Acne scar treatment in Fukuoka·Tenjin | Redness, hyperpigmentation, and indentation require different approaches

How to read this article

The Treatments listed are performed at our Fukuoka clinic (Tenjin). All are self-pay procedures (not covered by insurance), and clicking on a Treatment name will take you to a page with detailed information and the latest pricing. Insurance may cover treatment of active acne, and we include that information as well.

The most common misconception when consulting about acne scars istreating all "scars" as one category.In reality, there are some that fade over time even if left alone, and others that remain unchanged for life if left alone.

1. Redness — fades over time. Most fade within a few months to a year
2. Hyperpigmentation (brown) — fades over time. However, sun exposure can prolong it
3. Indentation —does not improve over time.the skin remains in a hardened state where it has been lost
4. Raised scar — uncommon on the face, but difficult to resolve

If you continue the same care without understanding this difference,you end up irritating scars that would disappear and neglecting scars that will not.In fact, many people who rubbed their skin constantly out of concern for redness ended up creating hyperpigmentation.

Conclusion of this articleRedness and hyperpigmentation fade even without treatment. The role of treatment is to "speed up" the process. Indentations remain unchanged for life without treatment. The role of treatment is to "shallow" them; they cannot be eliminated completely. Start by learning to distinguish which type your scar is.

Look in a mirror in both bright light and at an angle where light hits the skin from the side.Indentations are not visible under frontal lighting.

Redness type

The area where the acne healed is flat but still red. When pressed, the redness fades momentarily and returns when released.

This is a state where the capillaries enlarged by inflammation have not yet returned to normal. The skin surface has no texture or unevenness.

• How to distinguishIf you press lightly with a clear ruler or similar object and the redness disappears momentarily, it is the redness type.

Hyperpigmentation type

Brown or grayish color remains where the acne was. The color does not change when pressed.

Melanin is produced in response to inflammation and remains present. The surface is also flat.

• How to distinguishIf the color does not fade when pressed, it is pigmentation. It often mixes with redness.

Depressed type

A shadow appears when light is shone at an angle. You can feel a step when running your finger over it. When makeup is applied, it becomes more noticeable.

Inflammation extends deep, and the foundation of the skin is destroyed and lost.The missing part will not fill in even if left alone.There are 3 types depending on shape, and the ease of healing differs.

• Ice pick typeNarrow and deep. The entrance is small and the bottom is not visible, it is so deep. The most difficult type to treat.
• Boxcar typeRounded or square depressions with sharp edges. The bottom is flat and the outline is clearly defined.
• Rolling typeGentle undulation. The surface appears wavy because the skin underneath is contracted.
• How to distinguishStretch the skin left and right with your fingers. If it becomes shallower, it is rolling type; if unchanged, it is boxcar type or ice pick type.

Raised type

The scar is hard and raised. While not common on the face, it occurs in scars from acne on the lower jawline, chest, back, and shoulders. It may be accompanied by itching or pain.

This requires completely different treatment. If you have scars on your body that apply, please consult during an examination.

It is normal for them to be mixedWithin one cheek, redness, pigmentation, and depressions usually exist simultaneously. The purpose of distinguishing them is not "to determine just one,"to separate what is urgent from what is not.What is urgent is only the depressions, and how to avoid increasing those depressions is the focus of the latter half of this article.

First, I want to assure you thatthese two fade over time even without treatment.Whether to pursue treatment is a matter of "how quickly you want to lighten them."

How quickly they fade

• RednessIt takes several months to about a year to fade. The deeper the inflammation, the longer it takes.
• HyperpigmentationSeveral months to over a year. Those with naturally darker skin tones are more prone to residual marks and longer duration.

What not to do

Rubbing it.If you massage or use scrubs trying to quickly remove redness or hyperpigmentation, new inflammation develops in that area and hyperpigmentation gets layered on top. What was starting to fade gets reset.

For the same reason, avoid repeatedly applying strong peeling treatments based on your own judgment.

The most effective measure is sunscreen

Hyperpigmentation darkens with UV exposure, and the time it takes to fade lengthens. In other words,Whether or not you apply sunscreen changes how long it takes to fade.

Reducing UV exposure is more reliable than adding something. Daily sunscreen is more effective than expensive whitening cosmetics.

If you want to add something at home

• Vitamin C derivativeWorks during the melanin production process. For hyperpigmentation.
• NiacinamideInhibits the transfer of produced melanin to the skin surface. A gentle ingredient that is easy to continue using.
• Tranexamic acidUsed for inflammation-related hyperpigmentation. Can be applied topically or taken orally.

Unlike redness and hyperpigmentation, pitted scarshave lost the foundation of the skin itselfin that area. It is not a color problem but a shape problem. That is why no cosmetic product can fill them in.

