Acne Scars

Acne scars are permanent changes in the skin’s structure that remain after inflammation has healed. In cases of more severe acne, the surrounding tissue is damaged and the body forms irregular new collagen during the healing process. This results in indentations, pitting, or uneven skin texture that often do not fully resolve without targeted treatment.

In our practice, we are equipped with all relevant treatment options for both active acne and acne scars.

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Contents of this article

• What types of acne scars are there?

• Are red and brown marks after acne also scars?

• How can acne scars be treated?

• What role does the CO₂ laser play?

• What is laser subcision?

• How does classic microneedling work?

• How does radiofrequency microneedling work?

• How does fractional picosecond laser treatment work?

• What does the Cosmo Peel Forte do for acne scars?

• Are there any risks or downtime?

• When can I start treatment?

• What happens at the initial consultation?

• What costs can I expect?

• Why choose us?

• Frequently asked questions about acne scars

What types of acne scars are there?

Acne scars do not all look the same. There are three main types of sunken, so-called atrophic scars. Often several of them appear at the same time, which is why we frequently combine treatments.

Ice pick scars: Narrow, deep scars that look like small puncture marks. They reach far into the skin and are the most difficult to treat. The fractional CO₂ laser helps most here, often combined with other methods.

Boxcar scars: Wider, round to angular depressions with sharp edges. Shallow boxcar scars respond well to radiofrequency microneedling, the picosecond laser or the Cosmo Peel Forte, deeper ones rather to the CO₂ laser.

Rolling scars: Soft, wave-like depressions without sharp edges. They form because connective tissue strands pull the skin downwards. Laser subcision is particularly effective here, often combined with radiofrequency microneedling or a laser.

Raised scars, meaning hypertrophic scars or keloids, are less common and appear mainly on the chest, back and shoulders. We treat these differently, for example with cortisone injections or laser. You can find more on our scar treatment page.

Are red and brown marks after acne also scars?

Red or brown marks often remain after pimples have healed. These marks are not real scars, because the skin structure itself has not changed. Red marks are caused by dilated small blood vessels after inflammation, brown marks by increased pigment (post-inflammatory hyperpigmentation). Both often fade on their own over time, but this can take many months.

We can treat these marks specifically, for example with lasers, peels and brightening active ingredients. You can find more on our pigment spots page. Consistent sun protection helps prevent the marks from getting darker.

How can acne scars be treated?

There are various treatment options, including microneedling, radiofrequency microneedling, chemical peels (such as the Cosmo Peel Forte) and fractional laser, as well as laser subcision treatments.

What role does the CO₂ laser play?

The fractional CO₂ laser is considered one of the most effective options for pronounced acne scars. It ablates microscopic areas of skin, stimulates new collagen formation, and thereby smooths the skin texture in a lasting way.

The CO₂ laser is particularly suitable for patients with moderate to deep atrophic scars and lighter skin types. Individual consultation is essential to select the most appropriate method.

Depending on the type and severity of the scars, 2–4 sessions are usually recommended. Treatments are typically spaced several weeks apart to allow the skin to fully regenerate.

What is laser subcision?

With deep, indented acne scars, hardened connective tissue strands often pull the skin downwards. In laser subcision, we release these strands in a minimally invasive procedure directly beneath the scar. This allows the tissue to lift again, and the skin surface gradually evens out. Laser subcision is particularly suitable for rolling scars and deep, sunken scars. Dr. Johannes Bisschoff specialises in this treatment.

We often combine laser subcision with other lasers such as the CO₂ or picosecond laser, or with peels such as the Cosmo Peel Forte. This improves the depth of the scar as well as the texture and surface of the skin, leading to particularly natural results.

How does classic microneedling work?

In microneedling, fine needles create tiny channels in the skin. The skin responds with a repair process and produces new collagen and elastin. Over time, shallow acne scars and enlarged pores become finer and the skin texture more even. Microneedling is a gentle method with little downtime; the skin is usually red for only one or two days. Several sessions a few weeks apart are usually needed for a good result. For deeper scars, radiofrequency microneedling usually achieves better results.

How does radiofrequency microneedling work?

Radiofrequency microneedling combines fine needles with controlled radiofrequency energy. The needles penetrate the skin and deliver heat directly into the deeper layers, precisely stimulating collagen and elastin production. This method is particularly suitable for rolling and boxcar scars and is ideal for patients who prefer minimal downtime. After treatment, the skin is usually only mildly red for a few days. It is also one of the few options that can generally be used on darker skin types.

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How does fractional picosecond laser treatment work?

A fractional picosecond laser delivers extremely short energy pulses in the picosecond range into the skin. These ultra-short pulses create microscopic, pinpoint tissue channels (so-called micro-injury zones) without causing extensive damage to the surrounding skin. At the same time, the photoacoustic effect generates pressure waves that break up scar tissue and stimulate the body to produce new collagen and elastin. As a result, the structure, depth, and surface of acne scars improve with minimal downtime. This treatment is also considered safe for darker skin types.

