Acne scars can be significantly improved with the right combination of professional treatments, though the best approach depends on the type of scar you’re dealing with. No single treatment works for every scar, and most people need multiple sessions or a combination of techniques to see meaningful results. Understanding what kind of scars you have is the first step toward choosing a treatment that actually works.
Identify Your Scar Type First
Acne scars fall into two broad categories: indented scars (where tissue was lost) and raised scars (where the body overproduced collagen during healing). Most people dealing with acne scars have indented ones, and these come in three distinct shapes.
Ice pick scars are small, narrow indentations that point deep into the skin’s surface, almost like a puncture wound. They’re the hardest to treat because of their depth relative to their width. Boxcar scars are broader depressions with sharply defined edges, similar to a chickenpox scar. Rolling scars have varying depths with sloping edges that make the skin look wavy and uneven. Many people have a mix of all three types, which is why a single treatment rarely does the job on its own.
Raised scars, including keloids and hypertrophic scars, form when too much collagen builds up during healing. These are more common on the chest, back, and jawline, and they require a completely different treatment strategy than indented scars.
Microneedling for Mild to Moderate Scars
Microneedling is one of the most accessible professional treatments for acne scars. The procedure uses a device covered in tiny needles to create controlled micro-injuries in the skin, triggering your body’s natural collagen production. As new collagen fills in, scar depressions gradually become shallower.
Results vary, but clinical data gives a realistic picture of what to expect. In one study published in The Journal of Clinical and Aesthetic Dermatology, about 18% of patients reported 75% to 100% improvement in their scarring, while 24% saw 50% to 74% improvement. The majority of patients, around 55%, perceived a 25% to 49% improvement. That means most people will see noticeable but not dramatic change. Results improve with multiple sessions, typically spaced four weeks apart. Most treatment plans involve four to six sessions.
Microneedling works best on rolling scars and shallow boxcar scars. It’s less effective on deep ice pick scars. Professional sessions start around $300 each, making it one of the more affordable in-office options.
Laser Resurfacing for Deeper Scars
Laser treatments remove or remodel damaged skin layers so new, smoother skin can form. They come in two main types: ablative lasers that vaporize the outer skin layer, and non-ablative lasers that heat tissue beneath the surface without removing it.
For significant acne scarring, ablative lasers (particularly CO2 lasers) tend to produce the most dramatic results. These lasers penetrate deeper into the skin and create a stronger collagen-remodeling response. The tradeoff is downtime: expect roughly 7 to 10 days of recovery, during which your skin will be red, swollen, and peeling. Non-ablative lasers have less downtime but typically require more sessions for comparable results.
Cost reflects this difference. Ablative laser resurfacing averages around $2,509 per session, while non-ablative treatments average about $1,445. Depending on the provider, total costs for a full course of laser resurfacing can range from $1,650 to $3,420. Most insurance plans don’t cover scar treatment since it’s considered cosmetic.
Targeted Treatments for Ice Pick Scars
Ice pick scars are notoriously stubborn because they’re narrow and deep. Broad treatments like microneedling and even lasers often can’t reach the bottom of these scars effectively. A technique called TCA CROSS was developed specifically for this problem.
The procedure involves depositing a small amount of highly concentrated trichloroacetic acid (a chemical peel agent at 70% to 100% strength) directly into each individual scar. This controlled chemical injury stimulates collagen production from the bottom of the scar upward, gradually filling it in. Patients can expect a one to two grade improvement in their scars over a six-month period, and most people need three to six treatments for the best results.
TCA CROSS is often combined with other treatments. A dermatologist might treat ice pick scars with this method while addressing surrounding rolling or boxcar scars with microneedling or laser work.
Subcision for Tethered, Rolling Scars
Some scars look depressed not because tissue is missing, but because fibrous bands beneath the skin are pulling the surface downward. This is especially common with rolling scars. If you press on the edges of a scar and the depression lifts, it’s likely tethered.
Subcision addresses this directly. A needle or cannula is inserted beneath the scar to break up the fibrous tissue responsible for pulling it inward. Releasing these tethers allows the skin to rise back to a more even level, and the healing process stimulates new collagen production that helps maintain the improvement over time.
Subcision is frequently paired with other treatments. One study involving 45 patients combined subcision with microneedling over four sessions spaced four weeks apart and found meaningful improvements in scar appearance. Combining the two techniques, releasing the tether and then stimulating collagen, tends to produce better outcomes than either treatment alone.
What About At-Home Products?
Over-the-counter products can help with discoloration left behind by acne (called post-inflammatory hyperpigmentation), but they have limited ability to change the texture of true scars. If your “scars” are flat, dark or red marks, products containing vitamin C, niacinamide, or alpha hydroxy acids can fade them over several weeks to months. These marks aren’t actually scars and will often fade on their own, though slowly.
At-home retinoids can modestly improve skin texture over time by increasing cell turnover and stimulating some collagen production. They won’t fill in a deep ice pick scar, but they can soften the edges of mild scarring and improve overall skin quality. Using a retinoid consistently for several months before professional treatment can also prime your skin for better results.
At-home derma rollers are widely marketed, but the needles are too short to reach the depth needed for real scar remodeling. Professional microneedling devices penetrate significantly deeper and can be calibrated to your specific scar depth.
Building a Realistic Treatment Plan
The most effective approach for most people involves combining two or more treatments tailored to their specific scar types. A typical plan might look like subcision for tethered rolling scars, TCA CROSS for scattered ice pick scars, and a series of microneedling or laser sessions for overall texture improvement. These are usually done in stages over six months to a year.
Improvement is gradual. Collagen remodeling takes time, and you’ll continue to see changes for months after your final treatment. Most people achieve 50% to 70% improvement with a well-matched combination approach. That’s a significant visual difference, but it’s important to calibrate expectations: the goal is smoother, more even skin rather than scar-free skin.
Cost adds up quickly since these are almost always out-of-pocket expenses. A realistic budget for a multi-treatment plan ranges from $1,500 to $5,000 or more depending on the severity of your scarring and the treatments chosen. Some clinics offer package pricing or financing. Starting with a consultation from a board-certified dermatologist who specializes in scar revision will help you avoid spending money on treatments that aren’t suited to your scar type.