Acne scarring is the most requested scar treatment in Australian clinics and the most often disappointed, because “acne scars” is not one condition. It is at least four, and each responds to a different energy. A clinic that can tell them apart at consultation, and has the tools to treat more than one, keeps the patient. A clinic that treats every scar the same way loses them after two sessions.
First, is it a scar or a mark?
Much of what patients call acne scarring is post-inflammatory pigmentation or persistent redness, flat marks left after the lesion healed. These are not scars and do not need resurfacing. Red marks respond to vascular wavelengths, brown marks to pigment wavelengths or a low-fluence Q-switched pass, and both fade with time and sun protection. Treating a flat mark with an ablative laser adds downtime and risk for no gain. Sorting this out at consultation, ideally with a skin analysis system such as Alma IQ, is the single most useful thing a clinic can do.
The four true scar types
- Rolling scars are broad, shallow undulations tethered by fibrous bands beneath the skin. They respond well to fractional resurfacing, and the best results come when subcision releases the tethers first.
- Boxcar scars are wider depressions with sharp vertical edges. Fractional ablative resurfacing is the standard treatment, because it remodels the edges as well as stimulating the base.
- Ice pick scars are narrow, deep pits. Lasers alone under-deliver here. They are usually treated with a focal chemical technique or punch excision first, with resurfacing to blend the result.
- Hypertrophic and keloid scars are raised, and they are the opposite problem. Aggressive ablation can make them worse. They call for vascular and non-ablative approaches, often alongside intralesional treatment, and keloid-prone patients need conservative settings throughout.
Which Alma technology for which scar
- Alma Pixel CO2, fractional ablative at 10,600nm, is the workhorse for atrophic boxcar and rolling scars. Depth and density are set per patient with the LiteScan scanner. Pixel Peel randomises the firing pattern to shorten recovery at the same treatment density.
- Alma Hybrid fires ablative CO2 and non-ablative 1570nm side by side at a ratio the operator sets. For acne scarring that means one pass can be weighted towards dermal remodelling for a younger patient, or towards surface correction for textured, photodamaged skin, without changing machine. The 1570nm component is also what lets Hybrid treat darker skin types more conservatively.
- ClearSkin Pro on Alma Harmony is a non-ablative applicator that treats active acne and early scarring in the same course, which matters because you cannot resurface skin that is still breaking out.
- Alma Opus fractional plasma reaches a comparable endpoint to fractional ablative laser with shorter downtime, which makes it the volume tool for mild to moderate scarring and the platform of choice where a laser is not the right fit for the practice.
Skin type is the safety line
On Fitzpatrick IV to VI, post-inflammatory hyperpigmentation after resurfacing is the failure mode, not burns. Lower density, longer intervals, a bias towards non-ablative energy and a test area first all reduce that risk, and the patient should be on strict sun protection before the first session, not after. Darker skin can be treated well; it cannot be treated the same way.
What a realistic course looks like
Active acne has to be under control first, or every treatment is chasing new scars. Then most patients need a course rather than a session: typically three to five treatments spaced four to eight weeks apart, with collagen remodelling continuing for three to six months after the last one. Improvement is the honest word, not erasure. Photograph under identical lighting at every visit, because patients who see their own progress objectively stay the course and refer.
Case material and further reading
Alma publishes real acne scar cases treated in clinic, including a case analysis for acne and acne scars, the Treat a Scar, Save a Soul webinar, and an overview of Alma’s scar revision platforms. Peer-reviewed studies are listed in the clinical resources centre.
Buying from the manufacturer
Alma Lasers Australia is Alma’s own Australian subsidiary, not a reseller, and covers New Zealand from Sydney, so training, protocol support, service and parts come from the same team that sold you the platform. We do not publish list prices, because the configuration depends on which applicators your clinic will use. Bring your treatment prices and weekly bookings to a demo and we will build the numbers with you. Equipment finance is available through Medfin.
Laser scar removal: choosing the type of laser by scar type and skin tone
Clinics searching for laser scar removal equipment usually have three questions: which types of scars respond, which type of laser suits each one, and what happens on darker skin tone. The honest answers shape the treatment plan and the platform you buy.
Types of scars. Atrophic acne scars (ice pick, boxcar, rolling) respond to fractional laser resurfacing that stimulates collagen beneath the pit. Surgical and traumatic scars respond to a mix of resurfacing for texture and vascular treatment for redness. Hypertrophic and keloid scars need a different approach, usually vascular laser or fractional delivery of medication, and should be assessed by a doctor. Stretch marks are treated as a form of scar with fractional resurfacing or microplasma.
Type of laser. Fractional CO2 (Alma Hybrid, Pixel CO2) gives the strongest remodelling for deep atrophic scars, with several days of downtime. The 1570 nm non-ablative laser on Hybrid, and plasma resurfacing on Alma Opus, give a gentler option for milder scarring or patients who cannot take time off. Dye-VL on Harmony treats the redness in fresh scars. Alma Hybrid lets the practitioner combine ablative and non-ablative energy in one pass, which is why it is the platform most Australian scar clinics choose first.
Skin tone. Fitzpatrick IV to VI skin carries a higher risk of post-inflammatory pigmentation after aggressive ablative laser, so the treatment plan on darker skin tone leans on non-ablative 1570 nm, plasma or microplasma, with lower density and more sessions. Alma’s clinical training covers the settings and the pre- and post-care that keep this safe.
Treatment plan. Most scar revision courses run three to five sessions, four to six weeks apart, with photographs at baseline and at review. Results build over three to six months as collagen remodels, so clinics quote a course rather than a single treatment.
