. Peer-reviewed studies confirm that fractional laser therapy leads to progressive dermal restructuring, particularly in rolling and boxcar scars.
Even the best lasers cannot return scar tissue to its original, uninjured state. Scars will never completely disappear. But when treated correctly, they can become less visible, less textured, and far easier to live with. In clinical terms, a 50 percent improvement is considered an excellent result. That often equates to a visible difference in how a patient sees themselves.
Why Results Vary Between Clinics
Two patients with similar scars may have vastly different outcomes depending on how and where they are treated. At Self London, we do not take a laser-first approach. Every patient begins with a full dermatology consultation, which includes assessment of scar types, density, and depth; evaluation of skin tone, biology, and healing response; a check on whether active acne is still present; and VISIA skin imaging before any treatments. We also look at your overall health and nutritional status and aim to optimise wound healing.
We then build a staged treatment plan, not just a procedure. This may include multiple laser modalities, regenerative preparation, topical agents, and post-laser care. In some patients, we delay resurfacing altogether, opting to first prime the skin, improve barrier function, or address redness with vascular laser.
The Role of Skin Priming Before Laser
This step is often overlooked but can make a significant difference in outcomes. At Self London, we routinely use regenerative treatments such as polynucleotides to prepare the skin before laser. These biostimulatory agents improve dermal health, support fibroblast activity, and enhance the skin’s ability to repair after controlled injury.
In patients with dry, inflamed, or biologically fatigued skin, laser may not deliver optimal results unless this groundwork is done first. Clinical rationale includes the ability of polynucleotides to increase growth factors and antioxidant activity. They also help reduce pro-inflammatory cytokines. Priming improves post-laser healing and reduces downtime. This approach reflects a broader philosophy: laser should not be the first thing we do, it should be the most effective thing we do, when the skin is ready.
A Closer Look at the Lasers We Use
Erbium:YAG lasers are ideal for ablative resurfacing due to their precise water absorption and limited thermal damage. At Self London, we use both ProFractional (fractional ablative) and Contour TRL (full-field resurfacing) depending on the scar type and skin condition. Benefits include reduced risk of post-inflammatory pigmentation and erythema (redness), shorter healing times compared to CO2, and the ability to adjust depth and coagulation to balance safety and results.
UltraClear is a 2910nm cold ablative fibre laser, delivering high-impact results with minimal thermal injury. Its short pulse duration allows for clean ablation without excessive heat, making it especially valuable for Fitzpatrick skin types IV to V, diffuse atrophic or macular scarring, and in patients seeking meaningful results with minimal risk. Clinical studies show quicker re-epithelialisation, reduced redness, less discomfort, and high patient satisfaction when UltraClear is used alone or in combination.
Laser coring is a precise device technique, not a setting. Using our UltraClear, we can physically remove the walls of deep ice pick scars, creating a cleaner margin and triggering remodelling in a way no topical or filler can achieve. This treatment requires extreme care, experience, and understanding of laser-tissue interaction. It is not routinely offered in most clinics.
Combination Treatment: Tailoring to the Skin
Few patients improve significantly with a single device. This is why our acne scarring pathways often include layered interventions. Examples include polynucleotide priming followed by laser coring to ice pick scars, fractional erbium:YAG or UltraClear for boxcar or rolling scars, and pore improvement. Adjunctive BBL or ClearSilk laser may be used for vascular or pigmentary elements, and maintenance with polynucleotides or further fractional sessions is often advised over time.
This holistic approach aligns with what the scientific literature supports, that acne scars are not one thing, and so treatment must not be one-size-fits-all but more multi-modality.
Frequently Asked Questions About Laser for Acne Scars
Can I have laser if I still get breakouts?
Only if acne is well-controlled. Active breakouts can impair wound healing and increase the risk of post-inflammatory pigmentation. At Self London, we prioritise inflammation control before any laser treatment. If needed, we may use AviClear, spironolactone, or topical regimes in the interim.
What is the best age to treat acne scars?
There is no best age, but collagen remodelling is typically more efficient before age 40. However, excellent results can still be achieved later, particularly when combined with regenerative therapies. The longer scars remain untreated, the more deeply they can anchor in the dermis. Acne scarring often tends to look worse as we age due to overall collagen loss as part of the chronological ageing process.
Can acne scars come back after laser?
Scars do not return, but new ones can form if acne is not controlled. Maintenance skincare and hormonal management may be necessary for long-term success.
Do results last forever?
Collagen induced by laser is long-lasting but not immune to ageing. Skin continues to change with time, sun exposure, and hormonal shifts. Maintenance treatments may preserve results. This will of course depend on the extent and severity of scarring.
Timing, Downtime, and Maintenance
Most patients will require between two and four treatments, spaced six to twelve weeks apart, depending on the device and severity of scarring. Downtime varies: UltraClear has an approximate recovery time of five days; ProFractional Er:YAG requires five to seven days; Contour TRL, used for full-field resurfacing, may require up to ten days or more, depending on depth.
Post-laser support may include regenerative injectables, emollient wraps, and topical exosomes. At Self London, all aftercare is supervised medically and reviewed at follow-up. We also advise long-term maintenance. Even once scars have improved, the ageing process continues — and so does collagen loss. Annual touch-ups or supportive treatments such as polynucleotides, fractional laser, or skin boosters may be advised for sustained results.
Debunking the Myths
One common question is whether patients need to wait six months post-isotretinoin to have laser. In the past, guidelines recommended a six-month delay due to concerns around poor wound healing. However, multiple peer-reviewed studies now confirm that fractional ablative laser is safe when performed under proper clinical supervision, even during low-dose courses. At Self London, we assess skin quality and healing potential, not simply the time off medication.
Another concern relates to darker skin types. We routinely treat Fitzpatrick types IV to VI using erbium:YAG and UltraClear, both of which offer low thermal profiles. CO2 lasers are generally avoided due to increased pigmentary risk. We also use pigment-prevention strategies such as pre-conditioning, anti-inflammatory topicals, and tailored aftercare to minimise risk.
We prefer not to use CO2 lasers due to their higher risk of prolonged redness and hyperpigmentation. While they can be effective, erbium:YAG and cold fibre lasers now offer equivalent results with better safety. They also allow for fine-tuned control over depth and energy delivery. Our devices can dial-in heat energy similar to a CO2 laser, if it is felt necessary.
Scientific Insight: Why Collagen Remodelling Matters
Data has highlighted the role of fractional ablative lasers in inducing neocollagenesis and elastin production. Biopsies taken before and after treatment confirmed measurable increases in dermal collagen density, validating what experienced clinicians have long observed: real tissue remodelling is possible, and cumulative sessions compound this effect.
Other clinical studies note that scar texture improved more in patients who received combination treatment than those who received laser alone. This underpins our strategic model: treat the person, not the scar.
Why We Do Not Offer Scar Packages
Acne scar treatment is not a commodity. It cannot be delivered via pre-paid packages, influencer codes, or cookie-cutter settings. At Self London, every treatment is designed based on objective imaging, clinical experience, laser physics, and long-term outcomes. Patients are not upsold. They are educated, supported, and offered a plan based on integrity. This is what distinguishes doctor-led care from aesthetic marketing.
Conclusion: Can Laser Fix Acne Scars?
Laser does not erase scars. But it can transform them.
With expert diagnosis, the right tools, and realistic expectations, most patients will see meaningful, visible, and sustained improvement. The goal is not perfection — it is progress.
At Self London, we specialise in this type of work. Our clinic is equipped with world-class resurfacing technologies, regenerative skin science, and a philosophy rooted in honest, evidence-led care.
If your scars are holding you back, we are ready when you are.
