Botox for Acne Scars: Can Neurotoxins Help Smooth Skin?

Acne scars are stubborn. Anyone who has lived with them knows the routine: you notice them under bright office lighting, you catch them at an unflattering angle on a video call, and you start scrolling through treatments late at night. Chemical peels, microneedling, lasers, subcision, fillers, silicone gel sheets, the list goes on. In recent years, Botox entered that conversation. Patients ask whether botulinum toxin can soften textural scars or whether it is only for frown lines. The short answer is that Botox plays a supporting role for certain scar types and experienced botox Spartanburg https://www.linkedin.com/company/allure-medical-spa situations, not a universal fix. Used strategically, it can make scars sit flatter and look less obvious because it relaxes the muscular forces that crease or tether the skin. Used indiscriminately, it does little and can even blunt facial expression where you do not want it.

I have treated acne scarring across a range of skin types and ages, from a 24-year-old with fresh rolling scars after isotretinoin to a 47-year-old with decades-old ice picks and a habit of squinting that deepens every line. Botox treatment has a place, and the art lies in pairing it with the right techniques. Let’s walk through what Botox does, when it helps with acne scars, where it falls short, and how to build a plan that gives you visible, natural-looking improvement.
What Botox actually does on the face
Botox is a brand name for botulinum toxin type A, one of several neurotoxins used medically. Dysport, Xeomin, Jeuveau, and Daxxify are close cousins, with slightly different diffusion and onset profiles. They all work the same way: by blocking the release of acetylcholine at the neuromuscular junction, they reduce muscle contraction. That is the mechanism behind Botox for wrinkles on the forehead, for frown lines between the brows, and for crow’s feet. It is a muscle treatment, not a filler and not a resurfacing device.

Onset and duration matter when planning a scar protocol. Most patients see Botox results begin within 2 to 5 days, peak by 10 to 14 days, and then gradually soften over 3 to 4 months. Some hold results for 5 or 6 months, while highly expressive individuals metabolize it faster. Areas with smaller muscles, such as near the under eyes, can feel the effect at lower doses and may wear off a touch sooner. Botox benefits include softer dynamic lines, decreased movement-related creasing, and, in the scar context, less mechanical tension on the healing or tethered skin.
Why acne scars look the way they do
Not all scars behave alike. Acne can leave several patterns:
Atrophic scars, the most common category, sit below the surrounding skin: ice pick (narrow, deep pits), boxcar (wider, sharp edges), and rolling scars (broad depressions with sloping edges). Hypertrophic scars or keloids, far less common on the face, rise above the skin rather than sink below it.
Rolling scars are influenced by fibrous bands tethering the skin to deeper layers. That tethering, plus facial muscle activity, can create a see-saw effect. When you smile or squint, the scar looks deeper because the muscle pulls the area inward. I have watched even mild rolling scars turn harsh under strong zygomatic pull, then look better at rest.

A second dimension is remodeling. Collagen grows and reorganizes for months after an injury or procedure. If the skin experiences constant motion and tension, remodeling can become uneven. In that setting, relaxing the muscle temporarily can allow smoother healing after a treatment that deliberately injures the dermis in a controlled way, such as microneedling or a fractional laser.
Where Botox helps with acne scars
Think of Botox as a tension-relief tool. It does not fill a scar and it does not resurface. It can, however, reduce movement that exaggerates a depression or interferes with collagen remodeling. Three scenarios come up often in practice.

First, rolling scars along the lateral cheeks. If you have a habit of strong smiling or cheek lifting, the scars deepen when you emote. Small, strategically placed Botox injections across the zygomaticus and risorius areas can slightly soften pull. The goal is not to freeze your smile, just to take the edge off. This approach makes sense if your scars look much worse in motion than at rest. A light dose, often half of what you might use for crow’s feet, can change how a rolling scar reads in conversation and photographs.

Second, scars that crease with brow or glabellar movement. The classic frown line area, treated with Botox for frown lines, sometimes harbors post-acne boxcar scars. When the corrugator and procerus muscles contract, the scars fold and shadow. Treating the glabella reduces that folding. A similar principle applies to forehead lines that cross atrophic marks. Botox for forehead lines is already common, so the scar improvement is often a bonus rather than a primary goal.

