Acne scars can be significantly improved, though the right approach depends entirely on what type of scarring you have. Shallow scars may respond to topical treatments and light procedures, while deep or tethered scars typically need professional intervention like laser resurfacing, subcision, or radiofrequency microneedling. Most people see the best results from combining multiple treatments rather than relying on a single one.
Identify Your Scar Type First
Acne scars fall into two broad categories: indented (atrophic) and raised (hypertrophic or keloid). Within the indented category, there are three distinct shapes, and each responds differently to treatment.
- Ice pick scars are small, narrow indentations that point down sharply into the skin. They’re the deepest type relative to their width, which makes them the hardest to treat with surface-level methods.
- Boxcar scars are broader depressions with sharp, defined edges, almost like a small crater punched into the skin.
- Rolling scars vary in depth and have sloping edges, giving the skin a wavy, uneven texture.
- Hypertrophic and keloid scars are raised lumps of scar tissue that form where acne once was. Hypertrophic scars stay within the boundaries of the original blemish, while keloids grow beyond it.
A dermatologist can map your scarring and recommend a treatment plan tailored to the specific types present. Most people have a mix.
Laser Resurfacing for Moderate to Severe Scars
Fractional lasers are one of the most effective tools for acne scarring. They work by creating thousands of tiny columns of controlled damage in the skin, which triggers the body to produce new collagen and rebuild the tissue from within. There are two main categories.
Ablative lasers (most commonly CO2 lasers) vaporize thin layers of skin and create a wider zone of thermal damage in the deeper layers. This more aggressive approach promotes greater collagen production, making it well suited for deeper boxcar and rolling scars. The tradeoff is a longer recovery: skin typically takes one to two weeks to heal after CO2 laser treatment, during which the area may turn red or dark and form a crust that gradually falls away. Full results continue developing for many weeks after that initial healing window.
Non-ablative lasers (like fractional diode lasers) heat the deeper skin layers without breaking the surface. They cause columns of coagulation in the dermis while preserving the surrounding tissue, and the body fills in the damage with fresh collagen and elastin. Recovery is shorter, but results per session are more modest. Interestingly, research comparing fractional CO2 to fractional diode lasers found that collagen production was similar between the two, with CO2 producing about 39.7% collagen per unit area versus 37.8% for the diode laser, a difference that wasn’t statistically significant. This suggests non-ablative options can get you to a similar place over more sessions if you can’t afford the downtime of ablative treatment.
Microneedling and Radiofrequency Microneedling
Standard microneedling uses fine needles to create controlled micro-injuries in the skin, triggering a wound-healing response that remodels collagen over time. It works well for shallow rolling scars and overall texture improvement, and it’s one of the more affordable professional options at roughly $200 to $700 per session, with most providers charging $300 to $400.
Radiofrequency (RF) microneedling takes this further by delivering heat energy through the needles directly into the deeper layers of the dermis. This combination of physical puncture and thermal energy promotes more significant collagen remodeling than needling alone. Most treatment plans involve two to six sessions spaced about a month apart. RF microneedling sessions run $600 to $1,200 each, about 30 to 50% more than standard microneedling. Adding platelet-rich plasma (PRP) to either type of microneedling costs an additional $200 to $400 per session.
RF microneedling is a strong middle-ground option: more effective per session than standard microneedling, with less downtime than ablative laser resurfacing.
Subcision for Tethered Scars
Rolling scars often look indented because fibrous bands of tissue underneath are physically pulling the skin downward. Subcision addresses this directly. A needle is inserted beneath the scar to cut and release those fibrous bands, allowing the skin to lift. The bleeding that occurs during the process forms a clot underneath the scar, filling the space and promoting new collagen growth that further elevates the area over time.
Subcision is particularly effective when combined with other treatments. Because most people have multiple scar types, combination approaches that include volume restoration, skin tightening, and resurfacing tend to outperform any single treatment. A common strategy pairs subcision with filler injections or microneedling sessions to build on the initial improvement.
TCA CROSS for Deep Ice Pick Scars
Ice pick scars are notoriously resistant to lasers and microneedling because they’re narrow and deep. The TCA CROSS technique (chemical reconstruction of skin scars) uses a high concentration of trichloroacetic acid, typically 70%, applied precisely into the base of each individual scar with a fine applicator. The acid triggers an intense localized healing response that builds collagen from the bottom of the scar upward, gradually raising it to meet the surrounding skin.
In a clinical study of 20 patients with ice pick scars, 60% showed marked improvement, 30% showed moderate improvement, and 10% showed mild improvement. Multiple sessions are usually needed, and TCA CROSS is often followed by laser resurfacing or microneedling to smooth the overall texture once the deepest scars have been raised.
What Topical Treatments Can Actually Do
If you’re hoping a cream can replace a procedure, the honest answer is that topicals work more slowly and produce more subtle results. But they’re not useless, especially for mild scarring and as a complement to professional treatments.
Prescription retinoids (tretinoin, tazarotene, adapalene, trifarotene) stimulate collagen production and promote tissue remodeling. Tretinoin in particular strongly stimulates the production of two key types of collagen and improves the organization of newly formed collagen fibers. In clinical trials, adapalene at 0.3% improved skin texture by one to two grades in over half of patients. Tazarotene 0.1% applied daily for three months produced scar reduction comparable to microneedling in one head-to-head trial. Trifarotene showed significant scar reduction over 24 weeks compared to placebo.
These results are meaningful but modest compared to energy-based devices. Retinoids are best used as a long-term maintenance strategy, either before or between professional treatments, to keep collagen turnover active. They also help with post-inflammatory dark marks that often accompany scarring, improving overall skin appearance even if the physical depth of scars changes only gradually.
Why Combination Treatments Work Best
The reason no single treatment dominates acne scar management is that different scar types have different underlying problems. Ice pick scars need depth-filling. Rolling scars need their fibrous tethers released. Boxcar scars need both collagen rebuilding and surface smoothing. Most faces have all three.
A typical multi-step plan might look like subcision for tethered rolling scars, TCA CROSS for the deepest ice pick scars, followed by a series of fractional laser or RF microneedling sessions to resurface the overall texture. Topical retinoids can be used between sessions to support ongoing collagen remodeling. This layered approach addresses scarring at every level, from the fibrous bands pulling skin down to the surface irregularities that catch light unevenly.
Timing Matters More Than You Think
If you still have active breakouts, treating scars effectively becomes much harder. Medications used for active acne can interfere with scar treatments, and new inflammation can undermine healing. Your skin needs to be consistently clear before starting scar revision.
The other timing factor is how early you intervene. Treating acne aggressively before it has the chance to scar is far easier than correcting damage after the fact. Early-stage scars also respond better to treatment than older, more established ones. If you’re still breaking out, prioritizing acne control now will prevent the scarring you’d otherwise spend years and significant money trying to fix later.