The Latest Method for Removing Acne Scars: From Endolaser to CO2 Laser and Combination Treatments

The Latest Method for Removing Acne Scars

If you have searched for “the latest method for removing acne scars,” you are probably looking for a treatment that delivers noticeable results, does not involve a difficult recovery period, and is low-risk for your skin type (especially medium to dark skin tones, which are common in Iran). One point many people realize late is that acne scar treatment is not a one-size-fits-all solution; “acne scars” can be depressions, raised scars, redness, or brown spots, and each requires a different treatment.

In recent years, the focus of new treatments has shifted from “one fixed method for everyone” toward combination and personalized treatments. This means that after a thorough examination, the doctor determines which method (or combination of methods) is best for your scar type: from subcision to release adhesions beneath the skin, to endolaser/endolift (Endolift) and fractional lasers such as CO2 and erbium, or methods such as microneedling and Tixel.

First of all: if you still have active acne, it usually needs to be controlled first; continued inflammation and new breakouts can create new scars and compromise the results of scar treatment.

A Quick Comparison of the Latest Methods (for an Initial Choice)

The table below provides an overview in 1 minute. The final choice should always be made after identifying the scar type.

First, Diagnosis: What Exactly Is an “Acne Scar”?

In everyday language, we call everything an “acne scar”; medically, however, we are usually dealing with one of these 4 conditions, each with a different treatment approach:

• Depressed (atrophic) scars: This means tissue beneath the skin has been lost, causing the skin surface to sink. This is the most common type of acne scar.
• Raised scars (hypertrophic/keloid): This means excess tissue has formed, creating a raised area (and can be more genetic in some people).
• Post-acne redness (PIE): Red/pink/purple marks that are more related to superficial blood vessels and inflammation than to an actual scar.
• Post-acne brown spots (PIH): Darkening after inflammation, which is more common in medium and dark skin tones.

Three Important Types of Depressed Scars (Which Determine Treatment)

If your scars are depressed, one of these three types (or a combination of them) may be present:

• Rolling: Broad, wave-like depressions that usually have “subcutaneous adhesions”; they respond best to subcision followed by laser/microneedling.
• Boxcar: Depressions with distinct and relatively broad edges; they may improve with fractional lasers, microneedling, and sometimes subcision.
• Ice-pick: Narrow, deep pits; these often require focal treatments such as punch techniques or targeted repair methods.

The Latest Methods in Advanced Clinics: What Does “Latest” Really Mean?

When we talk about “the latest,” we do not only mean a new device; we mean treatments that:

• Are less invasive and cause less bruising/pain
• Target the depth and type of scar more precisely
• Are selected more safely for different skin types (especially darker skin)
• Deliver more natural and even results through combination-treatment protocols

Endolaser Subcision (Diode Endolaser): One of the New Trends for Adherent Scars

One method that has been widely discussed in Iran in recent years is endolaser subcision. The basic concept is similar to classic subcision: stiff, adherent strands beneath the skin that hold the depression down are released, allowing the skin to rise while promoting improved collagen production. The difference is that in the endolaser version, laser energy reaches the deeper layers through a delicate instrument and can create more targeted effects with better control.

Who Is It More Suitable For?

• People with “adherent” depressed scars (usually rolling scars)
• People concerned about bruising/hematoma from classic subcision, when the doctor determines this is a lower-risk option for them
• Those planning combination treatment (for example, fractional laser or microneedling after adhesion release)

What Results Should You Expect?

With acne scar treatment, the goal is generally “significant improvement,” not 100% removal. Particularly for old and deep scars, repeat sessions or combination with other methods may be necessary.

New and Commonly Used Lasers for Acne Scars: CO2, Erbium, Nd:YAG, and More

Lasers perform two key functions in acne scar treatment: skin resurfacing and collagen stimulation. However, the laser type must match your specific concern; for example, treating “post-acne redness” differs from treating “acne-related depressions.”