Third, peri-procedural support. When I plan a series of microneedling or fractional laser sessions for rolling scars, I occasionally use low-dose Botox one to two weeks prior to the first session and keep it going for a couple of months. It steadies the field while the skin heals. In subcision, where we release those fibrous tethers, less post-procedure muscle activity can help the newly freed skin settle in a smoother plane. Notice the nuance here: it is not always necessary, and I choose it when the patient shows strong dynamic movement over the treated zone.

I have also seen Botox help a specific cheek scar that rides on a hyperactive levator labii superioris muscle, the one that lifts the upper lip and can cause an asymmetrical smile. A single unit or two can reduce the pull enough that the depressed scar stops puckering. That is a microscopic intervention, more art than science, and it needs careful dosing to avoid lip imbalance.
Where Botox falls short
If a scar is a deep ice pick puncture, no amount of Botox will change its geometry. These require punch excision, TCA CROSS (a precise application of high-strength trichloroacetic acid), or laser resurfacing to build edges and fill the void. Boxcar scars with sharp vertical walls respond better to subcision plus filler or ablative lasers than to any muscle relaxation. Hypertrophic scars and keloids do not benefit from Botox; they respond to steroid injections, silicone, pressure, and sometimes pulsed dye lasers.

Occasionally, patients ask about Botox for acne itself. While there is emerging research on botulinum toxin decreasing sebum production in the T-zone and potentially reducing breakouts, it is not standard acne therapy. For active acne, topical retinoids, benzoyl peroxide, azelaic acid, oral agents, and light or laser-based adjuncts hold the evidence. Use Botox for acne scars or dynamic wrinkles, not for primary acne control unless you are in a study or working with a practitioner who has specific experience and clear expectations.
Combining Botox with the right tools
Most successful scar plans combine techniques. The general logic looks like this. First, release or resurface the scar to change its structure. Second, temporarily relax movement that distorts the area while healing. Third, if the depression remains, consider volume support.

Microneedling with radiofrequency, fractional non-ablative lasers such as 1550 nm, or ablative devices like fractional CO2 can all stimulate collagen. Each has trade-offs. RF microneedling, for example, works well on rolling scars and suits a wider range of skin tones with lower risk of pigment changes. Fractional CO2 punches harder per session but carries more downtime and a higher risk of post-inflammatory hyperpigmentation in darker skin. Subcision targets tethered scars directly. Hyaluronic acid filler can then prop up the released base. Botox slides in as a fourth wall, reducing shear forces as the collagen scaffolding rebuilds.

A typical plan I use for moderate rolling scars in a patient with Fitzpatrick IV skin tone: three RF microneedling sessions spaced four to six weeks apart, small-volume subcision of the worst tethers at session one, and low-dose Botox across the cheek elevator complex two weeks before the first session. I avoid heavy dosing so the smile still looks like a smile. If a few scars remain obvious at rest after the second session, I place a drop of a soft, moldable filler at the base. The Botox wears off by month four, at which point we assess stability. You see what is scar correction and what was movement reduction.
What a patient can expect, step by step
If you book a consultation at a medical spa or with a dermatology clinic for Botox for acne scars, expect a different conversation than for Botox for crow’s feet. The practitioner should examine your scars in motion and at rest, with bright lighting and from multiple angles. I ask patients to smile wide, frown, puff cheeks, squint, and talk. That tells me where the muscle is deepening the scar appearance. Photos matter. Botox before and after pictures help us sanity-check whether the change is true improvement or just a transient effect of lighting and expression.

The procedure itself is quick. After mapping injection sites with a washable pencil, we clean the skin and use tiny needles to place drops of product. Across the cheek, doses are usually conservative, often 4 to 10 units per side when the goal is movement modulation rather than wrinkle smoothing. It stings briefly. Most people describe the feeling as a pinch with mild pressure. Numbing is rarely needed for Botox injections, although for combined procedures like subcision and microneedling, topical anesthetic or local infiltration makes the session more comfortable.

