Why Won’t My Acne Scars Go Away — And What Actually Works?
Acne scars can be frustrating because they often linger long after the breakout itself is gone.
The redness may fade. The skin may calm. Active acne may finally feel more under control. But the uneven texture, shallow indentations, enlarged-looking pores, and rough patches left behind can remain visible — especially in certain lighting or under makeup.
That is because true acne scars are not simply sitting on the surface of the skin. They form deeper, where inflammation has disrupted the way collagen repairs itself. Once that scar tissue is established, topical skincare alone usually cannot remodel it.
This is exactly why microneedling has become such an important acne scar treatment.
At Cool Springs Plastic Surgery, our Aesthetics Center uses SkinPen microneedling to help improve the appearance of acne scars, rough texture, enlarged pores, dullness, hyperpigmentation, and overall skin quality. The goal is not to erase skin history overnight. It is to stimulate the skin’s natural repair process so texture can gradually look smoother, more refined, and more even over time.1
The Real Reason Acne Scars Stick Around
When a breakout causes significant inflammation, the skin rushes to repair itself. But that repair process is not always precise.
Instead of rebuilding smooth, organized collagen, the skin may lay down collagen in a disrupted pattern. That uneven repair creates the textural irregularities many people recognize as acne scarring — pitting, shallow depressions, rolling texture, and rough areas that do not respond the same way discoloration does.
That scar tissue is not damaged skin waiting to heal — it is healed skin, just healed incorrectly.
This is why acne scars often resist the creams, toners, brightening products, and exfoliants that can work well for surface-level concerns. Skincare can absolutely help with tone, dullness, post-breakout discoloration, congestion, and barrier support. But when the concern is true textural scarring, the skin usually needs a treatment that works below the surface.
What Microneedling Actually Does
Microneedling, also called collagen induction therapy, works by creating controlled micro-channels in the skin using fine needles. These micro-injuries are small and precise, but they send a meaningful signal to the body: begin repair.
As the skin responds, it produces new collagen and elastin — two proteins that help support skin structure, firmness, and smoothness.2
The key word is controlled.
This is not random irritation or surface exfoliation. It is a calibrated treatment designed to prompt the skin to rebuild more effectively. Over a series of treatments, that remodeling process can help soften the look of acne scars, refine visible pores, improve rough texture, and support a smoother-looking skin surface.
At Cool Springs Plastic Surgery, microneedling is performed with SkinPen Precision, a professional microneedling device used to create consistent, controlled treatment depth. SkinPen Precision is FDA-cleared to improve the appearance of facial acne scars in adults age 22 and older.3
The CSPS Approach to Microneedling
Not all microneedling treatments are performed the same way. Provider experience, treatment depth, skin evaluation, and overall treatment planning all play a major role in both safety and results.
At CSPS, microneedling is performed in a medical aesthetics environment by licensed estheticians. Treatments are planned around your skin type, scar pattern, sensitivity, downtime, and goals — not just the treatment name on the schedule.
That distinction matters because acne scarring is rarely one-size-fits-all.
Some patients have shallow rolling scars. Some have more defined boxcar scars. Some are dealing with a combination of acne scars, post-breakout discoloration, enlarged pores, congestion, dullness, or uneven tone. A good treatment plan needs to account for all of that.
CSPS’s microneedling page currently lists acne scars, enlarged pores, rough texture, hyperpigmentation, dullness, fine lines, and overall skin quality among the concerns microneedling may help address. It also notes that most patients benefit from a series of treatments, commonly spaced about four to six weeks apart.1
Proven Experience You Can Trust
When it comes to your skin, experience is the most important factor in achieving safe, transformative results. At Cool Springs Plastic Surgery, we have been at the forefront of skin rejuvenation since we first began offering microneedling in 2014.
Since then, our team has performed a total of 5,726 microneedling appointments across our locations. Our commitment to excellence remains as strong as ever — in the last 12 months alone, we have successfully treated 672 patients, helping them address concerns like acne scarring and uneven texture in our Brentwood and Franklin offices.
When PDGF May Be Added
For patients who want to enhance their treatment, CSPS also offers microneedling with PDGF.
PDGF stands for platelet-derived growth factor. During treatment, PDGF can be applied topically so it works through the micro-channels created by microneedling. The goal is to support the skin’s healing response and collagen-building process.
This is not PRP. There is no blood draw involved.
