Many patients return four to eight times, at intervals of three to six months or longer, over two to three years. Scar revision is a gradual, cumulative process — each session builds on the last rather than replacing it.
Overview
Different scars need different tools
Acne scars make up more than half of Dr. Henningsen’s practice. Patients travel from across Europe, the Middle East, Asia and the United States for it.
Acne leaves behind three main types of atrophic acne scars, and they rarely arrive alone. Rolling scars are soft, wave-like dips held down by strands of scar tissue anchored in the dermis. Ice-pick scars are narrow and steep, often only a millimetre across but running deep. Boxcars have flat floors and sharp vertical walls, like a small crater. Alongside them sits post-inflammatory erythema — the flat red marks that are not scars at all, and that respond to something else entirely.
This is why one device cannot do the job. A laser passed over a tethered rolling scar heats a surface that is being pulled down from below; the tethering wins. Acid applied to a boxcar floor does very little. The skill in acne scar revision lies almost entirely in reading which pattern is which, and treating each with the instrument that was designed for it.
Dr. Henningsen trained in the manual techniques of acne scar revision under Professor Chu at the West London Dermatology Centre and has since developed his own approach, teaching it at congresses and to dermatologists in training. He is listed as a Recommended Top 1% Acne Scar Specialist on myacnescars.com.
At a glance
- Treatment time45–120 minutes for a combined session
- AnaestheticTopical, local infiltration or nerve block
- Downtime2–7 days of swelling; residual redness up to 6 weeks
- SessionsOften several sessions, typically spaced 3–6 months apart
- ResultsCumulative over a course; assessed on standardised photographs
- Combines withSubcision, TCA CROSS, CO2, Genius RF, fillers
How it works
Read the scar, then choose the tool
The consultation is a mapping exercise. Under direct, oblique and side lighting, different scar populations become visible — and a cheek that looks uniformly “bumpy” to the patient resolves into a mix of tethered rolling scars, discrete ice-pick tracks and shallow boxcars.
Each is then assigned: subcision to release what is tethered, TCA CROSS to rebuild what is too narrow and deep for any device to reach, and a fractional energy device across the field to re-level the surface and drive collagen. Where a released scar leaves a soft hollow, a biostimulator or hyaluronic acid can be placed to support it while new collagen forms.
Most sessions therefore combine two or three methods in a single visit. It is more demanding to plan and more demanding to perform — and it is the reason results keep improving instead of plateauing.
Indications
Suited to
- Rolling scars — soft depressions tethered to deeper tissue
- Ice-pick scars — narrow, deep, steep-walled tracks
- Boxcar scars — flat-floored with sharp vertical edges
- Enlarged pores and irregular surface texture
- Post-inflammatory redness and pigmentation
- Scarring on the cheeks, temples, jawline, chest and back
- Skin of all types, including Fitzpatrick IV–VI with adjusted settings
- Acne that is still active — new lesions during a scar course produce new scars, so the disease is controlled first
- A patient looking for a single treatment rather than a course over months
- Flat red marks alone, which are post-inflammatory erythema rather than scarring and need a vascular laser
- Expectations of scar-free skin rather than substantially improved skin
In the clinic
Step by step
Consultation and photography
Twenty minutes with Dr. Henningsen. Scar types are separated, mapped and photographed in standardised lighting so progress can be measured rather than remembered.
Anaesthesia
Topical anaesthetic, local infiltration, or a nerve block depending on what the session involves. Tumescent anaesthesia is used for wider subcision fields.
The combined session
Typically subcision first to release tethering, then TCA CROSS on individual deep scars, then an energy device across the treated field.
Immediate aftercare
Swelling and pinpoint bleeding are expected. You are shown exactly how to clean and dress the area, and a nurse check-up can be arranged before you travel home.
Review at three to six months
New collagen is still forming at three months. We photograph in the same light, compare, and plan the next session around what has actually changed.
Documented results
Before & after
Drag the handle across each photograph to reveal the result. All images are unretouched and published with written patient consent.