Why they form

When acne inflammation destroys the pore wall, the contents leak into surrounding tissue. The body tries to process it and breaks down collagen in that area. After inflammation subsides, the skin is deficient by the amount that was broken down, and the indentation hardens.

The deeper and longer the inflammation lasts, the deeper the pitting becomes.And marks from self-extraction are precisely this "deep destruction," making them prone to become pitted scars.

How much treatment can restore

I will be honest.It will not become the same as the original skin.The goal is to "shallow it and bring it to a point where it is not noticeable." Multiple treatments are assumed, and the response varies by type.

• Rolling typeResponds relatively well. Treatment aimed at rebuilding the foundation is suitable.
• Boxcar typeIn the direction of shaving down the edges to make them gradual. Multiple sessions are needed.
• Ice pick typeBecause they are narrow and deep, area-based treatments cannot reach the bottom. Most difficult to improve; expectations should be lowered compared to the other two types.

Please know this beforehandPitted scar treatment does not change dramatically in a few sessions. It is the type of treatment that gradually shallows over 5 or more sessions. If someone presents a treatment that flattens it in one session, verify the basis.

This is what I most want to convey in this article.

Preventing scars in the first place is far more efficient than treating existing scars.This is because once pitted scars form, they do not completely return, whereas quickly calming existing acne is far easier and more reliable.

Attending scar treatment while new acne is inflaming and creating new pits on the side—this is the typical pattern for people whose treatment is not progressing.

Try insurance-covered treatment first

If you currently have acne, insurance covers topical medications such as adapalene and benzoyl peroxide. These medications have clear effects in reducing inflammatory acne, andare worth trying before considering self-pay procedures.

The cost differs by orders of magnitude from self-pay procedures. This is why, when patients come asking "I want to do something about acne scars," we often first propose treating the current acne.

Do not touch, do not squeeze

Pressing and extracting with pressure damages the pore wall and deepens inflammation. As explained in the previous section, that is exactly how pitted scars form.The more bothersome the acne, the more you should avoid touching it.

From Dr. HaneWhen I see the skin of patients who come for acne scar consultation, they often have acne that is inflaming right now, as much or more than the scars themselves. Before starting scar treatment, I suggest stopping that first. It may feel like a detour, but in the end this is the fastest path.

I divide treatments by scar type and what the treatment targets. Fees and detailed explanations are at the links under the treatment names.

For hyperpigmentation

Pico toning

Apply laser at low output over the entire face to gradually disperse melanin. Because it is applied in a way that rarely causes inflammation, it can be used for acne scar hyperpigmentation.

• Rough estimateEvery 2–4 weeks, approximately 5 sessions
• DowntimeMinimal. Mild redness immediately after treatment
• Suitable forThose with widespread brown hyperpigmentation
• Not suitable forThose with redness only, or those whose main concern is skin depression

For skin depression

Picofractional

The laser is applied in a dotted pattern, creating microscopic changes within the skin to stimulate collagen remodeling. Because the surface is not ablated, downtime is shorter, but more sessions are required.

• Rough estimateEvery 4 weeks, 5 or more sessions
• DowntimeRedness for 1–2 days
• Suitable forRolling type, shallow boxcar type. For those who cannot easily take time off work
• Not suitable forThose who want deep ice-pick scarring improved in a single session

Juvelook

An injectable preparation that promotes collagen production. Unlike laser, which works from above, this treatment builds up the foundation of depressed areas from below.

• Rough estimateEvery 4 weeks, approximately 3 sessions
• DowntimeBruising and mild swelling for several days
• Suitable forThose with both skin depression and lack of firmness
• Not suitable forThose with active acne

For skin texture and shallow irregularities

Massage Peel (PRX-T33)

Medication penetrates to deep layers without causing skin peeling, promoting collagen production. Because downtime is minimal, it can be performed between other treatments.

• Rough estimateEvery 1–2 weeks, 4–5 sessions
• DowntimeMinimal. Mild redness immediately after, dryness for several days
• Suitable forShallow irregularities and lack of firmness. For those who cannot easily take time off
• Not suitable forThose with active acne or open wounds

For active acne

Salicylic acid macrogol

Normalizes the stratum corneum and promotes a state in which pores are less likely to become clogged. Reducing new acne directly reduces new scarring.

• Rough estimateEvery 3–4 weeks
• DowntimeDryness, mild redness, rarely skin peeling
• Suitable forThose with comedones as the main feature and recurrent acne
• Not suitable forThose with severe dryness or active dermatitis

Treatment planningIf there is inflamed acne, the first step is to stop the inflammation. If only discoloration remains, use pico-toning. If there is skin depression casting a shadow, use picofractional or Juvelook, or a combination of both. Starting with depression treatment in the wrong order will lead to new depressions forming during treatment.

