The Acne Scar Clinic: 4-Step Treatment for Acne Scarring: Subcision, TCA Cross, Filler & Deep Fractional Laser
Acne scars can leave a lasting impact long after breakouts fade. But with modern advancements in aesthetic dermatology, we now have highly effective combination treatments that don’t just improve—but transform—your skin’s texture. If you’ve struggled with rolling, icepick, or atrophic acne scars, here’s what you need to know about the 4-step acne scar protocol: Subcision, TCA CROSS, dermal filler, and deep fractional erbium laser.
Step 1: Subcision – Releasing the Tethered Scars
Many depressed or rolling acne scars are caused by fibrous bands tethering the skin to deeper layers. Subcision is a minimally invasive technique that uses a fine needle or cannula to break up these bands.
Benefits:
Instantly lifts tethered scars
Stimulates collagen remodeling
Minimal downtime
What to expect: A bit of bruising is common, but discomfort is minimal with topical or local anesthetic. Subcision sets the foundation for the rest of the treatment plan by physically releasing scar tissue.
Step 2: TCA CROSS – Precision for Icepick & Boxcar Scars
TCA CROSS (Chemical Reconstruction of Skin Scars) is ideal for icepick and narrow boxcar scars that are too deep for lasers or fillers alone. High-concentration Trichloroacetic Acid (TCA) is carefully placed into each scar to trigger controlled chemical injury.
Benefits:
Targets deep, narrow scars
Promotes collagen production from within
Minimal downtime per session
What to expect: You may see slight scabbing in treated areas for 5–7 days. Multiple sessions are typically spaced 4–6 weeks apart.
Step 3: Filler (Hyaluronic Acid or Poly-L-Lactic Acid) – Lifting and Volume Restoration
Once scars are untethered and collagen is stimulated, filler is used to restore volume. For shallow, rolling scars or general texture improvement, dermal fillers like Hyaluronic Acid (HA) or Poly-L-Lactic Acid (PLA) work beautifully.
HA fillers provide immediate lifting and smoothness
PLA (e.g. Sculptra) stimulates long-term collagen production for gradual, natural-looking results
Benefits:
Immediate improvement (HA)
Long-term collagen boost (PLA)
Customizable for your scar type
What to expect: Minimal swelling or tenderness at the injection site, and results that evolve beautifully over time.
Step 4: Deep Fractional Erbium Laser – Resurfacing & Refinement
Finally, we address the skin surface texture and overall tone using a deep fractional erbium laser. Unlike ablative CO2 lasers, erbium fractional resurfacing is gentler on the skin while still delivering dramatic results in collagen stimulation and textural refinement.
Benefits:
Smoother skin texture
Reduced appearance of shallow scars and pores
Tighter, more radiant skin
What to expect: Depending on the intensity, expect 5–7 days of downtime with redness and flaking. Erbium lasers are preferred for lighter skin types and those seeking a lower-risk option than full ablative CO2.
Why Combination Treatment Works Best
Each scar is different—some are tethered, some are deep and narrow, others are wide and shallow. That’s why no single treatment works for everyone. This 4-step approach allows:
Precision (TCA CROSS for icepick)
Structural repair (subcision)
Volume restoration (filler)
Surface refinement (laser)
Your Personalized Plan
At Model Skin MD, we customize your acne scar treatment based on:
Scar type (rolling, boxcar, icepick)
Skin type and tone
Downtime tolerance
Budget and timeline
This protocol is often spaced over several sessions for optimal safety and results. Visible improvements often begin after just 1–2 visits, with continued remodeling over 3–6 months.
Ready to Reclaim Your Skin?
Book your acne scar consultation today and start your transformation with this gold-standard 4-step treatment. Your smooth, confident skin awaits.