One of the most common things I hear from patients walking into St. Johns Aesthetics is some version of this: "I finally got my acne under control, but now I have to deal with the scars." It's one of the most frustrating parts of the acne journey — and it's something we take seriously here.
Here's what I want you to understand before anything else: not all acne scars respond to the same treatment. In fact, using the wrong approach for the wrong scar type can make things worse. That's why the most important step isn't picking a treatment — it's properly identifying what you're dealing with first.
The Different Types of Acne Scars
Acne scars fall into two broad categories: atrophic (depressed) and hypertrophic (raised). Most of the patients we see in St. Johns present with atrophic scarring, which includes three distinct subtypes.
Ice pick scars are narrow, deep, and sharply defined — they look like small puncture marks in the skin. They're notoriously difficult to treat because of how deep they penetrate into the dermis.
Boxcar scars have sharp, defined edges and a wider, box-like shape. They can be shallow or deep, which significantly affects which treatments work.
Rolling scars create a wave-like texture on the skin due to bands of fibrous tissue pulling the skin downward. These respond particularly well to certain energy-based treatments.
"The treatment that clears one patient's ice pick scars beautifully might do almost nothing for another patient's rolling scars. This is why consultation — real consultation — matters."
— Lorie Carter, APRNHow We Assess Your Skin
During your consultation at SJAWC, we evaluate your scar type, depth, skin tone, and overall skin health before recommending anything. We also consider your lifestyle — downtime tolerance, sun exposure, and budget all play a role in building a plan that actually works for you.
We use a combination of visual assessment and sometimes photography under specific lighting conditions to map your scar distribution and depth.
Treatment Options We Offer
Depending on your scar profile, we may recommend one or more of the following approaches.
RF Microneedling uses radiofrequency energy delivered through tiny needles to stimulate collagen remodeling at precise depths. It's particularly effective for rolling and boxcar scars and typically requires a series of 3–4 sessions for optimal results.
HALO Laser Resurfacing combines ablative and non-ablative wavelengths in a single pass, targeting both surface texture and deeper collagen remodeling. It works beautifully for patients with a mix of scar types alongside sun damage or uneven tone.
Medical-Grade Chemical Peels can address superficial scarring and post-inflammatory hyperpigmentation — the redness and dark marks that often accompany or follow acne breakouts. We use ZO® Skin Health protocols in our peel treatments for consistent, clinically-informed results.
Not sure which treatment is right for you?
Schedule a consultation with Lorie — she'll assess your skin and build a personalized plan.
Why Combination Therapy Often Works Best
Here in St. Johns, the vast majority of patients I see don't have just one scar type — they have a mix. And that's actually good news, because it means we have multiple tools to work with.
A common protocol we use is starting with a series of RF microneedling sessions to stimulate foundational collagen production, then layering in a HALO treatment to address surface texture and tone, and maintaining results with a medical-grade homecare regimen through ZO® Skin Health.
Each plan is built from scratch based on your skin — not a template.
What to Expect at Your Consultation
Your initial consultation at SJAWC is a real conversation, not a sales pitch. We'll look at your skin together, talk through what's bothering you most, and walk you through the options honestly — including realistic timelines, what results to expect, and what it will cost.
We serve patients throughout St. Johns County — from Nocatee and Ponte Vedra to St. Augustine — and we're located right on Ashourian Ave, convenient for most of the county.
Frequently Asked Questions
How many treatments will I need?
It depends on your scar type and severity. Most patients see meaningful improvement after 2–4 sessions of RF microneedling, with additional improvement over 3–6 months as collagen continues to remodel.
Is there downtime?
RF microneedling typically involves 24–48 hours of redness. HALO has slightly more visible downtime — usually 3–5 days of peeling and redness. Chemical peels vary by depth.
Can these treatments be done on darker skin tones?
Yes, but with careful selection. Some lasers carry pigmentation risk on deeper skin tones. RF microneedling is generally safe across all skin tones. We always factor this into your treatment plan.
When will I see results?
Some improvement is visible within 2–4 weeks. Full collagen remodeling from RF microneedling takes 3–6 months. HALO results are often more visible earlier, with continued improvement over 3 months.
Is there anything I should avoid before treatment?
We'll give you a full prep protocol at your consultation, but in general: avoid retinoids for 5–7 days prior, and protect your skin from sun exposure leading up to any laser treatment.
