By Olympia Morris, PA-C · Medically reviewed by Dr. Oliver Morris, Medical Director
If you fought acne for years and won, only to be left with dents, shadows, and pores that seem to grow every time you look in the mirror, you already know the frustration. The breakouts stopped. The reminders didn’t. This is one of the most common concerns we hear at Olympia Aesthetics & Wellness in Palm Harbor, and it’s also one of the most misunderstood, because “acne scars” and “large pores” are actually several different problems wearing the same name.
Here’s the honest version. Some of what you see can improve a lot. Some of it can improve a little. And a few stubborn scars really do need specialized techniques that go beyond a standard in-office series. Knowing which is which saves you money, time, and the disappointment of chasing the wrong fix. Let’s sort it out.
First, are they scars or marks?
This distinction matters more than almost anything else, because the treatments are completely different.
True scars are changes in the skin’s structure. Acne damaged the collagen, and the surface healed unevenly. You can often feel these with a fingertip. They cast a shadow. They don’t fade on their own.
Marks are changes in color, not texture. The skin is smooth, but discolored where a breakout used to be. These usually fade with time and the right care, and they respond to a different set of treatments than true scars.
Two common marks get mistaken for scars all the time:
- Post-inflammatory hyperpigmentation (PIH) is the brown or tan spot left behind after a pimple heals, especially in medium to deeper skin tones. It’s pigment, not a divot.
- Post-inflammatory erythema (PIE) is the pink, red, or purple flat mark that lingers after a breakout, more common in lighter skin. It’s dilated blood vessels near the surface, not a scar.
If your “scars” are flat and colored, you’re likely dealing with PIH or PIE, and our companion guide on pigmentation and sun damage covers those in depth. The rest of this page focuses on true textural scars and pore size.
The four types of true acne scars
Atrophic (indented) acne scars come in a few shapes, and matching the shape to the treatment is the whole game.
Rolling scars
Broad, shallow, wavy depressions that give skin a gently uneven, undulating look. They’re caused by fibrous bands tethering the skin down from underneath. Rolling scars respond well to collagen-stimulating treatments and, when tethering is stubborn, to release of those bands.
Boxcar scars
Round or oval depressions with sharper, more defined edges, like a small crater. They can be shallow or deep. Shallow boxcars respond nicely to resurfacing and collagen induction. Deeper ones take more sessions and sometimes a combination approach.
Ice pick scars
Narrow, deep, V-shaped punctures that look like the skin was pricked with a fine tool. These are the most stubborn. Because they’re deep and narrow, energy treatments that work across the surface often can’t reach the bottom, which is why ice pick scars frequently need a targeted technique like TCA CROSS or minor procedural work. We’ll be honest about that below.
Hypertrophic and keloid scars
Less common with facial acne, these are raised rather than indented, more typical on the chest, shoulders, and back. They’re managed differently, often with injections rather than resurfacing.
Why do pores look large?
Pores don’t have muscles. You can’t actually shrink the opening the way a lot of marketing implies. What you can do is change how large they appear, and that’s a real, achievable goal.
Pores look bigger for a few reasons. Genetics set your baseline size. Oil production stretches the opening, so oilier skin tends to show more prominent pores. Sun damage and age reduce the collagen and elastin that keep the pore’s edges taut, so it starts to sag open. And a pore clogged with oil and dead skin simply looks wider than a clean one.
That’s why “how to minimize pores” comes down to a combination: keeping them clean and unclogged, controlling oil, and rebuilding the collagen scaffolding around them so the edges stay tight. The treatments that help acne scars, it turns out, help pore appearance too, because both are collagen problems at heart.
Treatments that genuinely help
RF microneedling with Sylfirm X
This is often our first choice for textural acne scars and enlarged pores together. RF microneedling uses tiny needles to create controlled micro-injuries, then delivers radiofrequency energy at the right depth to heat the deeper skin and trigger new collagen. The result is remodeling from within, which firms the skin, softens depressions, and tightens the tissue around pores.
At Olympia we use Sylfirm X, not Morpheus8. Sylfirm X is a pulsed-wave and continuous-wave RF microneedling system that lets us tailor the energy to your skin and concern. A systematic review of fractional radiofrequency microneedling found it a consistently effective, minimally invasive option for acne scarring, and controlled trials have shown measurable reductions in scar volume across a treatment series. It also works across a range of skin tones with a comparatively low risk of pigment changes when done correctly, which matters for anyone prone to PIH.
Learn more on our RF microneedling page, and see our companion guide on RF microneedling for how the technology works.
Fractional laser resurfacing (HALO, ProFractional)
Fractional lasers create tiny columns of treated skin surrounded by untouched skin, so you get real resurfacing with a faster recovery than old-school full-field lasers. This rebuilds collagen and smooths the surface, which is powerful for boxcar and rolling scars and for overall texture and pore refinement.
We offer Sciton HALO, a hybrid fractional laser that combines ablative and non-ablative wavelengths in one pass, and ProFractional, a purely ablative fractional option for deeper resurfacing. Systematic reviews of fractional laser for acne scars report most patients seeing meaningful improvement in scar appearance, with ablative fractional lasers generally producing the larger gains. See our HALO page for details.
Chemical peels (VI Peel)
Peels remove damaged surface layers and stimulate turnover, which helps with tone, mild texture, and the discoloration of PIH and PIE. On their own, medium-depth peels are better for marks and superficial texture than for deep scars, but they’re a valuable part of a plan and pair well with energy treatments. Our VI Peel is a good starting point for tone-and-texture concerns.