Fractional CO2 Laser: A Common Choice for Moderate to Deep Scars

Fractional CO2 laser creates very fine, controlled columns in the skin, prompting it to repair itself and produce new collagen. Results are generally gradual, and with proper sessions and care, unevenness is reduced.

If you would like to learn more about this method, you can visit the CO2 laser page at Gooneh Clinic.

An Important Note for Skin Prone to Hyperpigmentation

In medium to dark skin types, any exfoliating treatment/thermal energy, if not properly adjusted, can increase the risk of “post-inflammatory hyperpigmentation.” Therefore, the choice of device, settings, and post-laser care plan are truly decisive.

Erbium Laser (Er:YAG): More Precise Exfoliation with a Focus on the Surface

Erbium laser can also be effective for improving skin texture, more superficial scars, and unevenness, and in some people, due to its mechanism of action, may involve a lighter recovery period than CO2. However, if the scar is “adherent,” the adhesion usually needs to be released first (for example, with subcision), after which laser treatment can help.

Nd:YAG and Vascular/Pigment Lasers: For Redness and Color Changes

If your main concern is more “post-acne redness” or red/purple spots, the doctor may use lasers that target superficial blood vessels or inflammation. These laser types are not necessarily sufficient for deep depressions, but they can greatly improve the overall appearance of the skin and help prevent persistent aftereffects.

Microneedling and Its Newer Generations (Combination/Drug Delivery)

Microneedling uses extremely fine needles to create controlled micro-injuries, triggering the body’s repair phase and collagen production. This method is generally useful for mild to moderate scars, enlarged pores, and uneven texture, and because it can be combined with other treatments, it has an important role in modern treatment plans.

When Is Microneedling Not the First Choice?

• When scars are very adherent and deep (they often require subcision/a stronger laser)
• When you have severe active inflammatory acne (it may worsen inflammation)
• If you have a history of keloids (this must be assessed with great caution)

Tixel: A Modern Option for Improving Texture with a Lower Risk of Color Changes in Some People

Tixel is a “thermo-mechanical injury” technology; without using laser light, it transfers controlled heat to the skin surface to activate the renewal process. This can be an advantage in some skin types, but proper adjustment of treatment intensity and aftercare remain essential.

Classic Subcision: Still a Cornerstone in Treating Many Depressed Scars

Despite newer methods, classic subcision remains highly important for treating rolling scars. If subcutaneous adhesions are not released, no matter how much laser or microneedling is performed, the depression remains “tethered,” and results will be limited.

Common and Expected Side Effects

Temporary bruising and swelling are common in the first few days. Proper management (cold compresses as advised by the doctor, avoiding strenuous activity, and skin care) usually helps make the recovery period manageable.

Filler (Gel) or Fat Injection: To Fill Depressions (in Selected Cases)

Sometimes, after adhesions have been released and skin tissue has been renewed, some depressions still remain. At this stage, volumizing methods such as fillers can help achieve a “more even appearance more quickly.” The choice of material, injection technique, and injection location are very important, since incorrect injection can create unevenness or look unnatural.

For some people, especially when facial volume loss is present in addition to scarring, fat injection may be considered (though this decision must be based entirely on an examination and your aesthetic goals).

Punch and Minor Surgical Methods: The Best Choice for Deep Ice-Pick Scars

One common mistake is for people with ice-pick scars (narrow, deep pits) to undergo laser or microneedling repeatedly but remain dissatisfied. This is because these scar types sometimes require more targeted methods, such as punch techniques (very limited removal of the lesion followed by repair). These methods are not suitable “for everyone,” but in the right patient, they can create a significant difference.

The Best Treatment Is Usually Combination Therapy: How Does the Doctor Create a Plan?

In modern approaches, the doctor generally proceeds with the following logic:

1. Control active acne (if present) and reduce inflammation
2. Release adhesions in rolling scars (subcision/endolaser)
3. Resurface the skin and improve texture (fractional CO2 or erbium laser, or Tixel/microneedling)
4. Complete the outcome in remaining depressions (in selected cases with fillers or volumizing methods)
5. Treat pigmentation and redness (if needed, with dedicated lasers or skincare treatments)

Why Does Combining Methods Improve Results?