What does the Cosmo Peel Forte do for acne scars?

The Cosmo Peel Forte is a strong medical peel that combines TCA, phenol and glycolic acid. It removes the upper layers of the skin in a controlled way and penetrates deep enough to significantly boost collagen production. Especially with shallower rolling and boxcar scars, uneven skin texture and pigment spots after acne, a visible smoothing is often seen after just one session. If needed, a second treatment follows after about 8 weeks. Your contact person for the Cosmo Peel Forte is Dr. Christina Spiegelfeld.

Before the peel, you prepare your skin with skincare products that we select for you during the medical consultation. This gives the skin the right pH level so that the peel works more evenly. After the treatment, the skin is red and peels for about 7 to 10 days. The peel is suitable for light to medium skin types. A Cosmo Peel Forte costs EUR 600 to 800. Since we tailor the skincare products for preparation and aftercare to your needs and skin type, they are charged separately.

For deep ice pick scars, we like to combine the peel with laser treatment or radiofrequency microneedling, because a peel alone reaches its limits there. You can find more about our treatment options for other types of scars on our scar treatment page.

Are there any risks or downtime?

After radiofrequency microneedling, mild redness and swelling can be expected for 1–2 days.
After CO₂ or picosecond laser treatments, healing usually takes 7–14 days, as crusting, redness, and a sensation of tightness may occur. Final results develop gradually over several months.
With chemical peels, downtime depends on the substance used; with modern acid combinations, it can often be reduced to just a few days.
After a Cosmo Peel Forte, the skin peels noticeably for about a week. We discuss with you in advance how to care for your skin during this time.

When can I start treatment?

Ideally, we start treating the scars once the acne has healed or is well under control. As long as new inflammation keeps appearing, new scars can form. If you still have active acne, we treat it first. You can find more on our acne treatment page.

If you are taking or have taken isotretinoin (for example Ciscutan), a long break is not necessarily required. Whether and how long you should wait is something we discuss with you individually.

For laser treatments and peels, autumn and winter are the best seasons, as the skin is sensitive to sunlight afterwards. Radiofrequency microneedling, on the other hand, is possible all year round and also well suited to darker skin types.

What happens at the initial consultation?

At your first consultation, we take a close look at your skin and your scars. We determine which types of scars are present, how deep they are and what your skin type is. Based on this, we create a personal treatment plan that also takes into account your preferences regarding downtime, season and budget. A combination of several methods is often the most effective.

We also estimate roughly how many sessions will be needed. As every skin reacts differently, we support you throughout the entire treatment and adjust the treatment plan if necessary.

What costs can I expect?

The costs of treating acne scars are very individual. They depend on the method we use, how many sessions are needed and the size of the treated area. As a guide: laser treatment usually costs between EUR 270 and 800. Radiofrequency microneedling starts at EUR 550, and the first treatment to get to know the method is available at 50% off. A Cosmo Peel Forte costs EUR 600 to 800. At the initial consultation, we discuss which treatment makes sense for you and what costs you can expect.

Why choose us?

We are proud to offer all relevant treatment options and to have extensive experience due to our high case volume. In our Vienna practice, our dermatologists and cosmetologists work closely together in an interdisciplinary approach to find the best possible solution for each patient.
The first step is a holistic initial consultation. We assess existing scars and, taking into account your skin type, preferences regarding downtime, the time of year, and of course your budget, we develop an individualized treatment plan together.

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Frequently asked questions about acne scars

Will acne scars disappear completely?
Acne scars usually do not disappear completely, but they can be improved significantly. With the right combination of treatments, scars become flatter, the skin smoother and the overall complexion calmer. How much improvement is possible depends on the type and depth of the scars.

Does the treatment hurt?
Most treatments are easy to tolerate. Before laser treatments and microneedling, we usually apply a numbing cream. With the Cosmo Peel Forte, you will feel a distinct warmth during the treatment.

How many sessions will I need?
This depends on the method and your starting point. With the CO₂ laser, 2 to 4 sessions are usually needed, while one or two are often enough with the Cosmo Peel Forte. Microneedling and radiofrequency microneedling are usually carried out in several sessions a few weeks apart. You will receive a precise assessment at your initial consultation.

Which method is suitable for darker skin?
Darker skin types have a higher risk of pigment changes. Radiofrequency microneedling and the picosecond laser are particularly well suited here. The CO₂ laser and the Cosmo Peel Forte are better suited to lighter skin types.

When will I see results?
First improvements are often visible after a few weeks, once the skin has healed. As collagen production takes time, the final result usually shows after several months. Results generally improve with each additional session.

We look forward to seeing you at our practice in Vienna. Book your appointment online here or call us: +43 1 8905040

You can find our current prices in our price list.