Acne Scar Surgery Explained: Which Procedure is Right for You?

Acne scars often linger long after breakouts fade, serving as a constant reminder of previous struggles with your skin. While topical creams and other treatments can provide some relief, they may not fully address deep scars. This is where acne scar surgery comes into play. Beyond being a popular term in the world of skincare, it offers a transformative path toward achieving smoother, healthier skin.

For those who have struggled to differentiate between subcision, punch excision, or microneedling, this guide is for you. By the end, you’ll know what to ask your dermatologist and why a tailored plan is essential for long-term results.

And why Skinstitute, with its expert-led care, advanced technology, and deep understanding of Indian skin, is the trusted place to start that transformation.

Understanding Acne Scar Types: The First Step 

Acne scars aren’t all the same, and neither are their solutions. Identifying the scar type serves as the basis for an efficient treatment strategy. Acne scars are typically classified into two major categories: Atrophic (depressed) and Hypertrophic (raised). Let’s break them down:

• Atrophic Scars (Most Common in Indian Skin Types): These are depressions in the skin caused by tissue loss during the healing process.

• Ice Pick Scars: Pitted scars that are difficult to treat with topical methods due to their deep and narrow nature.
• Boxcar Scars: Broad, sharply defined edges with a box-like appearance. It can be shallow or deep and usually appears on the cheeks and temples.
• Rolling Scars: Shallow indentations with sloping edges that give the skin a wavy, uneven look

• Hypertrophic and Keloid Scars: These form due to excess collagen production during healing, resulting in raised, sometimes itchy or painful scars, more common in melanin-rich skin.

The effectiveness of treatment varies depending on the type. Indian skin, in particular, is prone to post-inflammatory hyperpigmentation (PIH), so choosing the right modality matters just as much as the technique.redictable outcomes. This balance of power and minimal invasiveness makes it a perfect match for Indian skin; powerful yet controlled.

Surgical Solutions: Precision Procedures for Permanent Results

Unlike creams or peels that only resurface the top layers, surgical procedures go beneath the skin to release tethered scars, replace damaged tissue, and stimulate new collagen. They’re minimally invasive but deliver long-term change when done correctly.

Let’s break down the most effective options:

• Subcision: A needle is inserted under the skin to break fibrous bands that pull scars inward. Ideal for boxcars or rolling scars, this method promotes collagen production and helps raise the depression.
• Punch Excision: Used for treating both ice pick and deep boxcar scars; it involves cutting out the scar and stitching the skin back. While it leaves a linear mark initially, it’s far easier to treat and fades over time.

• Microneedling (Collagen Induction Therapy): Though less invasive, microneedling is often performed using a dermaroller or microneedling pen with tiny needles that puncture the skin, stimulating natural healing and boosting collagen production. It is especially beneficial for treating mild rolling scars, requires minimal downtime, and is suitable for all Indian skin tones.
• Dermabrasion: Involves using a rotating instrument to “sand” the skin, removing the top layers and smoothing out shallow scars, thereby improving the texture and tone of the skin.

Each of these techniques can be combined for a “scar-by-scar” strategy, especially beneficial in Indian skin, where blanket laser treatments may cause pigmentation.

At Skinstitute, our customized surgical plans take into account your specific scar type, skin tone, and healing profile to ensure a safe and visible transformation.

Non-Surgical Alternatives vs. Surgery: When to Combine? 

Surgery is not always necessary for scars. In certain instances, alternative methods can improve or maintain results from surgical treatment for acne scars. And sometimes, the best results come from combining both, especially when dealing with mixed scar types or sensitive Indian skin. 

Here’s a comparison to help decide:

At Skinstitute, under the guidance of certified dermatologist Dr. Kumar Abhishek, we evaluate your scar history, skin sensitivity, and individual goals to create a customized treatment plan that minimizes downtime while maximizing skin transformation.

The Decision Matrix: Matching Procedures to Your Scars 

Are you still uncertain about which scar requires what solution? Here’s a simplified matrix.

This initial matrix serves as a foundation; however, the majority of individuals have a combination of scar types. Therefore, the treatment plan typically incorporates layered procedures to address various aspects such as depth, texture, and pigmentation in separate sessions.

Are You a Candidate? Key Assessment Factors 

Some people may have a strong desire to address their scars; however, not everyone is immediately suitable for surgical intervention. Before committing to any procedure, it’s important to understand if you’re the right fit for it.

You might be a good candidate if:

• Your acne has been inactive for at least 6–12 months.
• You have moderate to severe scarring, especially deep boxcar, ice pick, or rolling scars.
• Topical treatments and non-invasive procedures (like microneedling or chemical peels) have shown little to no improvement.
• You are in good overall health and not prone to keloid scarring.
• You have realistic expectations about results.

So, a professional consultation is always essential. Here’s how dermatologists generally determine eligibility:

• Scar Type & Depth: Different scars need different tools. For example, excision may be necessary for ice pick scars, while subcision or lasers may be more beneficial for rolling or boxcar scars.
• Skin Type & Tone: Skin tone matters as darker tones require tailored approaches to avoid post-procedure pigmentation.
• Scar Age: Fresh scars may benefit from gentler treatments, while older ones often require precise surgical methods.
• Medical History: Pre-existing skin conditions, medications, and scarring tendencies guide what’s safe and effective.

