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Acne scars stay long after the acne itself is gone — dents in the skin that keep reminding you of what was healed years ago. The good news: atrophic scars can now be significantly softened without aggressive procedures. One of the most interesting protocols of recent years uses biostimulatory threads — fine dissolvable threads placed in a mesh beneath the scars, prompting the skin to build new collagen and „fill“ the depression from within.
At a glance
- What it is: a protocol of biostimulatory (smooth, absorbable) threads placed in a mesh under atrophic acne scars
- How it works: as the threads dissolve, new collagen grows around them, lifting the base of the scar and firming the skin
- Who it is for: mild to moderate atrophic (depressed) scars, once active acne is under control
- Treatment time: 30–45 minutes, with anesthetic
- Results: gradual, developing over weeks and months; threads absorb, the collagen stays
- Combinations: often with subcision (scar release) and MicroNeedling — as planned
- Price: based on thread count and area — set at the consultation
On this page
- Why do acne scars stay?
- How threads lift the scar from within
- What studies say
- What the treatment looks like
- Combinations that speed up the result
- Which scars it works for — and which it does not
- How many sessions are needed
- Price
- FAQ
Why do acne scars stay?
Deep inflammation in acne destroys collagen in the dermis. When the skin heals, a depression remains wherever tissue was lost — an atrophic scar, firmly „tethered“ by fibers to deeper layers. No cream can bring back missing tissue; that is why treatments with visible results work in one of two ways: they stimulate new collagen or release the scar that pulls the skin down. Threads do both. [1,2]
How threads lift the scar from within
Smooth, bioabsorbable threads (the same material used in surgery for decades) are placed with fine needles in a mesh pattern into the dermis beneath the scarred area. The mesh gives immediate gentle mechanical support, but the main effect is biological: as the body breaks the threads down over the following months, new collagenous tissue is built around each one. The result is a natural „scaffold“ that lifts the base of the depression, firms the skin and smooths texture. As the threads absorb, your own collagen takes over the effect. [1,3]
Read more about the threads and their use on the face on our thread-lift page, and a full overview of scar treatments on the acne-scars page.
What studies say
Biostimulatory threads for acne scars are not a marketing trick — published clinical research stands behind them:
- In a randomized comparison, combining subcision (releasing the scar) with mono threads gave better improvement of atrophic scars than threads alone — which is why the protocol often includes scar release. [2]
- In another randomized study, threads with subcision achieved results comparable to fractional CO2 laser with subcision, with shorter downtime. [3]
- Case series describe satisfying softening of atrophic facial scars with threads alone, with good tolerability. [1,4]
What the treatment looks like
At the consultation we assess the scar type, skin condition and whether acne is fully under control. The treatment is performed with local anesthetic: if indicated, the fibers pulling the scar down are first released by subcision, then the threads are placed in a mesh beneath the area. It all takes 30–45 minutes. Temporary swelling, redness and bruising may follow and fade over the next days; normal activities resume quickly, with no harsh rubbing of the area for the first days.
Combinations that speed up the result
- Subcision — mechanical release of the scar before threads are placed; studies show the combination performs better. [2,3]
- MicroNeedling — for surface texture and finer irregularities, at intervals set by the doctor.
- Chemical peels and skincare — for tone and skin quality between protocols.
- PRP and exosomes — regenerative support between protocols, as the doctor assesses (PRP, exosomes).
- Polynucleotides — for skin quality and elasticity around the treated areas (polynucleotides).
- Hyaluronic filler — for individual deep depressions that threads alone do not lift enough (hyaluronic fillers).
Which scars it works for — and which it does not
It responds best on mild to moderate atrophic scars — rolling and deeper boxcar depressions on the cheeks and face. Deep, narrow icepick scars need other methods, and pronounced scarring usually needs a combination of methods. An important condition: active acne must be under control — inflammation is treated first, scars second. At the consultation you get an honest assessment of what is realistic in your case.
How many sessions are needed
Depending on the extent: usually 1–3 sessions spaced a few months apart. The result builds gradually — first changes are visible within weeks, and the full collagen-building effect is assessed after several months. The threads absorb, while the effect of the new collagen can last up to two years, individually.
Price
The price depends on the number of threads and the size of the area. You receive the exact plan and price at the consultation; the general price list is on the website.
FAQ
Is the treatment painful?
It is performed with local anesthetic and is well tolerated. Mild tenderness of the area may follow and passes within a couple of days.
When are results visible?
First improvements within weeks; the full effect develops over months as new collagen grows. The threads dissolve and the collagen stays — the effect can last up to two years.
Can the threads be seen or felt under the skin?
The threads are very fine and placed into a planned layer of the dermis. Mild tenderness is possible in the first days; the threads themselves are not visible.
What if my acne is still active?
Scars are treated only once inflammation is under control — at the consultation we set the order: acne first, scars second. A combined plan often includes peels and acne therapy, with the scar protocol later.
How many threads will I need?
It depends on the size and number of scars — from a dozen to several dozen per area. You get the exact count and price at the consultation.
Is laser or threads better?
They are not the same treatment: laser works on the surface and texture, threads build support beneath the scar. In one randomized study, threads with subcision were comparable to fractional CO2 laser with subcision, with shorter downtime — at the consultation we choose what suits your scars best. [3]
References
- Treating Facial Scars using Polydioxanone Threads. JPRA Open. 2025. doi:10.1016/j.jpra.2025.01.006
- Combined subcision with polydioxanone monofilament (PDO) threads versus polydioxanone monofilament (PDO) threads alone in treatment of atrophic post-acne scars. Arch Dermatol Res. 2025. doi:10.1007/s00403-025-04204-z
- PDO screw threads versus fractional CO2 laser, after subcision, for atrophic acne scar remodelling: a randomized group-based comparative study. Arch Dermatol Res. 2025. doi:10.1007/s00403-024-03727-1
- Ebrahim HM, Nassar A, ElKashishy K, et al. A combined approach of subcision with either cross-linked hyaluronic acid or threads in the treatment of atrophic acne scars. J Cosmet Dermatol. 2022;21:3334-3342. doi:10.1111/jocd.14675
Content prepared and medically reviewed by Dr Nenad Stanković, DDS/DMD, specialist in cosmetology, international lecturer and trainer in aesthetic medicine.