Recovery
What the days afterwards look like
Downtime depends on what was done, and we will tell you the real number before you book a flight.
- Subcision — swelling and bruising for two to four days. Same-day travel is possible.
- TCA CROSS — swelling for a day, small crusts for about a week, then residual redness for four to six weeks.
- Genius RF — swelling for around four days; a faint grid pattern can remain visible for up to eight weeks.
- CO2 or erbium laser — four to fourteen days of swelling, oozing and crusting depending on depth, then redness for up to three months.
Travelling to us? Most patients stay one or two nights before flying home. Same-day travel is possible with some redness and swelling, and a nurse can see you before departure.
Risks
What can go wrong
Expected
Swelling, bruising, crusting and redness in proportions that depend entirely on which methods were combined. The figures for each are on that treatment's own page.
Uncommon
Post-inflammatory hyperpigmentation, which is the risk that most often determines what we use and at what settings, particularly in darker skin. Prolonged redness. Infection.
Rare but serious
Scarring from treatment intended to treat scarring — from excessive energy, from infection, or from acid that ran outside the scar it was placed in. It is rare, it is almost entirely technique-dependent, and it is the reason this work is done by a dermatologist rather than delegated.
Evidence
What the evidence shows
What the evidence can — and cannot — tell usThe Cochrane review of interventions for acne scarring covered twenty-four randomised trials and 789 participants and concluded that the results do not support first-line use of any intervention. The only moderate-certainty finding in the whole review was for injectable filler. A structural reason recurs in every review of this field: there is no standardised, validated scale for grading acne scars, so outcomes cannot be compared between trials — which is why the confident percentages quoted across this industry should be read with scepticism, including when they are quoted in our favour.
What the literature does support, consistently and from several directions, is that scar subtype determines the instrument. Rolling and tethered scars respond to subcision, and better than they do to acid. Ice-pick scars respond to TCA CROSS, and better than they do to needling. Boxcars respond to fractional ablative resurfacing. Red marks respond to a vascular laser and to nothing else on this list. And across almost every comparison that has been made, combinations outperform any single method used alone.
That is the entire argument for how this practice works, and it happens to be the best-supported principle in the field.
Questions
Good to know
If your question is not here, ask it in the enquiry form — Dr. Henningsen answers these personally.
Ask a question- How many treatments will I need?
- How much improvement should I expect?
In our hands, most patients see a meaningful step at each session and a cumulative change over a course that is considerably more than any single treatment achieves. We have deliberately stopped quoting a percentage per session: there is no validated scale for grading acne scarring, which means the precise figures circulating in this field are not comparable between clinics or between studies. What is reasonable to expect is scars that are shallower, softer-edged and far less visible in ordinary light — not skin that has never scarred.
- Is the improvement permanent?
The structural work largely is — a released tether does not re-form, and new collagen is real tissue. But it is not static. Volume loss with age changes how any scar reads over decades, and some scars are held by more tethering than one course can release. We photograph in standardised conditions precisely so that this is a measurement rather than an impression.
- Can I have my consultation and treatment on the same day?
We strongly recommend an online consultation first. Treatment planning determines how much clinic time, anaesthetic and equipment your session needs, and doing that properly in advance is the difference between an adequate result and a good one.
- Do I need to stop active acne treatment first?
Mild acne is not a barrier. Moderate to severe acne is treated first — otherwise new lesions create new scars behind the ones we are correcting.
- Are fillers used?
Sometimes, and deliberately. Where subcision releases a scar and leaves a soft hollow, a hyaluronic acid filler or a collagen biostimulator such as calcium hydroxylapatite can support the floor while new collagen forms. With tumescent anaesthesia, filler is not appropriate in the same sitting because the anaesthetic drains it.
Consultation
Ready to talk about your skin?
Consultations with Dr. Henningsen are arranged individually. Tell us what you would like to change and we will come back to you with the options, the honest downtime and the realistic result.