Getting rid of acne scars is possible, but the right approach depends entirely on the type of scar you have and how deep it goes. Shallow scars can improve noticeably with topical treatments over several months, while deeper scars typically need professional procedures like laser resurfacing, microneedling, or subcision. Most people see the best results from combining treatments rather than relying on a single one.
Identifying Your Scar Type
Acne scars fall into two broad categories: depressed scars that sit below the skin’s surface, and raised scars that form bumps above it. Each type responds differently to treatment, so knowing what you’re working with saves time and money.
Depressed (atrophic) scars come in three shapes. Ice pick scars are small, narrow indentations that point downward into the skin, most common on the cheeks. Boxcar scars are wider, box-like depressions with sharp edges, typically 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. Of these three, rolling scars generally respond best to treatment, while ice pick scars are the most stubborn because of their depth.
Raised scars include hypertrophic scars, which stay within the boundary of the original breakout, and keloid scars, which grow beyond it. Both form when the body overproduces scar tissue. They’re more common on the jawline, chest, back, and shoulders, and people with darker skin tones are more likely to develop them.
Topical Treatments for Mild Scarring
If your scars are shallow, topical retinoids can produce visible improvement, though they require patience. A study of adapalene 0.3% gel found that 56% of participants improved by one or two scar grades after 24 weeks. When adapalene was combined with benzoyl peroxide, scarring decreased by about 22% at 24 weeks and 27% at 48 weeks. Researchers noted that while active acne can clear in three months, the collagen remodeling that actually softens scars takes at least six months of consistent use.
Topicals work by stimulating the skin cells responsible for producing collagen, gradually filling in shallow depressions and smoothing texture. They won’t eliminate deep ice pick or boxcar scars, but they can meaningfully improve overall skin texture and serve as a good complement to professional procedures.
Laser Resurfacing
Fractional laser treatments are among the most effective options for moderate to severe acne scarring. These lasers create tiny columns of controlled damage in the skin, leaving the surrounding tissue intact so it can drive healing. The body responds by breaking down disorganized scar tissue and replacing it with new collagen, gradually lifting depressed scars closer to the skin’s surface.
Ablative fractional lasers (like fractional CO2) penetrate deep into the skin and produce the most dramatic results. In clinical comparisons, patients averaged 61% to 69% improvement in overall scar severity. That level of improvement typically requires multiple sessions spaced weeks apart. Non-ablative lasers are gentler, producing less improvement per session but with significantly less downtime.
Recovery varies considerably. A hybrid fractional laser (combining ablative and non-ablative wavelengths) requires about five to seven days of downtime, with redness, swelling, and peeling. A fully ablative laser takes several weeks to heal and requires more intensive aftercare. The average cost runs around $2,000 per session for ablative treatments and $1,100 for non-ablative ones, and most people need two to five sessions.
Microneedling and Radiofrequency
Microneedling uses fine needles to create controlled micro-injuries in the skin, triggering collagen production as the skin repairs itself. When combined with radiofrequency energy, the needles also deliver heat into the deeper layers of skin, amplifying the remodeling effect. Treatment typically uses needle depths of 2 to 3.5 millimeters on the face, adjusted based on scar severity and location.
Microneedling is particularly well suited for rolling scars and broad, shallow boxcar scars. It’s less effective for narrow ice pick scars, which are better addressed with other methods. Most treatment plans involve three to six sessions spaced four to six weeks apart, with a few days of redness and mild swelling after each one. It’s generally more affordable than laser resurfacing, and the lower risk profile makes it a practical starting point for many people.
Subcision for Tethered Scars
Some depressed scars, especially rolling scars, are physically anchored to deeper tissue by fibrous bands that pull the skin surface downward. Subcision releases these bands using a small needle inserted beneath the scar. This frees the skin so it can lift back to a normal level, and the healing process generates new connective tissue underneath that helps maintain the correction.
Subcision works well as a standalone treatment for tethered rolling scars, but recurrence rates are high when it’s used alone because the bands can reattach during healing. For that reason, it’s often combined with fillers, microneedling, or laser treatments to sustain the improvement. If you press on a depressed scar and it flattens out, that’s a sign the scar is tethered and likely a good candidate for subcision.
Dermal Fillers
Injectable fillers can immediately lift individual depressed scars by adding volume beneath them. How long results last depends on the filler material. Hyaluronic acid fillers have shown sustained results for up to two years in follow-up studies. Fillers that stimulate your own collagen production can last even longer, with some maintaining improvement for up to four years.
Fillers are best suited for a small number of well-defined depressed scars rather than widespread scarring. They provide instant visible improvement, which makes them appealing, but they’re a recurring cost since the body eventually absorbs most filler materials. They work particularly well in combination with subcision for rolling scars, filling the space created once the fibrous bands are released.
Targeted Treatment for Ice Pick Scars
Ice pick scars are the hardest type to treat because they’re narrow and deep. The most effective targeted approach is a technique where high-concentration trichloroacetic acid is applied directly into each individual scar using a fine instrument like a toothpick. The acid causes controlled destruction of the scar’s interior, and as the skin heals, new collagen fills in from the bottom up. Each application takes only seconds per scar, and multiple sessions spaced several weeks apart progressively reduce scar depth. This technique is often combined with broader resurfacing treatments to address the surrounding skin texture at the same time.
Special Considerations for Darker Skin
If you have a medium to deep skin tone, treatment selection matters more because many procedures carry a risk of post-inflammatory hyperpigmentation, where the skin darkens in treated areas. Ablative lasers pose the highest risk and are generally best avoided. Topical treatments are considered the safest first-line approach.
When topicals aren’t enough, certain laser types are safer options. Devices that use longer wavelengths (like 1,064 nm lasers) and those that operate at lower energy settings can treat scars while minimizing the chance of triggering pigment changes. Picosecond lasers and low-fluence fractional devices are also better tolerated. The key is finding a provider experienced in treating darker skin tones, since proper device selection and energy settings make the difference between improvement and complications.
Combining Treatments for Best Results
The most effective scar treatment plans layer multiple approaches because different scar types respond to different mechanisms. A common strategy is to start with subcision for tethered rolling scars, follow with fractional laser or microneedling to stimulate broad collagen remodeling, and use targeted acid application for any remaining ice pick scars. Topical retinoids can be used between and after procedures to support ongoing collagen production.
Results are gradual. Collagen remodeling continues for months after each treatment, so the full effect of a session may not be visible for three to six months. A realistic expectation for professional treatment is significant improvement in scar appearance, typically in the range of 50% to 70% for moderate scarring, rather than complete elimination. Most people need a series of treatments over six to twelve months to reach their best outcome, with maintenance sessions occasionally needed afterward.