The honest part: deep ice pick scars
Here’s where we won’t oversell. Deep, narrow ice pick scars often don’t respond fully to surface treatments alone, because the energy can’t reach the bottom of the scar. These frequently need adjunct techniques:
- TCA CROSS, where a high concentration of trichloroacetic acid is applied precisely into the individual scar to trigger collagen from the base up. Studies show ice pick scars are particularly responsive to this focal technique.
- Subcision, a minor procedure that releases the fibrous bands tethering rolling scars from underneath, often combined with RF microneedling for better results than either alone.
Some patients are excellent candidates for these in our hands, and some deep or extensive cases are better served by a dermatologic surgeon or a scar-revision specialist. If that’s you, we’ll tell you plainly and point you in the right direction. We’d rather you get the right result than the one we happen to sell.
Which treatment for which problem
| Scar or pore type | What it looks like | Best-fit treatment |
|---|---|---|
| Rolling scars | Broad, shallow, wavy dips | Sylfirm X RF microneedling; subcision if tethered |
| Boxcar scars (shallow) | Small craters, defined edges | HALO or ProFractional; RF microneedling |
| Boxcar scars (deep) | Deeper craters | Combination: RF microneedling plus fractional laser, series |
| Ice pick scars | Narrow, deep punctures | TCA CROSS, often with a referral for extensive cases |
| Enlarged pores | Prominent pore openings | Sylfirm X RF microneedling; HALO; consistent skincare |
| PIH (brown marks) | Flat tan or brown spots | Peels, targeted skincare (see pigmentation guide) |
| PIE (red or pink marks) | Flat pink to purple marks | Often fades with time; laser for vascular redness |
Setting realistic expectations
Two things to hold onto before you start.
First, the goal is improvement, not erasure. Good treatment can take scars from something you notice every day to something you rarely think about. Skin that healed unevenly can be remodeled and softened, but it won’t become the skin you had before acne. Any provider promising 100 percent is overpromising.
Second, this is a series, not a single visit. Collagen remodels slowly. Most people need three to six sessions spaced several weeks apart, and the fuller result keeps developing for months after the last treatment as new collagen matures. Patience is part of the plan, and so is sun protection, because fresh collagen and unprotected sun exposure don’t mix.
Where to start
The right plan starts with an accurate read of your skin. During a consultation we assess your scar types, your skin tone, and your oil and pigment tendencies, sometimes using VISIA skin analysis to see what’s below the surface, then build a sequence that fits. Every aesthetic procedure at Olympia is performed by Olympia Morris, PA-C, under the medical oversight of Dr. Oliver Morris, our Medical Director.
Curious what a plan would cost? Our current pricing is published and transparent, and we serve Palm Harbor, Clearwater, Dunedin, Tarpon Springs, and the greater Tampa area. If you’d like a professional set of eyes on your skin, we offer complimentary virtual consultations to get you started.
Book your consultation and let’s figure out which of these actually fits your skin.
Frequently asked questions
Can acne scars be completely removed?
Honestly, no. The realistic goal is significant improvement, not erasure. With the right treatment series, most people see scars become much less noticeable, to the point where they stop thinking about them daily. Anyone promising complete removal is overpromising.
How do I minimize large pores for good?
You can’t permanently shrink the pore opening itself, but you can make pores look markedly smaller and keep them that way with maintenance. Keeping pores clean, controlling oil, and rebuilding collagen with RF microneedling or fractional laser tightens the tissue around each pore. Ongoing skincare and periodic treatments hold the result.
Is RF microneedling or laser better for acne scars?
It depends on your scars and skin. Sylfirm X RF microneedling is often ideal for textural scars plus pores and works well across skin tones. Fractional lasers like HALO shine for resurfacing boxcar and rolling scars and overall smoothness. Many people do best with a combination, which we map out at your consultation.
How many sessions will I need?
Most patients need three to six sessions spaced several weeks apart, with results continuing to develop for months afterward as new collagen matures. Deeper scars generally need more sessions, and a maintenance treatment now and then keeps things looking their best.
What about deep ice pick scars?
These are the most stubborn because surface treatments can’t reach the bottom of the scar. They usually need a targeted approach like TCA CROSS or subcision. Some cases we treat well in-house, and some extensive cases are better served by a scar-revision specialist. We’ll give you an honest assessment either way.
Are these treatments safe for darker skin tones?
Yes, with the right settings and an experienced provider. Sylfirm X in particular is designed to treat a range of skin tones with a lower risk of pigment changes. Post-inflammatory hyperpigmentation is a real consideration for medium and deeper tones, which is exactly why the assessment and technique matter so much.
References
- Fractional Radiofrequency Microneedling as a Monotherapy in Acne Scar Management: A Systematic Review of Current Evidence. PubMed. https://pubmed.ncbi.nlm.nih.gov/39781098/
- Efficacy of Microneedle Fractional Radiofrequency Combined With Topical Insulin for the Treatment of Facial Atrophic Acne Scars: A Split-Face, Double-Blinded, Randomized, Placebo-Controlled Trial. PubMed. https://pubmed.ncbi.nlm.nih.gov/39970082/
- The Use of a Fractional Laser in Acne Scar Treatment: A Systematic Review. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12194615/
- An Assessment of the Efficacy and Safety of CROSS Technique with 100% TCA in the Management of Ice Pick Acne Scars. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC2956965/
- A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC5965325/
