Acne Scar Removal

in Scottsdale, AZ

Acne scars — including ice pick, boxcar, and rolling types — form when severe breakouts damage the deeper layers of skin. Professional treatments like RF microneedling, laser resurfacing, and collagen-stimulating injectables can significantly improve texture and tone.

Or explore: Wrinkles & Fine Lines · Hyperpigmentation Treatment in Scottsdale, AZ · Melasma Treatment in Scottsdale, AZ

Scar types Rolling, boxcar, icepick Symptoms Cheek, forehead, jaw 4 methods RF MN, erbium, TCA, Bellafill Severity Early to established FAQ Common questions Book a consult Complimentary

Match the tool to the scar — not the scar to the tool.

Acne scars form when the inflammatory process during a breakout damages collagen in the dermis. The type of scar depends on whether collagen was lost (atrophic — the pitted kind) or overproduced (hypertrophic or keloid). Most patients seeking treatment have atrophic scars, and within that category — icepick, boxcar, and rolling — the right tool is different for each. Applying a resurfacing laser to a rolling scar that needs subcision-equivalent tissue release, or filling a narrow icepick scar that needs TCA Cross, produces incomplete results at best.

At Desert Bloom Skincare in Scottsdale, Dr. Natalya Borakowski, NMD assesses scar type, depth, skin tone, and distribution before recommending a protocol. For predominantly rolling scars, Bellafill (PMMA collagen stimulator) offers a uniquely durable approach. For icepick scars, TCA Cross addresses the narrow, deep structure that resurfacing can't reach. RF Microneedling (Virtue RF) is the foundation treatment for most mixed presentations. See full pricing or browse all treatments.

Currently dealing with active acne? See acne treatment options before scheduling scar work — active acne should be controlled before scar treatment begins.

At a glance

Scope: Atrophic acne scars — icepick, boxcar, rolling, and tethered. Hypertrophic and keloid scarring addressed separately.
Methods: RF Microneedling (Virtue RF), Erbium Laser Scar Revision (Quanta EVO), TCA Cross, Bellafill PMMA filler.
Fitzpatrick: Virtue RF and TCA Cross — all types incl IV–VI with temperature control. Erbium — Fitz I–III only.
How to start: Complimentary 30-minute consultation, scar-type assessment, individualized plan. Active acne must be controlled first.

Understand the structure

Acne scar types — and why matching matters

The most common reason scar treatment falls short is a mismatch between the scar type and the tool. Each atrophic scar type has a different structural cause, and effective treatment targets that cause specifically. Most patients have more than one type on the face — a combination approach is the norm.

Icepick scars

→Route: TCA Cross + RF Microneedling — Narrow, deep, V-shaped pits that extend into the dermis. Sharp narrow walls make them hard for ablative resurfacing to reach. Standard-of-care tool is TCA Cross — concentrated TCA applied to the scar base to trigger a focal collagen response.

Boxcar scars

→Route: RF Microneedling primary — Wider U-shaped depressions with defined vertical walls. Shallower boxcar responds to RF microneedling series. Deeper boxcar may benefit from Erbium resurfacing (Fitz I–III) as the ablative component drives more collagen remodeling.

Rolling scars

→Route: Bellafill structural lift — Broad, wave-like depressions caused by fibrous bands tethering the dermis to deeper structures — creating the rolling shadow effect. Best candidate for Bellafill (PMMA microspheres in bovine collagen): permanent structural lift plus ongoing collagen stimulation.

Tethered / mixed scars

→Route: Staged at consultation — Many patients have a combination — icepick and boxcar together, or rolling scars with overlying surface changes. Staged plan addresses the deepest structural problem first, then broader surface remodeling. Most comprehensive programs span 6–12 months.

Start with what you see

What does your scarring look like?

Use these descriptions to identify your likely scar type before your consultation. Scar-type confirmation and treatment planning happen in person — many patients have mixed presentations that need a staged approach.

I have deep, narrow pits — mostly on my cheeks and temples.

→See RF Microneedling + TCA Cross combo — This matches icepick scars — tiny holes with sharp edges, not broad depressions. Narrow structure means surface-level resurfacing doesn't reach the bottom; TCA Cross is the targeted tool.

I have wider flat-bottomed pits — U-shaped depressions.

→See RF Microneedling primary — Wide, flat-bottomed depressions with defined edges are typically boxcar scars. Shallow to moderate boxcar responds well to RF microneedling series. Deeper boxcar may benefit from Erbium resurfacing (Fitz I–III only).

My skin has a wavy, uneven surface — like rolling hills, not sharp pits.

