Can Rolling Acne Scars Be Removed?

If you have tried creams, salon microneedling or peels and your rolling scars have not changed much, there is usually a reason. It comes down to how rolling acne scars form, and understanding this makes the options clearer.

At Eve Clinics, we regularly treat acne scarring using a combination protocol, view our scar removal treatment page that addresses the underlying cause rather than just the surface. In this guide, we’ll explain exactly what rolling acne scars are, why they behave differently to other scar types and what the evidence says about the main treatment options for rolling acne scars in the UK.

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What Are Rolling Acne Scars, and Why Are They Different?

Not all acne scars are the same. The three main types, rolling, boxcar and ice-pick, have different structures beneath the skin, which is why they respond differently to treatment. Rolling scars are arguably the most misunderstood and most undertreated of the three.

Rolling scars form when fibrous bands of scar tissue develop beneath the skin, anchoring the surface skin down to the deeper tissue layers. These bands physically tether the skin, pulling it inward and creating the characteristic undulating, wave-like depressions that shift and move when you stretch the skin sideways. This is the key distinguishing feature of a rolling scar, and it is also the key to understanding why many standard treatments have limited effect.

Creams, serums and surface-level treatments cannot reach these fibrous bands. They sit below the dermis, often extending into the fat layer beneath. No amount of retinol, vitamin C or even standard microneedling will break them down. The tether remains and the shadow remains with it.

Scar Type	Appearance	Cause	Why Surface Treatments Fail	Often treated with
Rolling Scars	Broad, wave-like, shallow-to-medium depth. Surface moves when skin is stretched sideways.	Fibrous bands tethering skin to subcutaneous tissue beneath.	The band sits below the dermis, topicals and surface lasers cannot reach it.	Subcision to release the band + CO2 laser to remodel collagen above.
Boxcar Scars	Round or oval depressions with sharply defined, vertical edges. Shallow to deep.	Collagen destruction leaving a flat-bottomed pit with steep walls.	The defined walls need remodelling, not just stimulation.	CO2 laser resurfacing, plus punch excision for deeper variants.
Ice-Pick Scars	Narrow, deep, V-shaped channels extending into the dermis. Like a pin-hole.	Severe follicular inflammation creating a narrow tract of destruction.	Too narrow and too deep to be remodelled by laser or needling alone.	TCA CROSS chemical reconstruction, punch excision, followed by laser resurfacing.

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Why Many Treatments Fall Short for Rolling Scars

This is the question we hear most from new patients: “I’ve already spent thousands on treatments that didn’t do much, why would this be different?” It’s a fair question and it deserves an honest answer.

The majority of treatments marketed for acne scarring, salon microneedling, medium-depth chemical peels, LED therapy, high-street laser facials, work at the level of the epidermis and upper dermis. They stimulate some collagen remodelling and improve skin texture and tone. For mild surface scarring, they can be genuinely helpful.

But rolling scars are not a surface problem. The fibrous bands that create them sit in the deep dermis and subcutaneous layer, well below where these treatments reach. Stimulating collagen above the tether without releasing the tether itself is a bit like redecorating a ceiling while the floor beneath is still pulling it down. You might see a slight improvement, but the fundamental problem remains.

Two treatments that work on the structure of the scar are subcision (which releases the fibrous band) and ablative CO2 laser resurfacing (which remodels collagen above). Used in combination, they address the problem from both directions simultaneously. Published studies suggest that combining the two may give better results than either treatment alone for many patients.

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The Eve Clinics Approach: Subcision + CO2 Laser

Our combination protocol for rolling acne scars is built around two core interventions, sequenced and calibrated individually for each patient. We do not operate from a set menu of sessions, the protocol is designed around your specific scar type, depth, distribution, skin tone and history.

Step 1: Subcision: Releasing the Tether

Subcision is a minor surgical procedure done under local anaesthetic. A fine needle or cannula is placed beneath the skin at the base of each scar and moved gently to release the fibrous bands anchoring the scar to the tissue below. Once the band is released, the surface skin is free to rise, and the body’s natural wound-healing response floods the area with new collagen to fill the space left behind.