The best treatment is personalized. What may be effective for someone may not necessarily be helpful for another, highlighting the importance of a detailed assessment.

At Skinstitute, our specialists take a 360° approach to your skin, combining clinical expertise with cutting-edge technology to design treatments that truly work for you.

Step-by-Step: What Happens During Surgery?

Although acne scar surgery may sound intimidating, being aware of what to anticipate can ease any fears. Here’s what generally happens during this process:

1. Consultation & Custom Plan: Before beginning any procedures, a thorough evaluation of your skin is conducted, examining the type and pattern of your scars to determine the best-suited technique for your case. Sometimes, a combination approach is used for optimal results.

2. Prepping the Area: On the day of the procedure, your skin will be cleansed, and numbing cream (or local anesthesia) will be administered to ensure comfort. Protective eyewear may also be provided for laser treatments.

3. Procedure Execution:

• Subcision: Fine needle inserted under the skin.
• Punch Excision: Scar is cut and stitched.
• TCA CROSS: Chemical applied directly to the scar base.

4. Aftercare & Healing: Post-procedure, your skin may be red, swollen, or tender. Recovery times vary from a few days to a couple of weeks, depending on the method used. Detailed aftercare instructions, including gentle cleansing, sun protection, and possibly topical treatments to aid healing, are given too.

5.  Follow-ups: Your doctor will evaluate healing progress and suggest additional treatments, if necessary. Many patients experience visible enhancements over time, especially after multiple sessions.

At Skinstitute, we guide you through every step, from first consultation to final glow-up. The entire process is supervised by Dr. Kumar Abhishek, who brings years of extensive experience and expert care.

Recovery Roadmap for Indian Skin 

Recovery is not solely focused on the healing process, but also on preventing further pigmentation, scarring, or textural damage. Due to the reactive nature of melanin in Indian skin, it is crucial to prioritize post-operative care in order to avoid dark spots.

Here’s what to expect and how to ensure your recovery is smooth, safe, and scar-improving.

Week 1: Calm & Protect

• Redness, swelling, or minor scabbing is normal, especially after punch excision or lasers.
• Refrain from touching or picking the affected area, as it increases the chances of scarring and pigmentation.
• Opt for a gentle cleanser, no actives (AHAs, retinol), and use a rich moisturizer.
• Wear SPF 50+ daily, even indoors.

Week 2–4: Monitor & Maintain

• Mild tenderness and temporary dark patches may appear.
• Include soothing components such as niacinamide, ceramides, or Centella (if approved).
• Avoid salons, sun exposure, and harsh treatments.

Month 2–3: Visible Progress

• Collagen repair begins; scars start to fade noticeably.
• Skin tone evens out with good skincare consistency.
• Don’t overlook follow-ups, as they may require adjustments or a combination of treatments for best results.

Critical Tips for Indian Skin:

• Choose non-fragranced, pH-balanced products.
• Avoid DIYs or natural remedies that can irritate healing skin.
• Hydration, stress management, and enough sleep also significantly aid in skin recovery 

At Skinstitute, our post-care plans are science-backed, dermatologist-approved, and tailored just for you.

Managing Risks: Hyperpigmentation & Other Concerns 

While acne surgery is a safe and effective procedure when performed by professionals, it does carry some risks that patients should be mindful of. 

One of the most common concerns is post-inflammatory hyperpigmentation (PIH), which can occur in patients with medium to darker skin tones, causing temporary darkening of the treated area. While using sunscreen and proper pre-treatment prep helps, this side effect gradually fades in several weeks to months.

Other possible side effects include:

• Redness, swelling, or peeling post-procedure
• Temporary sensitivity or dryness in the treated skin
• Mild bruising or discomfort in subcision-based procedures
• Infection or delayed healing if post-care isn’t followed correctly

Fortunately, the majority of these risks are temporary and manageable, especially with adequate preparation, skilled execution, and diligent aftercare.

At Skinstitute, ensuring safety and achieving desired results are equally important to us. That’s why every acne treatment surgery is supported by medical expertise, strict clinical protocols, and personalized aftercare to help your skin heal right.

Why Dermatologists > Beauty Clinics for Scar Surgery 

Acne removal surgery is a specialized medical procedure rather than a cosmetic facial. Only board-certified dermatologists like Dr. Kumar Abhishek are trained to identify skin layers, control bleeding, and manage complications. 

Here’s why certified dermatologists should always be your first choice instead of beauty clinics.

At Skinstitute, our approach is clinical yet aesthetic, focusing on long-term outcomes rather than just temporary solutions. We utilize science, expertise, and intuition in every treatment. 

We prioritize the delicate nature of skin and treat it as the vital organ that it is, rather than just a surface to be smoothed over.

Take the Next Step: Personalized Scar Assessment

Every scar tells a story, and every story deserves a tailored solution. Here at Skinstitute in Bhubaneswar, we go beyond surface treatment. Our process involves analyzing your skin type, scar history, medical background, and desired outcomes to create a personalized plan for acne scar revision.

Dr. Kumar Abhishek brings years of dermatological and surgical expertise to offer advanced treatments that work, without compromising your skin health.

Whether you’re dealing with deep scars or surface-level textural issues, we’ll help you find the safest, most effective path forward with full transparency and clinical care at every step.

Let’s begin your journey to confidence, clarity, and better skin. Book your personalized scar consultation today at Skinstitute.