→See Bellafill for rolling scars — Rolling, undulating texture comes from fibrous tethering beneath the skin. Bellafill provides structural support from below, releasing the tethering effect and stimulating collagen. Why rolling scars don't respond as well to surface-level treatment alone.

I have a mix — some deep pits, some wider depressions, some texture.

→Plan a staged consultation — Mixed presentations are the norm, not the exception. The plan prioritizes the most structurally significant scar type first, then layers surface treatments for overall refinement. Timeline is longer — typically 6–12 months — but improvement is cumulative.

I have dark marks from old acne — not really pits.

→See hyperpigmentation hub — Post-inflammatory hyperpigmentation (PIH) — flat dark discoloration after a breakout healed — is not a scar and does not respond to scar treatments. It is a pigmentation concern. If you have both, the two are addressed on separate tracks.

Methods at Desert Bloom

Acne scar removal methods

Four methods cover the majority of acne scar presentations treated at Desert Bloom. Each links to its dedicated page where the full protocol, candidacy, and recovery details live. Pricing for all methods at the price list.

Foundation — All Scar Types

RF Microneedling — Virtue RF

Radiofrequency energy delivered through insulated microneedles creates controlled micro-injury in the dermis while simultaneously delivering RF heat to stimulate collagen remodeling. Virtue RF allows precise depth control, independent channel energy delivery, and is effective for acne scar remodeling across Fitzpatrick types I–VI with appropriate temperature and depth settings.

For acne scars, a series of 3–4 sessions spaced 4–6 weeks apart is typical. Each session deepens the remodeling response cumulatively. The workhorse treatment most patients start with — often the only tool needed for mild to moderate boxcar and mixed presentations.

Best forBoxcar scars, mixed presentations, all-over surface refinement

Sessions3–4 spaced 4–6 weeks apart

FitzpatrickI–VI (with temperature control)

See RF Microneedling details

Surface Resurfacing — Fitz I–III

Erbium Laser Scar Revision — Quanta EVO

Erbium:YAG ablative resurfacing on the Quanta EVO platform creates precise, controlled ablation of the scar surface — stimulating new collagen formation during healing and smoothing the irregular texture at the scar walls. Cool peel mode offers modest improvement with less recovery; the deeper mode is more aggressive and provides greater collagen response for established boxcar scars.

Effective as a complement to RF microneedling — typically in a staged approach where RF microneedling handles deeper remodeling and Erbium refines the surface. Appropriate for lighter skin types only.

Best forBoxcar surface refinement (after RF microneedling ceiling)

Sessions1–3 as supplement

FitzpatrickI–III only

See Erbium resurfacing details

Targeted — Icepick Scars

TCA Cross — Chemical Reconstruction of Skin Scars

TCA Cross uses a highly concentrated trichloroacetic acid solution (80–100%), applied precisely with a fine applicator to the base of an individual icepick scar. The controlled coagulative injury triggers an intense focal collagen response that fills the narrow channel from the inside out. Where ablative resurfacing addresses the surface, TCA Cross addresses the vertical depth.

Multiple sessions are typically required (4–6 spaced 4–8 weeks apart), and improvement is progressive. Often combined with RF microneedling — TCA Cross targets icepick components, RF microneedling addresses broader texture and surrounding boxcar scars. Performed by Dr. Borakowski.

Best forNarrow, deep icepick scars

Sessions4–6 spaced 4–8 weeks apart

FitzpatrickI–VI (concentration adjusted by skin type)

Discuss TCA Cross at consultation

Structural Lift — Rolling Scars

Bellafill — PMMA Collagen Stimulator

Bellafill is the only FDA-approved filler specifically indicated for acne scars. It uses polymethylmethacrylate (PMMA) microspheres suspended in bovine collagen — the collagen provides immediate structural support in the scar depression, while the PMMA microspheres remain permanently and stimulate ongoing collagen production over 12+ months.

Bellafill requires a skin test (or can be skipped if the patient eats beef — confirming absence of bovine collagen allergy). Not used in the under-eye area or on the lips. Performed by Dr. Borakowski and typically requires 1–2 sessions for initial correction. Because PMMA is permanent, placement precision matters — not a treatment to seek from a provider without experience.

Best forRolling acne scars (NOT under-eye, NOT lips)

Sessions1–2 for initial correction

FitzpatrickAll types (candidacy confirmed at consultation)

See Bellafill details

Compare

Compare acne scar treatments

Side-by-side view of the four methods. Pricing for each is on the price list.