Subcision alone can produce meaningful improvement in rolling scars, but the collagen produced in the healing response tends to be irregular and insufficient to fully correct deeper depressions. This is where CO2 laser becomes critical.

Step 2: CO2 Laser Resurfacing: Remodelling From Above

Following subcision, we use the DEKA SmartXide CO2 laser to treat the skin surface. The laser creates precise microscopic columns of controlled thermal injury, triggering a structured collagen remodelling cascade in the dermis. This new collagen may help to soften and smooth the scar depression from above, while subcision has released it from below. Combining the two may work better than either treatment alone for many patients, because it treats the scar’s structure at both levels.

For particularly deep rolling scars, we may add other skin treatments between sessions, for example microneedling. We will discuss this at consultation.

How Many Sessions Will I Need?

This varies significantly between patients and is something we discuss in detail during your consultation. Your plan will depend on your skin and how it responds. As a general guide:

• Mild rolling scarring: often 1 or 2 sessions of subcision and CO2 laser, spaced 3 to 4 months apart
• Moderate rolling scarring: often 2 or 3 sessions, spaced 3 to 4 months apart, sometimes with other skin treatments in between
• Severe or longstanding rolling scarring: may need 3 or 4 sessions over 12 to 18 months, with a plan that combines treatments

We always space sessions a minimum of 3 months apart to allow the collagen remodelling triggered by each treatment to mature fully before reassessing. Treating too frequently interrupts the healing process and reduces the cumulative benefit.

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How Common Rolling Scar Treatments Compare (General Guide)

Treatment	Reaches Fibrous Band?	Collagen Remodelling	Often used for	Typical downtime
Subcision + CO2 Laser	Yes, releases band + resurfaces	Deep + surface, dual layer	Rolling scars, mixed scarring	7 to 12 days
CO2 Laser Alone	No, surface remodelling only	Strong, upper-to-mid dermis	Boxcar, surface texture, mixed mild	7 to 10 days
RF Microneedling	No	Good, mid dermis via RF heat	Mild-moderate rolling, skin tightening	3 to 5 days
Salon Microneedling	No	Moderate, upper dermis only	Mild surface texture, skin tone	1 to 3 days
Chemical Peels	No	Moderate, epidermis/upper dermis	Pigmentation, mild surface texture	5 to 7 days
Topical Retinoids	No	Mild, surface cell turnover only	Post-inflammatory pigmentation, maintenance	None

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What to Expect: Recovery After Subcision and CO2 Laser

The figures in the table above are typical ranges, and your own recovery and results will vary. Because our acne scar protocol combines two procedures, recovery takes longer than after CO2 laser alone. Possible risks include bruising, swelling, small lumps under the skin, infection, prolonged redness, changes in skin colour and scarring. We will talk you through these in full at your consultation.

Immediately After Treatment

The subcision sites will feel bruised and tender and you will likely experience some swelling, particularly in the first 24–48 hours. The CO2 laser component means the skin will also be red and hot, similar to a significant sunburn. Both of these are normal and expected responses.

Days 1–3

Swelling and bruising from the subcision peaks in this window. The skin will begin to bronze as the surface healing process begins. Plan to be at home during this period. Apply your prescribed aftercare balm as directed and avoid touching or examining the skin too closely, the urge to assess progress at this stage is understandable, but the appearance at day 2 is no indication of the final result.

Days 4–7

Bruising fades. The surface skin will begin to peel as the laser-treated layer sheds. The swelling from subcision will have significantly reduced and you may begin to see early lifting of the scar depressions, though this is often partially masked by the residual surface healing. Most patients are comfortable with remote working from day 5 with camera off.

Days 7–10

For many patients the surface has healed by around day 7 to 10, and the new skin often feels smoother. There will be a pink or rosy flush to the skin that mineral makeup can cover comfortably. Many people feel ready to go out and return to work in person by around day 8 to 10, although this varies.

