Acne scars and acne marks: how they differ and how much treatment can help
Acne marks and acne scars are not the same. Red and dark marks are a change in skin color; the skin is still smooth, and most fade slowly on their own. Acne scars are skin that has sunk in and does not fill back up by itself. At Sandee Clinic, Ubon Ratchathani, the doctor first checks which kind you have, then chooses a method to match.
Thai medical licence no. ว.55040 • reviewed on 10/10/2026
English translation of the Thai page. If the two differ, the Thai version applies.
- With red and dark marks, the skin is still smooth. Most fade on their own, but it takes months.
- Acne scars are sunken skin that does not fill back up on its own. Procedures are needed to help.
- The goal is better-looking skin, not perfectly smooth skin, and it usually takes several sessions.
- Acne must be calmed down first, otherwise new spots will make new marks.
How acne marks differ from acne scars
Illustration, left to right
Run your fingers over the skin where you had acne. If the skin is smooth but the color has changed, it is an acne mark. If the skin dips into a hollow, it is an acne scar.
Acne marks
- Smooth skin, only the color differs from the skin around it
- Red marks usually fade slowly on their own
- Dark marks that are only a little darker than your skin usually fade within 6–12 months. If they are dark and deep, they may last a year or more.
- People with darker skin get dark marks more easily, and they last longer
Acne scars
- The skin sinks into a pit
- Any type of acne can leave scars, but they are common after deep acne lumps and acne that was squeezed or picked
- They do not fill back up on their own. Without treatment they usually stay that way
Types of acne scars
Illustration, left to right
Acne scars fall into 3 types by shape, and each type responds to treatment differently.
Deep, narrow pits
Small but deep holes (often called ice pick scars). They usually improve more slowly than the other types.
Sharp-edged pits
Round or oval pits with clear edges (often called boxcar scars).
Shallow, rounded pits
Wide, shallow pits that make the skin look wavy (often called rolling scars), caused by fibrous bands under the skin pulling it down.
Why acne must be controlled first
If you still have active acne, new spots will keep making new marks and scars, and many procedures cannot be done on inflamed skin.
So the doctor starts by calming your acne first, then treats the marks and scars. During that time you still need to keep using your acne medicine. Read about acne treatment on the how acne is treated page.
Care options at the clinic
There are several methods. The doctor chooses based on the type of mark, its depth and your skin tone. Not everyone needs every option.
Medicine
Used for dark marks, and to control acne so no new marks form. The doctor may prescribe a topical medicine that helps marks fade faster, together with sunscreen every day.
- Dark marks fade slowly, and the medicine must be used continuously for months.
- Without sunscreen, marks become darker and last longer.
- Some medicine groups must not be used if you are pregnant or planning to have a baby.
Fractional CO₂ program
The laser makes many very tiny holes in the skin, leaving normal skin between them.
Illustration
Used for acne scars. The laser makes many very tiny holes in the skin, leaving normal skin between them. The body makes new collagen to fill in, so the skin slowly becomes smoother.
- Usually done 2–4 times, weeks to months apart.
- Afterward, the skin is red, swollen and crusts for about 1 week. Faint redness may last another month or so.
- Results are not immediate. The skin slowly improves over several months after treatment.
- Thai skin often gets dark marks after treatment. Most fade within 3–4 months. Avoiding the sun and using sunscreen helps lower the risk.
- Other, less common risks are infection, acne flare-ups and white marks.
Fractional RF and Microneedle RF programs
The device sends radiofrequency waves to create heat under the skin.
Illustration
Also used for acne scars. The device sends radiofrequency waves to create heat under the skin, which prompts the skin to make new collagen. The clinic’s device can be used both without needles (Fractional RF) and with needles (Microneedle RF). The doctor chooses based on the type of scar and your skin tone.
- Can be used on all skin tones, and causes fewer dark marks after treatment than laser, but not none at all.
- Usually done 2–4 times, sometimes more, about 1 month apart.
- Afterward, the skin is red for about 1 day, longer for some people. There may be tiny bleeding spots or slight bruising.
- Results are clearest about 3–6 months after starting.
Subcision
The doctor inserts a needle under the skin to cut the fibrous bands pulling the skin down.
Illustration
Used for shallow, rounded pits held down by fibrous bands. The doctor injects a local anesthetic, then inserts a needle under the skin to cut the bands pulling the skin down. The skin lifts up, and the body makes new collagen to fill in underneath.
- Does not work well on deep, narrow pits.
- Usually done 3–6 times, at least 1 month apart.
- Afterward there will be bruising, swelling and tenderness, which is normal for this method.
- Risks to know about are hard lumps under the skin, raised scars, infection and temporary dark marks.
- Not suitable for people who bleed easily or take medicine that affects blood clotting.
Microneedle
Small needles make tiny holes in the skin, without heat, to prompt the skin to make new collagen.
- Suits shallow pits and uneven skin, and can be used on all skin tones.
- Little downtime, with slight redness for a short time.
- Results come gradually, usually over several sessions about 1 month apart. Compared with other methods, this one has the smallest effect on acne scars.
TCA CROSS
The doctor applies concentrated TCA acid to a single spot inside deep, narrow pits. It suits some types of pits. The doctor assesses you first, and in some cases it is done together with Microneedle.
Filler and meso injections for acne scars
A filling substance is injected into the scarred area so the pits look shallower. You see a change after treatment and there is no downtime, but injections alone give temporary results, so they are usually used with a main method. They must be done by a doctor.
Q-Switch program
The laser gives very short pulses of light that break pigment into smaller pieces.
Illustration
Used for dark marks. It is a laser that gives very short pulses of light, breaking pigment into smaller pieces.
- There is not much evidence that it works directly on dark acne marks, so it is usually used when medicine and sunscreen are not enough.