Botox results timeline follows the standard curve. You will not see scar changes the same day. Give it a week, sometimes two, for movement to soften. The scar may appear less deep during smiles or cheek lifts. If you pair it with microneedling or a laser, the overall texture changes over months as collagen remodels. True before after comparisons should be done at consistent intervals, ideally 8 to 12 weeks apart, same lighting, same camera distance.
Safety, side effects, and the natural look
Botox is considered safe when administered by a qualified provider. Common side effects include pinpoint bruising, swelling that settles within hours, and a dull ache at injection sites. Headaches occur in a small minority, particularly after forehead or glabellar treatment. Rare but important risks include eyelid or brow ptosis if the product diffuses into nearby muscles, asymmetry, or an over-relaxed, flat expression.

The cheek is full of expression muscles. When treating acne scars, we walk a tightrope. Too little Botox and you do not see a difference. Too much and your smile feels different. I place product more superficially and spread out the injections to lower the chance of a heavy look. A licensed provider with scar experience will explain these trade-offs and adjust dosing at follow-up.

For patients who worry about a frozen face, remember that Botox dosage is not all or nothing. A light, tailored plan can deliver a natural look. If you are pursuing facial rejuvenation at the same time, such as Botox for frown lines or forehead lines, be transparent with your practitioner about your priorities. Preserving expression while supporting scar therapy requires restraint and careful injection technique.
Cost, value, and how to budget
Botox pricing varies by region, clinic reputation, and whether pricing is per unit or per area. In the United States, unit prices commonly range from 10 to 20 dollars. Scar-targeted work across the cheeks typically uses fewer units than a full upper face treatment. Expect 40 to 120 dollars per cheek if you are doing a minimal modulation approach, more if paired with other areas. If you incorporate Botox into a larger acne scar protocol with RF microneedling or laser, clinics often offer packages or specials. While Botox deals look tempting, quality matters more than a discount. Poorly placed injections can cost you months of odd expression.

Insurance coverage does not apply to cosmetic Botox. Some clinics offer payment plans, and you can space sessions to fit your budget. When comparing cost and benefit, view Botox for acne scars as an amplifier or stabilizer rather than the main driver of improvement. The heavy lifting comes from subcision, resurfacing, and, when indicated, filler. If you have a set budget, invest first in the treatment that targets your scar type, then add Botox if dynamic movement is a clear aggravator.
Choosing a practitioner and clinic
Credentials matter. Look for a board-certified dermatologist, plastic surgeon, facial plastic surgeon, or an experienced injector in a medical spa with physician oversight. Ask directly about their experience with acne scars and not just wrinkle reduction. A good practitioner will show cases similar to yours and discuss realistic endpoints. If you are searching for botox injections near me or botox clinics in your area, skim botox reviews with a critical eye. Patient experiences can be helpful, but focus on those that describe scar treatment, not only frown lines. During the consultation, ask how they sequence procedures, what their botox treatment plan looks like over six months, and how they handle asymmetry if it occurs.

Two quick tells of professionalism: they measure and record your doses and injection sites, and they book a follow-up visit at two weeks to fine-tune. Botox injection technique and the map of botox injection sites vary, so documentation helps with consistency across sessions.
What the research and real-world results say
Clinical studies on Botox for acne scars are still small. The mechanistic rationale is strong, and case series show improvement in rolling scars when Botox is combined with subcision or microneedling. In my practice and among colleagues, the best botox results come when we respect the boundaries of the tool. You see a visible decrease in the depth of rolling scars during expression, a more even appearance in candid photos, and smoother remodeling after procedural work. You do not see a deep ice pick vanish.

Patient satisfaction tracks closely with expectation setting. Someone who expects Botox alone to erase scars is disappointed. Someone who understands that Botox reduces movement and helps other treatments shine is happy. I have watched patients keep a light cheek protocol in their maintenance schedule, similar to how they keep up with botox for forehead or crow’s feet. Two sessions a year can be enough once the scar structure has improved.
Aftercare and maintenance
After Botox, avoid vigorous rubbing, heated facials, and inverted positions for the first day. Gentle cleansing and sunscreen are fine. If you combine Botox with microneedling or laser, follow the specific aftercare for those procedures: no harsh actives until your provider clears them, moisturize as advised, and protect from the sun religiously. Botox aftercare is otherwise simple.