Because each method addresses “one part of the problem.” For example, laser improves the surface but does not always release adhesions beneath the skin. Or subcision releases adhesions, but a resurfacing method is usually needed to smooth the surface and even out the texture.

Preparation Before Acne Scar Treatment (Simple Checklist)

Before clinical methods such as laser, subcision, or microneedling, it is best to discuss the following with your doctor:

• A history of cold sores (herpes) on the face or around the lips
• Medications you are taking (especially blood thinners or supplements that increase bruising)
• A history of dark spots after inflammation or sun exposure
• A history of raised scars/keloids on the body
• Pregnancy or breastfeeding (important for selecting treatment type and medications)

Also, if your skin is tanned or you have had substantial sun exposure, the doctor may postpone resurfacing laser treatments to a more suitable time.

Post-Treatment Care: The Difference Between a Good Result and an Average Result

Many dissatisfactions after acne scar treatment stem not from the treatment itself, but from incomplete aftercare. Care varies by method, but the general principles are usually as follows:

Shared Care Principles

• Regular and proper sunscreen use: This is vital after laser/Tixel/microneedling (to prevent darkening).
• Avoid picking at the skin: Peeling scabs or pressing on the treated area can cause pigmentation and even new scars.
• Hydration and skin-barrier repair: Skin is more sensitive after treatment and should be kept moisturized according to the doctor’s prescription.
• Avoid heat and excessive sweating during the first few days (sauna, intense exercise, very hot showers), according to your doctor’s advice.
• Manage redness and inflammation: Temporary redness is normal; however, if you experience severe pain, blistering, discharge, or unusual worsening, notify your doctor promptly.

How Long Is the Typical Recovery Period?

This depends on the treatment method and intensity. Some treatments (such as certain erbium modalities or microneedling) may involve short-term redness, while stronger resurfacing treatments such as fractional CO2 usually cause several days of redness and flaking. Your doctor will determine the exact duration based on the settings and your skin condition.

At-Home Acne Scar Treatment: What Truly Helps and What Is Risky?

For post-acne spots (PIH) and, to some extent, improving superficial texture, at-home skincare treatments may be helpful; however, it is important to be realistic: deep depressed scars generally do not disappear with homemade masks.

Helpful and Low-Risk Steps (When Used Properly)

• Regular sunscreen use
• Repairing and hydrating products to strengthen the skin barrier
• If prescribed by a doctor: ingredients such as topical retinoids or acids for pigmentation (not self-administered, especially on sensitive skin)

Things That Can Worsen Acne Scars

• Self-treatment with lemon juice, baking soda, or highly irritating ingredients (risk of burns and pigmentation)
• Harsh scrubs and over-exfoliation
• Picking, peeling, and squeezing pimples

What Does the Cost of the Latest Acne Scar Removal Method Depend On?

It is not appropriate to give a fixed figure for acne scar treatment, because the cost depends on several factors, including:

• Scar type (depressed, raised, pigmentation, redness) and severity
• The chosen treatment or treatment combination (laser, endolaser, subcision, microneedling, etc.)
• The number of sessions required
• The technology and device used
• The doctor’s skill and experience, as well as the post-treatment care protocol

When Should You See a Doctor? (Warning Signs)

If you experience any of the following after a skin procedure or clinical treatment, it is best to be assessed promptly:

• Blisters, open wounds, or unusual discharge
• Severe and worsening pain
• Rapid and widespread darkening after treatment
• Signs of infection (warmth, bad odor, fever)

How Should You Get Started?

If you want to know exactly which “latest method for removing acne scars” is right for your skin, the best approach is to have the scar type identified through an in-person examination and then develop a step-by-step treatment plan. For a general introduction to the services and treatment approaches, you can visit the aesthetic clinic page.

Also, if you would like to learn more about common options before making a decision, this related article on the Gooneh Clinic blog may be helpful: What Is the Best Treatment for Acne Scars?

Frequently Asked Questions