- It takes several sessions. The doctor sets the number and spacing for each person.
- Treating too often or too many times risks small white spots on the skin, which are hard to treat, so the doctor must space sessions out and limit their number.
- Marks may darken again, especially with sun exposure.
Results vary from person to person.
Which mark usually gets which method
This table is only a rough guide. The doctor must always see your actual skin first.
| Type of mark | Usual approach |
|---|---|
| Red marks | Sunscreen and letting them fade on their own, along with acne control |
| Dark marks | Mainly topical medicine and sunscreen. Some cases add a Q-Switch program. |
| Shallow, rounded pits | Subcision, possibly with Fractional RF or Fractional CO₂ |
| Sharp-edged pits and deep, narrow pits | Fractional CO₂ or Fractional RF. The doctor chooses based on depth and skin tone. Deep, narrow pits improve more slowly than the other types. |
Comparing heat-based and needle-based methods
A summary from research (see the sources below the table) to show the rough differences. The doctor chooses a method based on your type of scar and skin tone.
| Method | How it works | Usually used for | After treatment |
|---|---|---|---|
| Microneedle | Small needles make holes in the skin, without heat | Shallow pits, uneven skin, all skin tones | The least downtime, slight redness for a short time |
| Fractional CO₂ | A laser makes very small dot-like wounds so the skin repairs itself | Moderate to deep pits | Crusting and redness for about 5 days. You must avoid the sun. Higher risk of dark marks, especially on darker skin. |
| Microneedle RF | Small needles deliver radiofrequency heat under the skin | Wide pits with rounded or sharp edges, darker skin, people who cannot take time off work | Most people can go back to work the next day. Lower risk of dark marks than CO₂. |
| Needle-free Fractional RF | Small electrode points send heat through the skin into deeper layers | Uneven skin, shallow pits, sagging skin | Redness for a short time. There are still few head-to-head studies. |
Deep, narrow pits respond less to every method than the other types. Most people have several types of pits mixed together, so several methods are often used together.
Sources: Treatment of scars (Plast Aesthet Res, 2020) • Microneedling in All Skin Types (J Drugs Dermatol) • A review comparing Fractional CO₂ and Microneedle RF (EMJ, 2026) • Treatment results in darker skin (J Cutan Aesthet Surg) • Results vary from person to person.
What to expect
This is worth knowing before you start, so you are not disappointed later.
- Treatment helps acne scars become shallower and look better, but it does not make the skin perfectly smooth as if you never had them.
- No method is done in one session. Most people need 3 or more sessions.
- Results come slowly, because you have to wait for the skin to make new collagen. It is measured in months.
- Many people get better results when more than one method is used together.
Results vary from person to person.
What to tell the doctor before treatment
Some of these may mean postponing treatment or switching to another method.
- You are pregnant or breastfeeding.
- You still have inflamed acne, or the skin there is infected.
- You have had keloids or raised scars.
- You have had cold sores on your lips. The doctor may give preventive medicine before laser.
- You have recently tanned from the sun.
- The medicines you take, and every acne medicine you have used in the past 2 years.
- You bleed easily or take medicine that affects blood clotting.
For patients under 18, the doctor decides case by case, and a parent or guardian joins in hearing the treatment plan.
Skin care after treatment
Use sunscreen every day and avoid strong sun.
Illustration
The time after treatment matters as much as the day of treatment, especially when it comes to the sun.
- Use SPF 30 or higher sunscreen every day, and avoid strong sun for about 6–8 weeks.
- Do not pick or scratch the crusts. Let them fall off on their own.
- Use only the medicines and creams the doctor prescribes.
- Come to your appointments, even if your skin looks better.
Costs
Costs depend on the method, the size of the treated area and the number of sessions. See the price of each method on the prices and promotions page.
The doctor will give you a plan and a rough cost after examining your skin. For a first estimate, ask on LINE @sandeeclinic or call 087-491-6969.
Frequently asked questions
Can acne scars go away on their own?
Acne scars do not fill back up on their own, unlike red and dark marks where the skin is still smooth, which mostly fade slowly on their own. Have the doctor check whether you have marks or scars, because they are cared for differently.
How many months do dark acne marks take to fade?
Dark marks that are only a little darker than your skin usually fade within 6–12 months. If they are dark and deep, they may last a year or more. Using sunscreen every day and not picking your acne helps stop marks getting darker.
How many sessions does acne scar treatment take?
It depends on the method and how deep the scars are. Most people need several sessions. In general, Fractional CO₂ and Fractional RF are done 2–4 times, and Subcision 3–6 times, about 1 month apart. The doctor will tell you your plan after examining your skin.
Will my face get darker after laser for acne scars?
Thai skin often gets dark marks after laser. Most fade within 3–4 months. Avoiding the sun and using sunscreen every day helps lower the risk. If you are worried about this, tell the doctor, who may choose a method with a lower risk of dark marks.
I still have acne. Can I start acne scar treatment now?
Acne should be calmed down first, because new spots make new marks and many procedures cannot be done on inflamed skin. The doctor will treat your acne first, then start caring for the scars.
Will my skin be perfectly smooth after acne scar treatment?
Treatment helps scars become shallower and look better, but it does not make the skin perfectly smooth as if you never had them. Results come slowly over several months, and results vary from person to person.
Can I send photos of my acne scars on LINE before I come?
Yes. Our staff will give first advice and help book a day to see the doctor. Diagnosis and treatment planning are done by the doctor after an exam at the clinic.
Let the doctor assess you before choosing a treatment
Sandee Clinic Ubon–Trakan Road, Mueang Ubon Ratchathani • Open 11:00–20:00 · Closed on Tuesdays
This page is general information and does not replace an examination by a doctor • Results vary from person to person
