Acne scars can be significantly improved, but the right approach depends on what type of scar you’re dealing with. Shallow scars may respond to at-home topical treatments over several months, while deeper scars typically need professional procedures like microneedling, laser resurfacing, or chemical reconstruction. Most people see the best results from combining treatments rather than relying on a single method.
Know Your Scar Type First
Not all acne scars are the same, and treatments that work well for one type can be ineffective for another. Acne scars fall into two broad categories: indented scars (where tissue was lost) and raised scars (where the body overproduced collagen during healing).
Indented scars come in three main varieties. Ice pick scars are small, narrow holes that point deep into the skin, almost like a puncture wound. Boxcar scars are broader depressions with sharp, defined edges. Rolling scars have sloped edges and varying depths that give the skin a wavy, uneven texture. Raised scars, called keloids, grow beyond the borders of the original breakout and form a thick, bumpy mound of scar tissue.
Understanding which type you have matters because depth and shape determine which treatments can reach the problem. Ice pick scars, for instance, are too narrow and deep for most surface-level treatments to make a real difference.
Topical Treatments for Mild Scarring
If your scars are shallow, topical products can meaningfully improve texture over time. Retinoids (derivatives of vitamin A) are the most studied option. They speed up cell turnover and stimulate collagen production in the deeper layers of skin. A study published in the Indian Dermatology Online Journal found that a combination of retinoic acid and glycolic acid improved acne scars in over 91% of patients after 12 weeks of consistent use. Tretinoin specifically has been shown to decrease the depth of atrophic scars in up to 94% of patients in some studies.
Over-the-counter retinol is a gentler starting point, though prescription tretinoin delivers stronger results. Pair it with a glycolic acid product (used on alternating nights to avoid irritation) to enhance exfoliation and allow the retinoid to penetrate more effectively. You’ll need at least three months of daily use before judging whether it’s working. These products make your skin more sensitive to UV damage, so daily sunscreen is non-negotiable while using them.
Other topicals worth considering include azelaic acid, which can help fade the dark marks (post-inflammatory hyperpigmentation) that often accompany scars, and vitamin C serums, which support collagen synthesis and brighten skin tone. These won’t reshape deep scars, but they can make the overall appearance of scarred skin noticeably more even.
Microneedling for Moderate Scars
Microneedling uses a device covered in fine steel needles to create controlled micro-injuries in the skin. This triggers your body’s wound-healing response, generating new collagen that gradually fills in depressed scars. It works well for rolling scars and shallow boxcar scars.
For acne scars, practitioners typically use needles 1.5 to 2 mm in length, which reach the superficial dermis where collagen remodeling happens. Deeper scars may call for 2.5 to 3 mm needles, though this is less common. Delicate areas like around the eyes use shorter needles of 0.5 to 1 mm. A topical numbing cream is applied before the procedure, and sessions usually take 20 to 30 minutes.
Most people need three to six sessions spaced about four weeks apart. Your skin will be red and feel sunburned for a few days afterward. The real texture changes develop gradually over three to six months as new collagen matures beneath the surface. Professional microneedling sessions generally cost between $200 and $700 each, depending on your location and provider.
At-home derma rollers exist, but their shorter needles (typically 0.25 to 0.5 mm) can’t reach the depth needed for meaningful scar remodeling. They may help with product absorption and mild texture, but they won’t reshape actual scars.
Laser Resurfacing for Deeper Scars
Fractional CO2 laser treatment is one of the most effective options for moderate to severe acne scarring. The laser creates tiny columns of controlled damage in the skin, leaving surrounding tissue intact so healing is faster. As the skin repairs itself, new collagen fills in the scarred areas from the inside out.
Clinical studies show fractional CO2 lasers produce 50 to 80% improvement in the depth of atrophic acne scars. Most patients need one to three sessions, spaced four to six weeks apart, though some treatment plans call for up to four sessions depending on severity. The average cost of laser skin resurfacing is $1,829 per session, according to the American Society of Plastic Surgeons.
Recovery is more involved than with microneedling. Expect about a week of redness, swelling, and peeling. Your skin will look noticeably pink for several weeks after that. The collagen remodeling process continues for three to six months after your last session, so the final results take time to appear. Many patients report that the most meaningful texture changes show up around the three-month mark, when shallower scars smooth out and shadows from deeper ones become less visible.
Fractional lasers work best on boxcar and rolling scars. They’re less effective on ice pick scars, which are too narrow and deep for the laser energy to fully reach.
The CROSS Technique for Ice Pick Scars
Ice pick scars are the most stubborn type, but a technique called CROSS (Chemical Reconstruction of Skin Scars) was designed specifically for them. A dermatologist applies a high-concentration trichloroacetic acid solution directly into each individual scar using a fine applicator. The acid destroys the damaged tissue at the bottom of the scar and triggers new collagen formation that pushes the scar up to the level of surrounding skin.
Results from this approach are strong. In a pilot study using 100% concentration, 80% of patients achieved excellent improvement (greater than 70% reduction in scar depth), and the remaining 20% showed good improvement after four sessions. Sessions are typically spaced two to four weeks apart. Each treated scar forms a small scab that heals over about a week. The procedure itself takes only minutes, and discomfort is brief since each application is just a tiny dot of acid.
CROSS is often combined with other treatments. A common approach is to use CROSS on ice pick scars first, converting them into shallower depressions, then follow up with laser resurfacing or microneedling to smooth the overall skin surface.
Subcision and Fillers for Tethered Scars
Some rolling scars look worse than they are because fibrous bands of scar tissue beneath the skin pull the surface downward. Subcision is a minor procedure where a needle is inserted under the scar to break these tethering bands, releasing the skin so it can rise back to a more normal level.
Subcision works particularly well when combined with a dermal filler injected underneath the released scar to prop it up and prevent the bands from reattaching. The filler provides immediate volume while also stimulating your own collagen production over time. Results from the filler component last six months to two years depending on the product used. Some practitioners also combine subcision with microneedling or laser in the same treatment plan for more comprehensive improvement.
Combining Treatments for Best Results
The most effective acne scar treatment plans combine multiple approaches tailored to the specific scar types on your face. A person with a mix of ice pick, rolling, and boxcar scars might undergo CROSS for the ice picks, subcision for tethered rolling scars, and fractional laser for overall texture refinement. Meanwhile, a daily retinoid and sunscreen routine supports the skin’s healing between procedures.
Expect the full process to take six months to a year from first treatment to final results. Collagen remodeling is slow biology. Most patients begin seeing meaningful texture changes at the three-to-six-month mark after a procedure, but continued improvement can happen for months beyond that. Plan for multiple sessions of whichever procedure you choose, and budget accordingly since most insurance plans consider scar treatment cosmetic.
Protecting Your Results
Sun exposure is the single biggest threat to healing skin. UV radiation breaks down new collagen, darkens post-inflammatory pigmentation, and can make scars more visible than they were before treatment. Use a broad-spectrum SPF 30 or higher every morning, even on overcast days, especially during the months you’re actively treating scars.
Equally important: make sure your active acne is fully under control before starting scar treatment. Procedures like microneedling and laser resurfacing on skin that’s still breaking out can worsen inflammation and create new scars. Get the acne managed first, then address the scars it left behind.