If you run your finger over an acne mark, you'll feel that the surface isn't smooth but rather sunken. Why don't depressed acne scars fill in well with general lasers alone? It's because the scar is pulling the tissue inward, not at the skin's surface, but within the dermis.
Today, we will focus on two procedures for deeply depressed acne scars: suture-free punch and subcision. While acne is something almost everyone experiences during adolescence, the depressed acne scars that remain after inflammation subsides often don't disappear on their own over time, leading to ongoing concern.
Why Surface Treatment Isn't Enough for Depressed Scars
Acne marks form deeply depressed shapes within the dermis, not on the surface. This is because fibrotic tissue pulls inward. As a result, scars can be deeper than they appear, making them difficult to resolve with conventional lasers alone.
If a scar's structure involves tissue being pulled inward within the dermis, an approach that releases this pulling force itself is needed, rather than just surface treatment.
For scars that are deeply depressed by 1-2mm or more, a combination of procedural methods and laser treatment is often used. It's not completed by one alone; rather, it's a combination of procedures to release the pulling tissue and lasers to refine the surface.
Suture-Free Punch, a Punch Technique with Reduced Suture Marks
Punch technique has been performed in the United States since the 1990s. It is often applied to chickenpox scars or deeply depressed acne scars measuring 1-5mm. A medical punch device is used to lift the scar area to a normal height.
In the past, punch procedures required suturing, which could leave suture marks. Suture-free punch was developed to address this. After lifting with a punch, a special medication is used to fix it, completing the procedure without separate suturing.
This is considered an advantage as it allows for an immediate return to daily life without a long recovery period. However, recovery patterns can vary individually, so it's advisable to monitor post-procedure progress according to the medical staff's guidance.
Subcision, the Principle of Cutting Pulling Fibrous Tissue
Subcision is often performed for wide and deep rolling scars. The principle is that by cutting the clumped fibrous tissue that is pulling the skin downward with a medical needle, the depressed scar fills in.
Since healthy skin is not directly abraded, daily life can be resumed relatively quickly after the procedure. However, after subcision, bruising may appear in the treated area due to blood accumulation. Interestingly, the longer this bruising lasts, the more the scar tends to fill in, so it's best not to disturb it forcefully.
At Yonsei Star Dermatology Sinchon, you can also receive Intracision, which can be applied to shallow scars. The most suitable method will be determined through a 1:1 customized consultation after checking your current symptoms and skin condition with the medical staff.
If you have any questions, inquire via chat consultation regarding depressed scar treatment
Procedure Methods, Compared at a Glance
The three procedures differ in the scar shapes they address and their approach. They are summarized in the table below.
| Procedure | Scars Primarily Treated | Core Principle |
|---|---|---|
| Suture-Free Punch | 1-5mm boxcar, chickenpox scars | Lifted with punch, then fixed with medication |
| Subcision | Wide, deep rolling scars | Fibrous tissue cut with needle to fill in |
| Intracision | Shallow scars | Relatively light separation approach |
Scars often appear not in a single shape but as a mix of various forms. Therefore, rather than a single procedure, a treatment plan is usually formulated by comprehensively assessing the acne scar condition and combining procedures.
Things to Know Before Treatment
In the clinic, factors other than the timing of scar formation often have a greater impact on the results. Keeping the following in mind before starting can be helpful:
- The difficulty of scar treatment is determined not by the timing of its occurrence, but by how deeply it is depressed and the individual's skin regeneration capacity.
- It's more realistic to view it as a process that requires consistent treatment for 6 months to 1 year, rather than finishing in one or two sessions.
- Bruising after subcision can be part of the recovery process, so do not touch it excessively.
- It is a priority to consult with a dermatologist experienced in procedures to first identify your scar type.
- As effects and progress can vary individually, it is important to follow the planned course of treatment to the end.
Treatment Where Consistency Creates Results
Not all treatments show effects in just 1-2 sessions; many require consistent treatment for 6 months to 1 year. The most important part is to trust your medical team and continue the treatment as planned.
If scar types are complex or if deep traumatic scars are also present, methods like Surgical Scar Revision may be considered. Since the appropriate combination for you is determined through consultation, we recommend having your condition checked first.
If you have any questions, inquire via chat consultation for depressed acne scar treatment
Representative Director Dr. Sang-Joo Lee (MD, PhD, Yonsei University College of Medicine and Graduate School, completed dermatology residency at Severance Hospital, President of the Korean Dermatological Association) Representative Director Dr. Sang-Joo Lee's Profile First published 2023-09-20 / Last reviewed 2026-06-16
This article is for general information purposes only, and as scar types and recovery patterns can vary individually, please confirm an accurate diagnosis and treatment plan through consultation with medical staff.