Maintenance depends on your goals. If you only used Botox as a bridge during a series of scar treatments, you may stop after three to four months and see how the scars behave without it. If you treat dynamic wrinkles at the same time, you may keep your regular botox schedule, often every three to four months. Some patients stretch appointments to two or three times a year once they find a rhythm.
The role of fillers and why they are not duplicates of Botox
People sometimes conflate Botox with fillers. Fillers add volume and lift depressed scars from below. Botox quiets motion. For rolling scars that still show a shallow depression at rest after subcision, a tiny bead of hyaluronic acid can make a dramatic difference. The effect is immediate, which is satisfying. The art is to use micro-aliquots so you do not end up with lumpiness. You can blend filler with a cannula, minimizing bruising. Filler results last six to eighteen months depending on the product, location, and metabolism. It complements Botox rather than replaces it.
My approach to a first-time patient with acne scars and strong facial movement
A composite scenario helps. A 32-year-old presents with moderate rolling scars on the lateral cheeks, a few boxcars near the temples, and an expressive smile that deepens everything. She has tried at-home microneedling rollers and glycolic peels, with little change. Her priorities are to look better in daylight and avoid excessive downtime.

I would propose a staged plan. Session one: subcision focused on the rolling scars, plus RF microneedling across both cheeks. Two weeks before, we place low-dose Botox in a lattice over the cheek elevators, careful not to touch the muscles that elevate the upper lip too strongly. Ice and arnica for bruising, and two days of social downtime for redness. Session two: repeat RF microneedling at four weeks, reassess tether points. If a few scars remain deep, micro-filler at the base. Session three: maintenance at eight to twelve weeks with another RF round if needed. Then we pause. By month four, the Botox has largely worn off. We compare botox before and after pictures and decide whether a light maintenance dose is helpful for expression. The result is not a face without movement, but scars that no longer spike when she laughs.

The plan could shift if she had darker skin with higher pigment risk, if she needed to look camera-ready within a week, or if she had a history of keloids. For a patient with lots of boxcars and little dynamic change, I would steer toward fractional ablative resurfacing and filler, and skip cheek Botox entirely.
Common questions I hear, answered briefly
Is Botox safe for acne scars on the cheeks? Yes, in skilled hands and at conservative doses. It is safe, with the usual botox side effects profile of minor bruising and temporary soreness. The cheeks require careful mapping to avoid a heavy smile.

How long do Botox results last in this context? Similar to wrinkle treatment, about three to four months. The structural changes from subcision and resurfacing can persist, so you may not need long-term Botox to maintain improvement.

What does it feel like? Quick pinches with light pressure. Most patients rate botox injection pain as mild, especially compared to subcision or deeper laser passes.

How much does it cost? If priced per unit, you might spend 100 to 300 dollars for cheek modulation alone, depending on dose and your market. Most of your investment will be in the scar procedures rather than the Botox itself.

Can I book an appointment online? Many clinics offer botox appointment online options and will schedule a separate in-person consultation if you are a new patient. Bring clear photos and be ready to discuss your medical history, medications, and prior treatments.
When to skip Botox
Skip Botox if your scars are almost entirely static ice picks or boxcars that do not change with movement. Skip it if your occupation depends on a broad, expressive smile and even small dampening would bother you, at least until the procedural series is done and you can re-evaluate. Also skip if you are pregnant or breastfeeding, or if you have a known neuromuscular disorder that makes neurotoxins inappropriate. Any active skin infection is a temporary no-go.
Final perspective
Botox is a precise instrument, not a magic wand. For acne scars, it works best as a supportive tool that reduces movement and mechanical stress while other treatments remodel the skin. Expect measured gains, not overnight transformation. When your practitioner maps your facial activity carefully, doses conservatively, and pairs Botox with techniques matched to your scar type, you can achieve smoother skin and a more even look in motion. That is the goal that matters in real life, the moment you catch your reflection while you are laughing with friends and notice the scars are not the first thing you see.