I will be direct. The following three goals cannot currently be achieved in aesthetic medicine.

• Making skin depressions disappear completelyThey can be made shallower, but the skin cannot return to the same state as surrounding skin. The realistic goal after multiple treatments is to reach a point where depressions are inconspicuous.
• Filling deep ice-pick scars with surface treatmentBecause the opening is narrow and the base is deep, surface treatments applied to the entire face cannot reach the bottom. Expectations for this type must be adjusted lower than for other scar types.
• Finishing in a single treatmentDepression treatment works by gradually flattening depressions over multiple sessions.

From the perspective of someone handling nasal surgery, I will discuss matters specific to the nose.

Why does the nose scar easily

The nose has the largest sebaceous glands and deepest pore depth in the face. When inflammation occurs there,it does not remain superficial but tends to extend deep.Because deeper inflammation results in deeper depressions, the same size acne on the nose leaves scarring more easily than on the cheek.

Additionally, nasal skin is thick and firm, making treatment less effective once a depression has formed. This area combines conditions of being prone to scarring and difficult to treat.

Hard to distinguish from enlarged pores

Nasal depressions can sometimes be difficult to distinguish from enlarged pores. If sizes vary and shadows appear when light is cast at an angle, it is more likely to be a scar rather than a pore.

The distinction is explained in detail in another article. Article on nose pores Please also check it out.

For those planning nose surgery

After nose surgery, there is a period during which the area is secured with tape. During this time, the skin becomes moist and the pores become blocked,making acne temporarily more likely to appear.If inflammation develops, scars unrelated to the surgery may remain.

For those planning surgery, we recommendcalming acne before the procedureif possible. We will also assess your skin condition during the consultation, so please feel free to mention any concerns.

I have both red and brown marks. Which should I treat first?

Both will fade over time, so there is no need to decide urgently. The priority is whether there are indentations in the same face and whether acne is currently present.

When will I see changes?

For pigmentation, differences are often noticeable after around 3 sessions, while indentations require 5 or more sessions. With redness, time plays the main role rather than active treatment.

Can cosmetics treat indentations?

No. Indentations are a matter of shape, not color, because the skin foundation has been lost. Cosmetics are useful for redness, pigmentation, and preventing new acne.

Can acne-scar treatment be done while acne is still present?

Certain treatments cannot be performed while inflamed acne is present. Calming current acne first before proceeding to scar treatment actually leads to faster progress overall.

I think I made it worse with self-care.

This is common, so it is fine to start by stopping those practices. Many people see a change in their condition within a few months just by stopping three things: rubbing, squeezing, and layering strong products.

Can men receive treatment?

Yes. Men often have higher sebum secretion and more pronounced inflammation, so consultations regarding indentations are not uncommon.

The treatments introduced on this page areall elective procedures (not covered by insurance).Insurance-covered medications used to treat existing acne are handled separately.

Effects common to all treatments

• Redness and swellingMay occur within several days for many treatments
• Dryness and peelingOccurs with treatments that work on the stratum corneum
• BruisingMay occur with treatments involving needles or injections
• HyperpigmentationAfter inflammation, it becomes more likely to occur, especially on sun-exposed skin. Special caution is needed in acne-scar treatment.
• InfectionFrequency is low, but not zero with needle-based treatments
• Individual variation in resultsThe expected change may not be achieved. Differences are particularly noticeable with deep indentations.

Pricing, required number of sessions, and risks specific to each treatment are listed on the page for that treatment.

Physician supervising this page

Dr. Kazuhide HaneDirector, Zetith Beauty Clinic Fukuoka Branch

Graduated from Kobe University School of Medicine in 2021. Previously served as director of the Osaka branch, and became director of Zetith Beauty Clinic Fukuoka Branch from 2025. In addition to surgical procedures centered on rhinoplasty, he also handles injection and device treatments in cosmetic dermatology.

When you are unsure which type

Redness and pigmentation, indentations and pores are difficult to distinguish with a mirror. During examination, we use oblique lighting and palpation to confirm what is currently happening. We will also recommend whether treatment of existing acne should come first. We offer free consultations at the Fukuoka Branch (Tenjin), so please contact us.

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Related pages

• Fukuoka cosmetic dermatology guide Pores, acne scars, spots, and sagging skin by concern
• Nose pores guide Blackheads, enlarged pores, and dark spots — 3 types
• About the Fukuoka Branch Access, hours, and resident physicians

※ This page is provided for general medical information purposes and does not guarantee results. All treatments listed are elective procedures (not covered by insurance). Treatment suitability, cost, and risks are determined individually through consultation. Results vary by individual. ※ All photos shown are images. They are not before-after cases from our clinic.