Method	RF Microneedling	Erbium Resurfacing	TCA Cross	Bellafill
Best scar type	Boxcar, mixed, all-over	Boxcar surface refinement	Icepick (narrow, deep)	Rolling (tethered, wavy)
Mechanism	Dermal collagen remodel	Ablative surface + collagen	Focal collagen fill-in	Structural lift + PMMA stim
Downtime	1–2 days redness	3–7 days depending on depth	3–5 days per scar	1–3 days bruising
Sessions	3–4 spaced 4–6 weeks	1–3 as supplement	4–6 spaced 4–8 weeks	1–2 for correction
Fitzpatrick	I–VI (all types)	I–III only	I–VI	All types

RF Microneedling

Best scar type: Boxcar, mixed, all-over
Mechanism: Dermal collagen remodel
Downtime: 1–2 days redness
Sessions: 3–4 spaced 4–6 weeks
Fitzpatrick: I–VI (all types)

Erbium Resurfacing

Best scar type: Boxcar surface refinement
Mechanism: Ablative surface + collagen
Downtime: 3–7 days depending on depth
Sessions: 1–3 as supplement
Fitzpatrick: I–III only

TCA Cross

Best scar type: Icepick (narrow, deep)
Mechanism: Focal collagen fill-in
Downtime: 3–5 days per scar
Sessions: 4–6 spaced 4–8 weeks
Fitzpatrick: I–VI

Bellafill

Best scar type: Rolling (tethered, wavy)
Mechanism: Structural lift + PMMA stim
Downtime: 1–3 days bruising
Sessions: 1–2 for correction
Fitzpatrick: All types

Decide your route

What to expect based on your scar severity

Acne scar severity is graded by depth, width, and the extent of involvement. The bands below describe typical starting points — scar-specific planning is confirmed at consultation after in-person mapping of your scar pattern.

Mild

Shallow, few scars — early boxcar or superficial textural changes from past breakouts. Skin quality generally good.

Typical path: 3-session RF Microneedling series. Many patients achieve significant improvement in this band with one modality.

Moderate

Mixed scar types — shallow to moderate-depth boxcar and icepick across a broader area. May have residual PIH alongside structural scars.

Typical path: RF Microneedling series (foundation) + TCA Cross for icepick components + Erbium if Fitz I–III and surface refinement is the remaining goal. Staged over 6–9 months.

Severe / Complex

Deep, widespread mixed scarring including rolling component, icepick, and surface texture changes. May have a previous failed treatment history.

Typical path: Bellafill for rolling scars + TCA Cross for icepick + RF Microneedling throughout. Full program spans 9–12 months. Realistic expectations required — significant improvement is achievable, but complete resolution of deep scarring is rarely possible with any treatment.

Final routing happens at your complimentary consultation.

FAQ

Acne scar removal — frequently asked

Can acne scars be fully removed?

Not completely — but they can be substantially improved. Most patients achieve meaningful reduction in scar depth, visibility, and overall skin texture that makes a significant difference to how their skin looks in regular lighting. The realistic goal is improvement, not elimination. How much improvement is achievable depends on scar type, depth, skin quality, and treatment response. Dr. Borakowski sets realistic expectations at consultation rather than promising a specific outcome.

How do I know if I have icepick, boxcar, or rolling scars?

Icepick scars look like tiny punched-out holes with sharp edges — narrow and deep. Boxcar scars are wider flat-bottomed depressions with defined vertical walls. Rolling scars create a wavy, undulating skin surface that casts shadows rather than showing sharp edges. In practice, most people have a mix; identifying the predominant type is part of the consultation. A simple lighting test at home: hold a flashlight to the side of your face and observe the shadow pattern — sharp edges suggest icepick or boxcar; soft rolling shadows suggest rolling.

What makes Bellafill different from other fillers for acne scars?

Most HA fillers for acne scars are temporary — the body absorbs the material over months and the scar returns to its previous depth. Bellafill's PMMA microspheres are not absorbed; they remain and continue stimulating collagen long after the initial correction. This is why Bellafill is the only FDA-approved filler specifically for acne scars — the durability of the result is a different category from temporary HA filler. Appropriate for rolling scars in eligible candidates; not used under the eyes or on the lips.

How many RF microneedling sessions are needed for acne scars?

Most protocols involve 3–4 sessions spaced 4–6 weeks apart. Each session cumulatively adds to the collagen remodeling response — the full result develops over 3–6 months after the last session as new collagen matures. Patients with moderate to severe scarring may require additional sessions, or the addition of TCA Cross or Erbium for components not responding to RF microneedling alone.

Can RF microneedling be used on darker skin tones for acne scars?

Yes. Virtue RF Microneedling is approved for and used across Fitzpatrick types I–VI at Desert Bloom. Key adjustments for deeper skin tones are temperature control and insertion depth — both managed by Dr. Borakowski's protocol. Different from certain ablative lasers (Erbium, CO2) which are restricted to lighter skin tones. If you have Fitzpatrick IV–VI skin and have been told scar treatment isn't available for you, RF microneedling and TCA Cross are both viable options at Desert Bloom.

