Treating Acne Scars: Microneedling, Radiofrequency and Lasers

Treating Acne Scars: Microneedling, Radiofrequency and Lasers

Acne can clear up and still leave its mark. If your breakouts have calmed down but your skin’s texture hasn’t bounced back, you’re probably looking at scars rather than active acne, and that difference changes everything about how we treat it. The encouraging news: modern, in-office treatments can genuinely smooth acne scars. The honest part: it takes the right tool for your scar type, usually more than one session, and realistic expectations. Here’s the plain-language guide, backed by the research.

First, let’s separate two things people often blur together. Active acne is inflammation happening right now: clogged pores, pimples, redness. Scars are the structural changes left behind after it heals. Resurfacing scars while acne is still flaring can make things worse, so step one is always getting breakouts under control. Then we treat what remains: texture (the dents) and color (the marks).

Most acne scars are atrophic, meaning they sit below the surrounding skin, and clinicians sort them into three shapes that respond differently to treatment.¹

• Ice-pick scars are narrow and deep, like a tiny puncture. They’re the most stubborn.
• Boxcar scars are wider with sharp, well-defined edges, like a small crater.
• Rolling scars are broad and shallow with a gentle, wave-like surface, caused by tethering bands pulling the skin down from underneath.

Separately, many people, especially those with deeper skin tones, also have post-inflammatory hyperpigmentation (PIH): flat brown or dark marks left after a pimple heals. PIH is color, not texture, and often fades over time or with the right resurfacing approach. Matching the treatment to the scar type, and to your skin, is the whole game.¹

Microneedling uses fine needles to create thousands of controlled micro-channels in the skin. Those tiny, precise injuries switch on your body’s repair response and stimulate fresh collagen, exactly what a depressed scar is missing. A meta-analysis of randomized trials found it meaningfully improves atrophic acne scars, with the strongest results after a series of sessions.² It has minimal downtime and pairs well with PRP (platelet-rich plasma) drawn from your own blood; combining the two improves results over microneedling alone.⁶

RF microneedling takes that idea deeper. The needles deliver radiofrequency energy into the lower layers of the skin, heating the tissue to remodel collagen at a depth plain microneedling can’t reach, which helps with rolling and boxcar scars. Morpheus8, the device we use, is well documented across facial applications,³ and reviews of radiofrequency microneedling support its role in treating acne scars while largely sparing the skin’s surface.⁴

Lasers work from the top down, removing and tightening the outer layers so smoother skin replaces scarred skin. Our Fotona platform uses an erbium (Er:YAG) laser. A meta-analysis comparing erbium and CO₂ lasers found both significantly improve atrophic acne scars, with erbium generally associated with a gentler recovery.⁵ Laser is powerful for crisp boxcar edges and texture, but asks for more downtime and extra care in darker skin.

This is especially important in our diverse Miami community. In richer skin tones, overly aggressive resurfacing carries a real risk of triggering new pigmentation. The reassuring part: energy-based treatments can be used safely in skin of color when the device and settings are chosen thoughtfully, often favoring microneedling and radiofrequency, or gentler laser settings.⁷ It’s exactly why a one-size protocol doesn’t serve everyone.

Two honest truths. First, this is a series, not a one-and-done visit; most scar protocols run several sessions spaced a few weeks apart.² Second, the goal is improvement, not erasure: we soften scars so they catch the light less and bother you less, but no treatment returns skin to perfectly scar-free. The best plans usually combine approaches, microneedling for some areas, radiofrequency for deeper scars, laser for texture, chosen around your scars and skin tone.⁶

We offer microneedling (with optional PRP), Morpheus8 radiofrequency microneedling, and Fotona laser resurfacing, and we build every acne-scar plan around your scar type and skin tone. Pricing is personalized at your consultation, because the right combination and number of sessions depend entirely on your skin. Our team treats patients in English, Spanish, and Portuguese, and we serve Aventura, Sunny Isles, Bal Harbour, and North Miami Beach.

Can acne scars be completely erased? Not completely, and any honest provider will tell you so. The realistic goal is meaningful improvement in texture and tone, which the evidence supports with the right treatment series.²

What’s the difference between microneedling and RF microneedling? Standard microneedling stimulates collagen near the surface; radiofrequency microneedling like Morpheus8 adds heat that reaches deeper layers, making it a stronger option for rolling and boxcar scars.³ ⁴

Which treatment is best for my acne scars? It depends on your scar type, ice-pick, boxcar, or rolling, and on your skin tone. That’s why we start with an assessment and often combine methods rather than relying on just one.¹

Are these treatments safe for darker skin tones? Yes, when devices and settings are chosen carefully. Energy-based treatments can be used safely in skin of color, which is why personalization matters so much in our patient base.⁷

How many sessions will I need? Usually a series of several sessions spaced a few weeks apart, with gradual improvement over the months that follow as new collagen forms.²

Do I need to wait until my active acne is controlled? Yes, ideally. We treat scars once breakouts are settled, so we’re resurfacing healed skin rather than inflaming active acne.

1. Boen M, Jacob C. A Review and Update of Treatment Options Using the Acne Scar Classification System. Dermatol Surg. 2019. PMID: 30856634. https://pubmed.ncbi.nlm.nih.gov/30856634/
2. Shen YC, et al. Microneedling Monotherapy for Acne Scar: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Aesthetic Plast Surg. 2022. PMID: 35426044. https://pubmed.ncbi.nlm.nih.gov/35426044/
3. Hendricks AJ, et al. Dermatologic facial applications of Morpheus8 fractional radiofrequency microneedling. J Cosmet Dermatol. 2022. PMID: 35916259. https://pubmed.ncbi.nlm.nih.gov/35916259/
4. Tan MG, et al. Radiofrequency Microneedling: A Comprehensive and Critical Review. Dermatol Surg. 2021. PMID: 33577211. https://pubmed.ncbi.nlm.nih.gov/33577211/
5. Husein-ElAhmed H, Steinhoff M. Comparative appraisal with meta-analysis of erbium vs. CO₂ lasers for atrophic acne scars. J Dtsch Dermatol Ges. 2021. PMID: 34558190. https://pubmed.ncbi.nlm.nih.gov/34558190/
6. Kang C, et al. Combined Effect of Microneedling and Platelet-Rich Plasma for the Treatment of Acne Scars: A Meta-Analysis. Front Med (Lausanne). 2021. PMID: 35237616. https://pubmed.ncbi.nlm.nih.gov/35237616/
7. Teymour S, et al. Energy-based devices in the treatment of acne scars in skin of color. J Cosmet Dermatol. 2023. PMID: 36575886. https://pubmed.ncbi.nlm.nih.gov/36575886/

Medically reviewed by Dr. Thiago Queiroz, D.O., Medical Director, Lumini Medical Spa. Educational, not a substitute for an in-person consultation.