PDGF may be recommended for patients with more advanced texture concerns, acne scarring, or those who want additional regenerative support with their treatment plan. Not every patient needs it, and your provider will determine whether standard microneedling, microneedling with PDGF, or another resurfacing option makes the most sense for your skin.
What to Expect
Before Treatment
Your provider will assess your skin, review your concerns, and discuss the appropriate protocol and number of sessions for your goals. Microneedling works best as a series. For acne scars or more visible texture concerns, several treatments may be recommended.
During Treatment
A topical numbing cream is applied beforehand to help keep you comfortable. The SkinPen device is then passed over the treatment area in controlled sections. Most patients describe the sensation as warmth, vibration, or pressure rather than sharp pain.
After Treatment — Days One and Two
Your skin may look and feel similar to a sunburn. Warmth, tightness, redness, sensitivity, and mild flaking can be normal. Minor pinpoint bleeding during treatment may also occur. CSPS currently advises patients to avoid sun exposure and avoid applying makeup for at least 24 hours after microneedling.1
After Treatment — Day Three and Beyond
For many patients, visible redness improves significantly within a few days. Skin may feel slightly dry or appear subtly brighter as the initial healing phase settles. The deeper healing process that improves acne scars and uneven texture continues over the following weeks.
Results
Surface radiance and smoother-feeling skin may appear earlier, but acne scar improvement is gradual. More meaningful changes typically build over a series of treatments as new collagen develops.
In this example, Natalie Moros, LPN applied numbing cream beforehand, and Chrissy Handly, RN experienced the temporary sunburn-like appearance that is common immediately after treatment. You can already see noticeable improvement in skin brightness and texture within just five days.
Follow us on Instagram for more cases like this or check out our Microneedling Before & After Gallery.
When Acne Scars Need a Combination Plan
Microneedling is one of the strongest starting points for acne scars because it addresses collagen remodeling. But acne scars are often only one part of the bigger skin picture.
Some patients also have post-inflammatory discoloration, redness, rough surface texture, active congestion, sun damage, or enlarged-looking pores. When that happens, the best plan may include more than one tool.
Depending on your skin and goals, your provider may recommend:
- Microneedling to support collagen remodeling and improve the appearance of acne scars and texture
- Microneedling with PDGF for additional regenerative support
- Chemical peels to help improve surface dullness, discoloration, and uneven tone
- BBL, MOXI, or HALO when pigment, redness, sun damage, or more advanced resurfacing needs are part of the concern
- Medical-grade skincare to support barrier health, maintain results, and help keep skin clearer and more even between treatments
The important part is that your treatment plan should be built around your skin — not around a single procedure.
Skincare That Helps Maintain Results
Skincare cannot replace microneedling for true depressed acne scars, but it can make a meaningful difference in how your skin looks between treatments and how well your results are maintained.
The right routine can help support clearer pores, smoother texture, brighter tone, a stronger barrier, and better protection from future discoloration. A few CSPS shop products that may fit into an acne-scar maintenance plan include:
Daily Clarifying Pads
Daily Clarifying Pads are a strong option for blemish-prone, congested, or uneven-textured skin. CSPS describes them as formulated with salicylic and glycolic acid to help refine pores, reduce breakouts, and smooth skin texture.5
Koji Brightening Pads
Koji Brightening Pads may be helpful when post-breakout discoloration, brown spots, dullness, or uneven tone are part of the concern. CSPS describes them as daily-use brightening pads designed to visibly improve brown spots, uneven tone, dullness, and texture.6
Skin Balancing Serum
Skin Balancing Serum is a smart support product for patients who need lightweight hydration and skin-calming support without a heavy finish. CSPS lists it among its best-selling medical-grade skincare products and describes it as a reset product to soothe irritation and refine skin texture.7
EltaMD UV Clear Broad-Spectrum SPF 46
For acne scars, sunscreen is essential. UV exposure can make discoloration look darker and make uneven tone more noticeable, especially when using exfoliating products or undergoing resurfacing treatments. CSPS describes EltaMD UV Clear Broad-Spectrum SPF 46 as a lightweight, oil-free sunscreen designed for sensitive, acne-prone, and rosacea-prone skin.8
Your provider can help determine which products to use before treatment, which to pause, and when to restart them afterward.
SHOP SKINCARE FOR ACNE-PRONE SKIN →
Who Is a Good Candidate?