Months 1–6

This is where the real results develop. The collagen remodelling triggered by the laser, combined with the new collagen generated by the body to fill the subcision space, matures progressively over three to six months. Most patients notice the most significant visible improvement between month two and month four. We schedule a review appointment at this stage to assess progress and plan any further sessions if needed.

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Is This Treatment Right for My Skin Tone?

This is a question we take seriously. Darker skin tones (Fitzpatrick IV–VI) carry a higher risk of post-inflammatory hyperpigmentation (PIH) with ablative laser treatments, meaning the treatment itself can sometimes worsen pigmentation if not performed with care and expertise.

At Eve Clinics, we do not take a one-size-fits-all approach. For patients with Fitzpatrick IV–VI skin, we:

• Perform a thorough skin tone assessment at consultation, including Fitzpatrick typing and PIH risk evaluation
• Adjust the DEKA SmartXide laser settings, for example using lower density and energy, to reduce the risk of pigmentation changes. This may mean more sessions are needed
• May recommend preparing your skin for 4 to 6 weeks before treatment to reduce PIH risk, which we discuss at consultation
• Start conservatively and build gradually across sessions, reviewing response at each stage

We will always be honest with you if we feel the risk profile for your skin tone makes ablative laser inadvisable. In some cases, another approach may suit your skin better, with a lower risk of pigmentation changes. The right answer for your skin is the one we discuss together at consultation, not a decision made before we’ve seen you.

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Adult Acne Scarring: Can Older Scars Still Improve?

A significant proportion of the patients we treat for rolling acne scars have carried them since their teens or twenties, sometimes for decades. A common concern is whether scars that have been present for many years are still treatable or whether the window for improvement has passed.

The answer is often reassuring. Older acne scars can still respond to combination treatment. The fibrous bands that cause rolling scars are usually still there to be released, whether they formed five years ago or thirty. The collagen response to CO2 laser can vary with age and how your skin heals. Older scars can still respond well, and we will assess your suitability at consultation.

Whatever the age of your scars, we will talk through realistic goals with you at consultation.

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Frequently Asked Questions

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Treating Acne Scarring Across Warwickshire and the Midlands

Eve Clinics is a specialist medical aesthetics clinic based in Leamington Spa, Warwickshire. We see patients with acne scarring from across the Midlands, as well as people travelling from further afield.

At your acne scar consultation, our clinical team will examine your scarring in detail, map your scar types and build a treatment protocol designed specifically for your skin. There are no packages, no upselling and no commitments required at consultation. Just an honest clinical conversation about what’s achievable and what the right path forward looks like for you.

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References

1. Orentreich DS, Orentreich N. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatologic Surgery. 1995;21(6):543–549. doi:10.1111/j.1524-4725.1995.tb00259.x
2. Ahramiyanpour N, et al. Subcision in acne scarring: A review of clinical trials. Journal of Cosmetic Dermatology. 2023;22:744–751. doi:10.1111/jocd.15480. PubMed PMID: 36315903
3. Sun N, et al. Complications of Subcision for Acne Scarring: Experience from Clinical Practice and Review of the Literature. Journal of Cosmetic Dermatology. 2025. doi:10.1111/jocd.16629. PMC11743319
4. Harrysson A, et al. Subcision for Atrophic Acne Scarring: A Comprehensive Review of Surgical Instruments and Combinatorial Treatments. Journal of Cutaneous Medicine and Surgery. 2023. PMC9868281
5. Saedi N, Jalian HR. Laser Carbon Dioxide Resurfacing. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. NBK560544
6. Varani J, et al. Connective tissue remodeling induced by carbon dioxide laser resurfacing of photodamaged human skin. Archives of Dermatology. 2000. PubMed PMID: 15545540
7. Goodman GJ, Baron JA. Postacne scarring, a qualitative global scarring grading system. Journal of Cosmetic Dermatology. 2006;5(1):48–52. doi:10.1111/j.1473-2165.2006.00222.x
8. Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Archives of Dermatology. 1988;124(6):869–871. doi:10.1001/archderm.1988.01670060015008

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This article is written for informational purposes and does not constitute medical advice. Always consult a qualified clinician before undertaking any medical treatment.