What's the difference between TCA Cross and a regular TCA peel?

A TCA peel applies a lower concentration of trichloroacetic acid across the entire treatment area — causing even exfoliation and stimulating general collagen turnover. TCA Cross (Chemical Reconstruction of Skin Scars) uses a much higher concentration applied precisely to the base of individual icepick scars using a fine applicator — triggering an intense focal collagen response inside the scar channel rather than across the surface. Fundamentally different tools used for different purposes.

How long until I see results after starting acne scar treatment?

Depends on the methods used. RF microneedling results develop gradually over 3–6 months as new collagen matures — most patients notice improvement 4–8 weeks after the first session, with full result visible 3 months after the final session. TCA Cross builds over multiple sessions, with each session filling the scar channel incrementally. Bellafill provides immediate structural improvement that continues to develop over 12 months as PMMA stimulates collagen. Most comprehensive programs show meaningful results at the 6-month mark.

Treatment plan led by

Dr. Natalya Borakowski, NMD

Medical Director, Desert Bloom Skincare

References

1.
Niaz G, Ajeebi Y, Alshamrani HM, Khalmurad M, Lee K.. Fractional Radiofrequency Microneedling as a Monotherapy in Acne Scar Management: A Systematic Review of Current Evidence.. Clinical, Cosmetic and Investigational Dermatology; 2025.
DOI: 10.2147/CCID.S502295
PMID 39781098 — Systematic review of RF microneedling for acne scar management; supports use of Virtue RF as primary modality.
2.
Solomon P, Bloom J, Sadeghpour M.. Facial Soft Tissue Augmentation With Bellafill: A Review of 4 Years of Clinical Experience.. Plastic Surgery (Oakville); 2021.
DOI: 10.1177/2292550320933675
PMID 34026672 — Clinical experience review of Bellafill for facial soft tissue augmentation including acne scars; supports PMMA collagen stimulator as durable option for rolling scars.
3.
Seirafianpour F, Pour Mohammad A, Moradi Y et al.. Systematic review and meta-analysis of randomized clinical trials comparing efficacy, safety, and satisfaction between ablative and non-ablative lasers in facial and hand rejuvenation/resurfacing.. Lasers in Medical Science; 2022.
DOI: 10.1007/s10103-022-03516-0
PMID 35107665 — Meta-analysis comparing ablative and non-ablative laser modalities; relevant to Erbium resurfacing role in acne scar treatment.
4.
Persson C, Jfri A, Mukovozov I.. Post-inflammatory Hyperpigmentation in Skin of Color: Emerging Therapies and Treatment Strategies.. Cureus; 2026.
DOI: 10.7759/cureus.107234
PMID 42153065 — Contextualizes PIH risk in skin of color and the importance of Fitzpatrick-appropriate treatment selection for all scar types in darker skin tones.

Reviews

What our patients say

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“Natalya has been taking care of my skin for several years now and I’m always thrilled with my results! She is one of the most knowledgeable doctors in her field and has a true appreciation for natural Asethetics. I’ve gone to her for laser, hydrofacials, fillers, and botox. I would trust her with any service that she provides.”

Briana Basler

“Dr. Natalya is amazing, a true professional. I was not familiar at all with the threading procedure when I first called. I was curious about the non-surgical rhinoplasty I read about after deciding full surgery was not what I wanted right now. It seemed to good to be true!! Brian took a good amount of time explaining things to me over the phone when I first called, sent me photos and encouraged me to go to their website and instagram page to learn more. Dr. Natalya then spent another 30+ minutes with me as well during my consultation. I felt so at ease and well informed. A week later, I had the procedure done and the results are incredible! I highly recommend Desert Bloom! (Before and after photos were taken the day of the procedure… I was mid-blink in the one, not sad…haha)”

Gennifer Reid

“I cannot say enough good things about Dr Natalya, as I am *thrilled* with my results! She was patient and thorough. Within a few minutes, you will see exactly how knowledgeable she is. She's got a great bedside manner and will sit down and make sure that you are comfortable with your treatment. She will tell you what the optimal treatment is, but she will not force you into anything. She will work with whatever your needs are, and I appreciate her very much for that. If only I lived closer! Thank you, again, Dr. Natalya!”

Adrienne Cerulo

Scottsdale, Arizona

Tool fits the scar — not the other way around

Rolling scars respond to filler-based approaches. Boxcar and icepick need resurfacing or TCA Cross. Dr. Borakowski maps each scar type to the right method and stages a realistic plan.

Book a consultation