Microneedling may be appropriate for patients concerned with:
- Atrophic or depressed acne scars
- Rolling or boxcar-style scar patterns
- Enlarged-looking pores
- Rough or uneven skin texture
- Dullness
- Mild discoloration
- Fine lines
- Overall skin quality
A consultation is the right starting point. Your provider will evaluate your skin, scar type, current acne activity, sensitivity, pigment risk, and goals to determine whether microneedling is the right treatment — and whether PDGF, chemical peels, lasers, or skincare should be part of the plan.
Microneedling may not be appropriate for patients with active breakouts in the treatment area, certain inflammatory skin conditions, open wounds, infection, or pregnancy-related restrictions. Your provider will review your full history before treatment.
Frequently Asked Questions
How is microneedling different from a facial or chemical peel?
A facial works primarily at the surface of the skin. It can cleanse, exfoliate, hydrate, and temporarily improve the look of tone and texture. A chemical peel exfoliates the outer layers of the skin to help improve brightness, discoloration, and surface texture. Microneedling works differently — it creates controlled micro-channels that stimulate collagen production below the surface. For acne scars and structural texture concerns, that deeper remodeling is what makes microneedling especially valuable.
How many microneedling treatments do I need for acne scars?
Most patients need a series. CSPS currently notes that many patients see the best results with three to six treatments spaced about four to six weeks apart, depending on the concern and treatment plan.1 Milder texture concerns may respond in fewer sessions. Deeper or more widespread scarring may require a longer series or a combination plan.
Does microneedling hurt?
A topical numbing cream is applied before treatment to help keep you comfortable. Most patients describe the sensation as pressure, warmth, or vibration. After treatment, the skin may feel sensitive, tight, or warm for a short period of time.
What is PDGF, and do I need it?
PDGF stands for platelet-derived growth factor. When paired with microneedling, it can be applied topically during treatment so it works through the micro-channels created by the SkinPen device. It may be recommended for patients who want added regenerative support, but not every patient needs it. Your provider will discuss whether it makes sense for your skin and goals.
Is microneedling safe for all skin tones?
SkinPen Precision is FDA-cleared for improving the appearance of facial acne scars in adults age 22 and older. The current SkinPen intended-use language includes facial acne scars in adults with all Fitzpatrick skin types.3 Your provider will still evaluate your individual skin tone, pigment history, sensitivity, and treatment plan before recommending microneedling.
How long before I see results?
Some patients notice brighter, smoother-feeling skin within the first week. Deeper acne scar improvement takes longer because collagen remodeling happens gradually. More visible texture changes typically build over several weeks and through a full treatment series.
Can microneedling be combined with other skin treatments?
Yes. Depending on your skin, CSPS providers may recommend combining microneedling with PDGF, chemical peels, laser treatments, or medical-grade skincare. Combination plans can be especially helpful when acne scars are accompanied by discoloration, redness, dullness, sun damage, or ongoing congestion.
Schedule Your Microneedling Consultation
If acne scars, rough texture, or enlarged-looking pores are keeping your skin from looking as smooth as you want it to, microneedling may be a strong place to start.
Cool Springs Plastic Surgery offers SkinPen microneedling and advanced skin treatments at our Nashville-area locations in Brentwood, Franklin, Mt. Juliet, and Nashville/Music Row. During your consultation, our team will evaluate your skin, review your goals, and recommend the treatment plan best suited to your scar pattern, skin tone, downtime, and long-term results.
Call (615) 771-7718 or book your non-surgical appointment online.
Sources
- Cool Springs Plastic Surgery. Microneedling Nashville — Collagen Induction Therapy. coolspringsplasticsurgery.net
- American Society for Dermatologic Surgery. Microneedling. asds.net
- SkinPen Precision System. FDA 510(k) Clearance — Intended Use: Improvement of facial acne scars in adults age 22 and older with all Fitzpatrick skin types.
- Cool Springs Plastic Surgery. Skin & Laser Treatments. coolspringsplasticsurgery.net
- Cool Springs Plastic Surgery Shop. Daily Clarifying Pads. shopcsps.com
- Cool Springs Plastic Surgery Shop. Koji Brightening Pads. shopcsps.com
- Cool Springs Plastic Surgery Shop. Skin Balancing Serum. shopcsps.com
- Cool Springs Plastic Surgery Shop. EltaMD UV Clear Broad-Spectrum SPF 46. shopcsps.com