What do I look for during the first consultation?
I first distinguish active acne from the changes left behind by previous acne. Red or brown marks and true structural depressions are not the same problem.
For depressed scars, I look at depth, distribution, movement relative to the surrounding tissue and the contribution of volume loss. Raised scars or a tendency toward keloid formation can lead to a different treatment pathway.
I also ask about previous laser treatments, microneedling, subcision, fillers or chemical peels and whether significant pigmentation followed any of them.
If you are currently taking isotretinoin, this should be mentioned during the consultation because it can affect procedure selection and timing.
When useful, I supplement standard photography with digital skin imaging. Light and shadow simulation can help document how depressions appear under different illumination, while colour analysis can help distinguish redness from pigmentation.
How is the treatment plan built?
After examination, I group the dominant problems rather than assigning a separate procedure to every visible scar.
For selected narrow and deep scars, TCA CROSS or focal radiofrequency treatment of individual scars may be considered.
For broader depressions that are tethered to deeper tissue, subcision may be appropriate.
When surface texture is the main problem, conventional microneedling, RF microneedling or fractional CO₂ laser may be considered.
When volume loss contributes significantly to the appearance, dermal filler or fat transfer may be incorporated into the plan.
For a more detailed explanation of why particular methods suit different scar features, see Choosing Acne Scar Treatment: Matching Treatment to Scar Type.
Is treatment performed in one session or in stages?
Some patients can begin with a single treatment, while others benefit from addressing different problems in sequence.
For example, after tethered depressions are released, the remaining surface irregularity may become easier to assess. In another patient, individual deep scars may be treated first. The next step is based on what remains after the initial treatment rather than on a fixed package.
For patients travelling from abroad, treatment can sometimes be organised around a single visit when clinically appropriate. A preliminary assessment can be made from suitable photographs before travel to help plan the visit, but the final decision about which procedures can be safely and meaningfully combined is made after the in-person examination. Follow-up can continue remotely when appropriate.
If significant inflammatory acne is still active, reducing the risk of further scarring takes priority and this may change the timing of scar procedures.
What will I know after the consultation?
By the end of the consultation, the aim is to clarify which scars are the treatment priority, which tissue problems are contributing most to their appearance, which treatment is being considered first and whether the plan is likely to be a single stage or a staged process.
We also discuss the expected recovery after the first procedure and when reassessment should take place. Any later treatment is selected according to what actually remains after the first stage.
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