Acne Scar Treatment: Pico + Microneedling + Subcision — VERZO CLINIC Bangkok

TL;DR: Acne scars fall into three main categories: ice pick scars (narrow, deep holes), boxcar scars (broad depressions with sharp edges), and rolling scars (wide, shallow undulations). Most patients have a mix of types. Treatment approach depends on the dominant scar type, depth, and skin texture.

Written by Dr. Waleerat Thaweebanchongsin, licensed aesthetic medicine specialist with over 10 years of specialized experience in scar treatment. VERZO CLINIC near BTS Ekkamai, Sukhumvit Road. Free consultations via LINE @verzo.

Last updated: April 2026

Frequently Asked Questions

What are the different types of acne scars?

Acne scars fall into three main categories: ice pick scars (narrow, deep holes), boxcar scars (broad depressions with sharp edges), and rolling scars (wide, shallow undulations). Most patients have a mix of types. Treatment approach depends on the dominant scar type, depth, and skin texture.

How does pico laser help acne scars?

Pico laser with MLA (Micro-Lens Array) creates controlled micro-injuries that stimulate collagen remodeling. The focused energy breaks up scar tissue and promotes new collagen formation to fill in depressed scars. It is most effective for shallow boxcar scars and overall texture improvement. Typically 4-6 sessions at 4-week intervals.

What is microneedling (Exceed) for acne scars?

Microneedling uses fine medical-grade needles to create controlled micro-channels in the skin, triggering the wound healing cascade and collagen production. Exceed is an advanced microneedling device with precise depth control. It excels at treating widespread texture irregularities and shallow to moderate scarring.

What is subcision for acne scars?

Subcision is a minor surgical technique where a needle or cannula is inserted beneath a tethered (pulled-down) scar to release the fibrous bands anchoring it to deeper tissue. This allows the scar to rise to the skin surface level. It is the gold standard for rolling scars and is often combined with filler like Ejal40 for optimal results.

Can these treatments be combined?

Yes, combination protocols are the most effective approach. A common protocol is subcision for tethered scars, followed by Ejal40 filler to prevent re-tethering, then pico laser or microneedling for overall texture refinement. Dr. Waleerat designs personalized combination plans based on scar assessment.

How many sessions do acne scar treatments require?

Ice pick scars: 3-5 sessions of TCA CROSS or subcision. Boxcar scars: 4-6 sessions of pico laser. Rolling scars: 2-3 subcision sessions plus 4-6 pico or microneedling. Realistic improvement ranges from 30-70% depending on scar severity and type.

What is the Ejal40 + subcision combination?

After releasing tethered scars with subcision, Ejal40 (polynucleotide-based bio-stimulator) is injected into the subcised area. This prevents the scar from re-adhering and stimulates tissue regeneration. The combination provides better results than subcision alone, as demonstrated in clinic protocols.

How much does acne scar treatment cost in Bangkok?

Pico laser per session: 3,000-8,000 THB. Microneedling per session: 4,000-8,000 THB. Subcision per area: 5,000-15,000 THB. Combination programs: 25,000-80,000 THB for a full course. Bangkok pricing offers significant savings versus equivalent treatments in Western countries.