The main gold standard for acne scars has still been fractional CO2 laser for the longest time. This is generally agreed upon by many doctors. We have tried many treatments for acne scars and general. The downtime is about 2-4 days of redness and another 2-3 days of fine scabbing.
I am not supposed to say that microneedling helps acne scars because there is supposed to be no clear medical evidence that it works but in the past when microneedling was not regulated, I do see results although it depends on the needle depth and the number of treatments. My personal view on it is for the same downtime and pain, fractional CO2 laser still has better results as it has the extra laser heat to produce more collagen remodelling.
There is no place for deep chemical peel for acne scars now for Asians unless they are not suitable for fractional CO2 laser. Other viable treatment for acne scars for people who do not want long downtime can be dermal fillers. But this treatment is not permanent. A good typical dermal fillers like vobella (Juvederm range) last about a year plus.
Subcision can be employed together with fractional CO2 laser for better results on very fibrotic stubborn scars but the downtime can be 2-4 weeks and should be used as a second resort to fractional CO2 laser.
Hope that helps.
