Getting rid of acne scars is possible, but the right approach depends entirely on what type of scars you have. Indented scars and raised scars require opposite strategies, and some treatments work dramatically better on certain scar shapes than others. Most people see meaningful improvement with professional treatments, though deeper scars typically need multiple sessions and sometimes a combination of techniques.
Identify Your Scar Type First
Acne scars fall into two broad categories: indented (atrophic) and raised (hypertrophic or keloid). Indented scars sit below the skin’s surface because tissue was lost during the healing process. Raised scars stick up above the skin because the body overproduced scar tissue. This distinction matters because a treatment that flattens raised tissue won’t fill in a depression, and vice versa.
Within the indented category, there are three distinct shapes. Ice pick scars are small, narrow, and deep, almost like a puncture wound pointing down into the skin. They’re common on the cheeks and notoriously difficult to treat. Boxcar scars are wider depressions with sharp, defined edges, most often found on the lower cheeks and jaw where skin is thicker. Rolling scars have sloping edges at varying depths, giving the skin a wavy, uneven texture. Many people have a mix of all three.
Hypertrophic scars stay within the boundaries of the original breakout, while keloid scars grow beyond it. Both appear as firm, raised lumps where acne once was.
Laser Resurfacing for Indented Scars
Fractional CO2 laser treatment is one of the most effective options for indented acne scars, with clinical studies showing 50 to 80 percent improvement in scar appearance. The laser removes microscopic columns of damaged skin while leaving surrounding tissue intact, which triggers the body to rebuild collagen and smooth out depressions.
Expect about 5 to 7 days of downtime after a session. Your skin will be red, swollen, and sensitive during that window. Most people need two to four sessions spaced several weeks apart for optimal results, and costs range from $800 to $2,500 per session depending on the type of laser used. Hybrid fractional lasers tend to sit at the higher end of that range.
Non-ablative lasers are a gentler alternative with less downtime, but they produce more subtle results and require more sessions to achieve similar improvement.
Microneedling and RF Microneedling
Standard microneedling uses a device covered in tiny sterile needles to create controlled micro-injuries in the skin. These punctures trigger a healing response that produces new collagen over time. It works well for mild to moderate scarring, but results build slowly over multiple treatments and tend to be more subtle.
Radiofrequency (RF) microneedling adds heat energy delivered through the needles, reaching deeper layers of skin. The results are faster, more dramatic, and longer lasting compared to standard microneedling. RF microneedling can also be adjusted to target different depths, making it more versatile for mixed scar types. Sessions typically cost $500 to $1,500 each, and most people need three to four treatments.
Targeted Treatments for Specific Scar Types
TCA CROSS for Ice Pick Scars
Ice pick scars are too narrow and deep for most surface-level treatments to reach effectively. A technique called TCA CROSS uses a highly concentrated acid (70 to 100 percent) applied in tiny amounts directly into each individual scar. This controlled chemical injury forces the scar to heal from the bottom up, gradually raising the depressed tissue closer to the surrounding skin level. It typically requires several sessions spaced a few weeks apart, and it works best on the deepest, most severe ice pick scars.
Subcision for Rolling Scars
Rolling scars often look the way they do because fibrous bands of tissue underneath are pulling the skin’s surface downward. Subcision releases those bands using a small needle inserted beneath the scar. Once the tethering is broken, the scar elevates. The procedure also triggers a healing response underneath that builds new collagen to fill the space.
Subcision becomes even more effective when combined with other treatments. Pairing it with skin suctioning, fractional CO2 laser, RF microneedling, or platelet-rich plasma has shown increased improvement compared to subcision alone. For significant rolling scars, this combination approach often produces the best results.
Chemical Peels
Chemical peels remove the outer layers of skin to promote new cell growth and smoother texture. They’re most effective for shallow scarring and post-inflammatory discoloration (the dark or red marks left behind after a breakout, which aren’t true scars but often look like them). For deeper atrophic scars, peels alone won’t produce dramatic results, though they can complement other procedures. Sessions range from $150 to $700, making them one of the more affordable professional options.
What Topical Products Can Do
Over-the-counter and prescription topicals can improve scar appearance, but they work slowly and have limits. Prescription retinoids are the most studied option. Consistent daily use promotes skin cell turnover and collagen production, but visible improvement in scar texture typically takes around 12 months. That’s a realistic timeline, not a failure of the product. Retinoids are a reasonable starting point for mild scarring or as a complement to professional treatments, but they won’t reshape deep ice pick or boxcar scars on their own.
Products containing vitamin C, niacinamide, or alpha hydroxy acids can help fade discoloration and improve overall skin texture. They’re best suited for the flat dark or red marks that linger after breakouts rather than for true indented or raised scars.
Managing Raised Scars
Hypertrophic and keloid scars need a different strategy entirely. Silicone gel sheets are a well-supported first-line treatment. The recommended approach is wearing them for at least 12 hours a day over a period of 2 to 3 months. This consistent pressure and hydration helps flatten the raised tissue gradually.
For more stubborn raised scars, dermatologists may use steroid injections to shrink the tissue, or combine injections with other approaches. Keloid scars in particular tend to recur, so treatment often involves multiple modalities and longer follow-up.
Aftercare for Professional Treatments
What you do after a procedure matters almost as much as the procedure itself, especially with laser resurfacing. For the first few days after CO2 laser treatment, apply ice packs wrapped in a soft cloth for 15 to 20 minutes at a time, several times a day, to manage swelling. Keep the treated area covered with a clean bandage and change it twice daily after gently washing the skin.
Use only what your provider specifically recommends on the treated area. Applying other products, even “natural” ones, can interfere with healing. Avoid sun exposure on the treated skin until it’s fully healed, and when you do go outside, use a mineral sunscreen with at least SPF 30 or cover the area with clothing or a hat. Sun damage during the healing window can cause lasting discoloration, especially in darker skin tones.
Realistic Expectations and Cost
No single treatment eliminates acne scars completely. The goal is significant improvement, not perfection. Most professional treatments reduce scar visibility by 50 to 80 percent over a series of sessions, and combining techniques (for example, subcision followed by RF microneedling) often outperforms any single approach.
Cost adds up. A typical course of RF microneedling might run $1,500 to $6,000 total across three to four sessions. Laser resurfacing can cost $2,400 to $7,500 for a full treatment series. Insurance rarely covers acne scar treatment because it’s considered cosmetic. Some clinics offer payment plans, and starting with a consultation helps you understand which combination of treatments makes sense for your specific scar types and budget before committing.