Acne scars can be significantly improved, though the right approach depends entirely on the type of scar you’re dealing with. Depressed scars, raised scars, and dark marks left behind after breakouts each respond to different treatments. Most people see meaningful improvement with professional procedures, and some milder scars respond to topical treatments you can start at home.
Know Your Scar Type First
Not all acne scars are the same, and a treatment that works well for one type can be completely wrong for another. Acne scars fall into two broad categories: atrophic (indented) and hypertrophic (raised).
Atrophic scars are the most common. They form when the skin doesn’t produce enough collagen during healing, leaving depressions in the surface. Within this group, ice pick scars are deep, narrow pits with sharp borders. Boxcar scars are wider with defined edges, almost like a small crater. Rolling scars create a wave-like unevenness across the skin because fibrous bands underneath pull the surface downward.
Hypertrophic scars sit above the skin’s surface as firm, raised tissue. They form when the body overproduces collagen during healing. Keloids are a more aggressive version that grow beyond the original wound boundary. The distinction matters because treatments designed to stimulate collagen production (great for depressed scars) would be counterproductive for scars that already have too much collagen.
Topical Retinoids for Mild Scars
If your scars are shallow, prescription retinoids are worth trying before investing in procedures. Adapalene, available over the counter at lower strengths and by prescription at higher concentrations, does more than just smooth skin texture. Research published in the Journal of Drugs in Dermatology found that adapalene promotes actual scar remodeling by stimulating the production of new collagen and elastic tissue, not just fading surface discoloration.
The catch is that retinoids work slowly and have limits. You’re looking at a minimum of 24 weeks of consistent use to see measurable reduction in scar counts. They work best on newer, shallower scars. Deep ice pick scars or significant rolling scars won’t respond meaningfully to topical treatment alone, but retinoids are often used alongside professional procedures to enhance results.
Laser Resurfacing
Fractional CO2 laser resurfacing is one of the most effective treatments for depressed acne scars. The laser creates thousands of microscopic channels in the skin, triggering a wound-healing response that generates new collagen and resurfaces damaged tissue. Clinical studies show improvement of 50 to 80 percent in atrophic acne scars, making it one of the higher-performing options available.
Most people need one to three sessions spaced four to six weeks apart, though some treatment protocols call for up to four sessions depending on scar severity. Recovery is the trade-off for those results. Expect redness, swelling, crusting, and peeling that can keep you out of social situations for about a week, sometimes longer after more aggressive settings. The average cost is around $1,829 per session according to the American Society of Plastic Surgeons, and insurance rarely covers scar treatment.
Less aggressive lasers (often marketed as “non-ablative” fractional lasers) offer shorter recovery times with more modest improvement. They’re a reasonable option if you can’t take a week off but are willing to do more sessions to build results gradually.
Microneedling and Radiofrequency
Microneedling uses fine needles to create controlled micro-injuries in the skin, prompting your body to produce collagen as it heals. Standard microneedling works, but radiofrequency (RF) microneedling takes it further by delivering heat energy through the needles into the deeper layers of skin. This heats larger volumes of tissue compared to older needle-only devices, creating a stronger collagen response.
Treatment typically involves needles penetrating 2 to 3.5 millimeters into the skin. Newer non-insulated needle designs deliver energy along the full length of the needle rather than just the tip, which means better results with fewer passes and less bleeding during the procedure. RF microneedling is particularly effective for boxcar and rolling scars, where rebuilding volume across a broader area matters more than targeting a single narrow pit.
Recovery is generally shorter than with CO2 lasers. Most people experience redness and mild swelling for a few days. Multiple sessions are needed, typically three to five spaced a month apart, to see full results.
Subcision for Rolling Scars
Rolling scars have a specific problem that lasers and microneedling don’t fully address: fibrous bands of scar tissue beneath the surface that tether the skin downward, creating that uneven, wave-like appearance. Subcision directly targets these bands.
During the procedure, a needle is inserted at an angle beneath the scar and moved back and forth in a fan-like motion to physically cut the fibrous strands pulling the skin down. The released skin can then settle at a more normal level, and the pocket of space that forms underneath fills with new tissue over time. Subcision is often paired with other treatments for better results. Microneedling can be performed as soon as a day after subcision, and it’s also commonly combined with fractional laser treatment, chemical peels, or fillers.
TCA CROSS for Ice Pick Scars
Ice pick scars are notoriously difficult to treat because they’re so narrow and deep. Lasers can’t always reach the bottom, and microneedling may not concentrate enough energy in such a small area. The TCA CROSS technique was designed specifically for this problem.
A dermatologist deposits a small amount of highly concentrated trichloroacetic acid (70 to 100 percent) directly into the base of each individual scar. This triggers a controlled inflammatory response that stimulates collagen production from the bottom up, gradually filling the scar over multiple treatments. Expect a one to two grade improvement in scar depth over about six months. It’s not a dramatic overnight fix, but for deep ice pick scars that don’t respond well to other treatments, it’s one of the more reliable options.
Dermal Fillers for Immediate Volume
If you want visible improvement quickly, injectable fillers can physically raise depressed scars to match the surrounding skin. Hyaluronic acid fillers are the most commonly used, with some formulations designed specifically to avoid a bluish tint that can occur when fillers are injected too superficially.
The limitation of hyaluronic acid fillers is that they’re temporary. Your body gradually breaks them down, and you’ll need repeat treatments to maintain results. Semi-permanent fillers made from calcium hydroxyapatite can maintain at least some degree of improvement for up to 12 months after a single treatment, with rolling scars responding particularly well. Permanent filler options also exist but carry higher risk and require careful consideration with your provider.
Treating Raised Scars
Hypertrophic and keloid scars need the opposite approach from depressed scars. Instead of building collagen, the goal is to break it down and flatten the excess tissue. Silicone gel sheets are the simplest first-line treatment. Worn for at least four hours per day over a minimum of three months, they hydrate and compress the scar tissue, gradually softening and flattening it. Research in the Journal of Clinical and Aesthetic Dermatology found that continuing treatment for at least six months helps prevent recurrence after a scar has flattened.
For more stubborn raised scars, corticosteroid injections can shrink the tissue by reducing collagen production and inflammation. These are typically done in a series of sessions spaced several weeks apart. Keloids, which tend to grow back aggressively, often require a combination of injections, silicone therapy, and sometimes surgical removal followed by additional treatment to prevent regrowth.
Combining Treatments for Better Results
The most effective acne scar treatment plans rarely rely on a single method. A person with a mix of scar types might undergo subcision for rolling scars, TCA CROSS for ice pick scars, and a round of RF microneedling or laser resurfacing across the full face to improve overall texture. Retinoids can be layered in throughout the process to support collagen remodeling between procedures.
Realistic expectations matter. Even aggressive, multi-modal treatment plans typically improve scars rather than erase them completely. A 50 to 80 percent improvement from laser resurfacing, for example, is a genuinely noticeable change in how your skin looks and feels, but it’s not the same as having skin that was never scarred. Most people find that level of improvement is enough to feel significantly better about their appearance, especially when combined with other targeted treatments for their worst individual scars.
Timing also plays a role. Starting treatment earlier, while scars are still relatively new, tends to produce better outcomes than waiting years. If you’re still having active breakouts, getting acne under control first prevents new scars from forming while you’re investing time and money in treating the old ones.