Getting rid of an acne scar depends entirely on what type of scar you’re dealing with. Shallow scars can fade significantly with consistent topical treatments over several months, while deep or pitted scars typically need professional procedures like microneedling, laser resurfacing, or subcision. Most people see the best results from combining approaches, because acne scars vary in shape and depth, even on the same face.
Identify Your Scar Type First
Acne scars fall into two broad categories: depressed (atrophic) and raised (hypertrophic). The treatments that work for one can be completely wrong for the other, so this step matters.
Atrophic scars sit below the surface of your skin and come in three shapes. Ice pick scars are small, narrow holes that point deep into the skin, almost like a puncture. Boxcar scars are wider, box-shaped depressions with sharp, defined edges. Rolling scars have sloping edges and varying depths, giving the skin a wavy, uneven texture. Of the three, rolling scars tend to respond best to treatment, while ice pick scars are the most stubborn.
Hypertrophic scars are raised lumps of scar tissue that form when your body overproduces collagen during healing. They stay within the boundaries of the original breakout. Keloid scars are similar but grow beyond the original spot, creating a scar larger than the acne that caused it. Both types are more common on the jawline, chest, and back.
Topical Treatments for Mild Scarring
If your scars are relatively shallow, topical retinoids are the most evidence-backed option you can start at home. Retinoids (tretinoin, adapalene, tazarotene) stimulate collagen production in the skin, which gradually fills in depressed areas and smooths texture. In one clinical study, patients using 0.3% adapalene gel daily for 24 weeks saw significant improvement, with nearly 39% of participants going from severe scarring to the mildest grade. That’s a meaningful change from a topical product, though results take months to appear.
The key with retinoids is patience and consistency. You won’t notice much in the first four to six weeks. Improvement builds gradually as new collagen develops beneath the scar. Start with a lower concentration if your skin is sensitive, and use sunscreen daily, since retinoids make your skin more vulnerable to UV damage, which can darken scars.
Over-the-counter options like adapalene (sold as Differin) are a reasonable starting point for mild, shallow scarring. For deeper atrophic scars, topical treatments alone are unlikely to make a dramatic difference.
Microneedling for Moderate Scars
Professional microneedling uses a device covered in fine needles to create thousands of tiny, controlled injuries in the skin. Your body responds by producing new collagen to repair those micro-wounds, and that new collagen fills in and firms the scarred area over time. Clinical research reports improvement rates between 25% and 75%, depending on scar type and how many sessions you complete.
The number of sessions you’ll need depends on your scars. Rolling scars typically respond well in 3 to 5 sessions. Boxcar scars usually need 4 to 6. Ice pick scars, because of their narrow depth, often require 6 to 8 or more sessions with realistic expectations about how much improvement is possible. Sessions are spaced 4 to 6 weeks apart, and your skin continues to improve for 3 to 6 months after your final session as collagen remodeling continues beneath the surface.
Microneedling is generally well tolerated across skin tones, which makes it a popular option for people with darker skin who face a higher risk of pigmentation problems from laser treatments.
Laser Resurfacing for Deeper Scars
Fractional lasers create microscopic columns of damage in the skin, leaving surrounding tissue intact so healing happens faster. There are two main types, and the right choice depends on how deep your scars are and how much downtime you can handle.
Fractional CO2 lasers penetrate deeper into the dermis and trigger aggressive collagen remodeling. They’re the stronger option for deep, pitted scars, improving skin thickness, texture, and pitting over multiple months. The trade-off is recovery: expect oozing and crusting for the first day or two, followed by intense redness and peeling for 5 to 10 days, with sun sensitivity lasting several weeks. Most people need to plan for 7 to 14 days of noticeable downtime.
Erbium lasers work at a more superficial level and are better suited for milder texture concerns. Recovery is shorter, typically 3 to 7 days of redness, light peeling, and skin tightness. If your scars are shallow or you’re looking to refine overall skin tone alongside mild scarring, erbium is the gentler path.
With either laser, final results take time. New collagen continues developing for months after the procedure, and most practitioners recommend waiting at least 3 to 6 months between sessions to allow for full cellular regeneration in the deeper skin layers.
Subcision for Tethered, Rolling Scars
Some depressed scars, especially rolling scars, are pulled downward by fibrous bands of scar tissue anchoring the skin’s surface to deeper layers. Subcision is a minor procedure where a needle is inserted beneath the scar to physically cut those fibrous bands, releasing the skin so it can rise back to its normal level. The controlled trauma also triggers a clot and new collagen formation underneath, which further lifts the scar from below.
Subcision works best when combined with other treatments. Studies show it has increased effectiveness when paired with fractional CO2 laser, microneedling with radiofrequency, or platelet-rich plasma. In some cases, a dermal filler is injected beneath the scar after subcision to prevent the fibrous bands from reattaching and to provide immediate volume. This combination approach addresses both the tethering and the lost volume that make scars visible.
Fillers for Volume Loss
Dermal fillers can plump up individual depressed scars by restoring volume beneath them. Most hyaluronic acid fillers used for this purpose are temporary, lasting anywhere from 6 to 18 months before your body absorbs them. Bellafill is the only filler with FDA approval specifically for moderate to severe atrophic acne scars on the cheeks (in patients over 21). In its clinical trial, about 71% of treated patients showed improvement at the 12-month mark, though long-term effectiveness beyond one year hasn’t been formally established.
Fillers are particularly useful for broad, shallow depressions where the skin has lost underlying support. They don’t work well for narrow ice pick scars or raised scars.
The TCA CROSS Method for Ice Pick Scars
Ice pick scars are notoriously difficult to treat because they’re narrow and deep. The CROSS technique (chemical reconstruction of skin scars) was designed specifically for them. A practitioner deposits a small amount of highly concentrated trichloroacetic acid (70% to 100%) directly into the base of each individual scar. This causes controlled destruction of the scar tissue, and as the skin heals, new collagen fills in the narrow channel from the bottom up.
The technique was originally developed for and tested on patients with darker skin tones (Fitzpatrick types IV and V) and was designed to minimize side effects like scarring and pigmentation changes. Multiple sessions are usually needed, spaced several weeks apart, with gradual improvement after each round.
Risks for Darker Skin Tones
Post-inflammatory hyperpigmentation, where treated skin darkens temporarily, is the most common concern for people with medium to dark skin. The risk varies by treatment type. Traditional ablative CO2 and erbium lasers carry a notable risk of hyperpigmentation and prolonged redness. Non-ablative fractional lasers are generally safer for darker skin, though pigmentation changes can still occur even at low energy settings.
Microneedling and the TCA CROSS technique tend to be better tolerated across a wider range of skin tones. Chemical peels carry significant risk: in one study using Jessner’s solution followed by 35% TCA for ice pick scars, over 73% of patients developed post-inflammatory hyperpigmentation, lasting up to three months in some cases. If you have darker skin, the choice of treatment and the practitioner’s experience with your skin type matters enormously.
Why Combination Therapy Works Best
Most people don’t have just one type of acne scar. A single cheek might have a few ice pick scars, a couple of boxcar depressions, and some rolling areas, all requiring different approaches. Combination therapies are more effective than any single treatment because they can address volume loss, skin tethering, and surface texture at the same time. A typical plan might involve subcision for tethered rolling scars, the CROSS technique for ice picks, and a course of microneedling or fractional laser for overall texture.
Whatever approach you choose, collagen remodeling is a slow process. The most visible changes happen in the first few months after a procedure, but skin continues to improve and firm for up to six months. Plan for multiple sessions of any treatment, spaced weeks to months apart, and set realistic expectations: most procedures improve scars significantly rather than erasing them completely.