E-Scar – Medical Acne Scar Treatment

Atrophic scars are a common consequence of severe inflammatory acne or acne that has been treated incorrectly. When the damage is prolonged or inflammation spreads deep from the epidermis into the dermis, the skin's supporting structure is affected, leaving indentations on the surface.

Atrophic scars generally form through several stages:

• Destruction of collagen and elastin in the inflamed area — the two proteins primarily responsible for skin elasticity and structure.
• Damage to the supporting tissue beneath the skin in the dermis, leaving the surface without a foundation.
• The skin loses its structure and collapses inward, forming depressions of varying shapes.
• Older scars become harder to improve as fibrous tissue forms and the filling response diminishes over time.

Understanding this mechanism explains why topical products struggle to "fill in" atrophic scars — the real damage sits in the dermis, beyond the reach of most conventional skincare actives.

Ice pick scars. Small openings with deep, narrow bases that often extend into the dermis. The hardest type to improve with surface-level methods.

Boxcar scars. Wide openings with flat bases and sharply defined edges. They can be shallow or deep depending on the original damage.

Rolling scars. Wide openings with undulating bases, caused by fibrous bands tethering the scar base to the tissue below. Usually requires subcision to release.

On a single face, a client typically has several scar types coexisting — which is why a treatment protocol needs to combine multiple techniques rather than apply one fixed method.

A common belief is that scars should be treated as early as possible. In reality, intervening on atrophic scars while the skin is unstable can worsen inflammation and slow recovery.

Your skin needs to be carefully assessed before scar treatment begins:

• Inflammatory acne has been controlled, with no active inflammatory lesions.
• The skin barrier is healthy enough to tolerate mildly invasive procedures.
• The skin is not in a phase of irritation or peeling from strong treatments.
• The client already has a stable skincare routine.

Conversely, if scars are left for too long, fibrous tissue in the dermis thickens and the response to filling methods tends to decline. The best time to treat atrophic scars is therefore when the acne has stabilised but the scars have not yet fully fibrosed — something that needs to be assessed directly by a dermatologist on each individual skin type.

Every skin type and every scar type has its own characteristics. Applying the same method to all clients often leads to uneven results and wasted time and money. There is no single technology or method that suits every scar type.

Some common mistakes when treating acne scars without a suitable protocol:

• Self-trying multiple products that do not suit the skin's condition.
• Treating in the wrong direction, prolonging the course.
• Inexperienced technicians performing uncontrolled procedures.
• Acne progressing into severe inflammation, leaving dark marks and new scars.

At Eternal we do not build a protocol around a single fixed technology. Instead, the doctor assesses the skin comprehensively to select and combine the most suitable methods at each stage. Successful scar treatment is not about using many technologies — it is about choosing the right method for the right skin.

An in-depth skin consultation at Eternal differs from an ordinary consultation in that it is carried out directly by a dermatologist, with skin scanning and a real assessment of the skin base before any treatment direction is proposed.

The consultation includes:

• Reviewing your skin history and current care habits.
• Scanning and assessing the actual skin base with specialised equipment.
• Analysing the level of inflammation and the risk of dark marks and scarring.
• Identifying the root cause (hormones, skin barrier, an incorrect routine, etc.).
• Proposing a personalised treatment direction suited to your skin's condition.

During the one-on-one consultation, clients discuss their skin and scar concerns directly with the doctor and receive a personalised protocol. The doctor also adjusts the skincare routine to suit each stage of treatment.

The results of acne scar treatment show not only in the depressions being filled in but also in an overall change in the skin's structure:

Before treatment: the skin is often thickened and rough, lacks radiance and shows mild sagging in areas with many scars.

After the treatment journey: the skin is smoother, hydration improves, and it becomes firmer with better collagen growth in the treated areas.

A real case at Eternal: a client with long-standing, multi-type post-acne scarring who had previously undergone CO2 laser and subcision elsewhere without improvement. After an E-Scar course, scars were filled in by around 90–95% depending on scar type — a clear improvement after only about one month.

Another real case: a client with atrophic scars present for over 5 years across rolling, boxcar and ice-pick types. After a course combining subcision, TCA Cross and microneedling, scar depth and surface texture improved markedly — ice-pick scars improved by around 80%. Individual responses vary. See more real treatment case files recorded at Eternal.

Eternal is committed to using only entirely real images, recorded at Eternal or sent by clients. Original videos and images are always available for clients to view and verify.