Pimple scars can be improved significantly, but the right approach depends on what type of scar you’re dealing with and how deep it goes. Most acne scars fall into two broad categories: depressed scars (where the skin dips inward because too little collagen formed during healing) and raised scars (where excess collagen created a bump). Treatments range from in-office procedures that can produce dramatic improvement to topical products that gradually soften mild scarring over months.
Identify Your Scar Type First
Not all acne scars respond to the same treatment, so identifying what you have saves time and money. Depressed (atrophic) scars are far more common and come in three varieties:
- Ice pick scars are narrow, deep holes that look like tiny puncture marks. They extend deep into the skin and are the most stubborn to treat.
- Boxcar scars have sharp, defined edges with a flat base, almost like a small crater. They can be shallow or deep.
- Rolling scars create a wavy, uneven texture because fibrous bands beneath the skin pull the surface downward.
Raised scars are less common with acne. Hypertrophic scars stay within the boundaries of the original breakout and may flatten on their own over time. Keloids extend beyond the original spot, can keep growing, and often feel itchy or tender. Raised scars require a completely different treatment strategy than depressed ones, so getting the distinction right matters.
Professional Treatments With the Strongest Evidence
Laser Resurfacing
Fractional lasers work by creating microscopic columns of damage in the skin, triggering your body’s wound-healing response and forcing new collagen production. The two main options are CO2 lasers and erbium lasers. CO2 lasers penetrate deeper and produce more dramatic results, but recovery takes 7 to 14 days or longer, with redness, swelling, crusting, and peeling. Erbium lasers are gentler, with most people returning to normal activities in 3 to 5 days, though the results per session are more modest.
Most patients need 3 to 6 laser sessions to see meaningful improvement. Early changes can appear within a few weeks, but the real texture improvement happens gradually over 3 to 6 months as new collagen forms beneath the surface. Many people look back at photos months later and notice softening they didn’t see at first.
Microneedling
Professional microneedling uses thin needles (ranging from 0.5 to 2 millimeters long) to create tiny punctures in the skin. This controlled damage stimulates your body to produce more collagen and elastin, the proteins responsible for firm, smooth skin. Deeper scars require longer needles that reach further into the skin. The procedure typically requires multiple sessions spaced several weeks apart, with gradual improvement over 3 to 6 months.
Subcision
For rolling scars specifically, subcision is one of the most effective options. A provider inserts a small needle beneath the scar to break the fibrous bands that pull the skin downward, releasing the tethered surface. In one study of 45 patients, 95.6 percent saw improvement after subcision combined with microneedling. Rolling scars and wider, deeper depressions respond best. Ice pick scars, however, don’t improve much with this technique.
Expect some swelling and bruising afterward that takes several days to settle. Subcision is often combined with other treatments like microneedling or fillers to maximize results.
Chemical Reconstruction (TCA CROSS)
This technique targets individual scars, particularly ice pick scars, by applying a high-concentration acid directly into each depression with a small applicator. The controlled chemical injury stimulates collagen production that gradually fills the scar from below. In one clinical study, 60 percent of patients saw marked improvement, 30 percent saw moderate improvement, and patients who completed five or six treatment rounds with the highest concentration all achieved excellent results. Sessions are repeated every few weeks, and ice pick scars that resist other treatments often respond well to this approach.
Dermal Fillers
For depressed scars, injectable fillers made of hyaluronic acid (the same substance in many moisturizers) can physically lift the indentation to match the surrounding skin. The procedure is quick and results are immediate. While fillers were traditionally considered temporary, research now shows they can last as long as 10 years after injection for acne scars, making them a more durable option than many people assume.
What You Can Do at Home
Over-the-counter options won’t eliminate deep scars, but they can meaningfully improve mild texture issues and discoloration. Retinoid creams (available in lower strengths without a prescription, or stronger versions with one) speed up skin cell turnover and boost collagen production over time. Consistent use for several months can soften shallow scarring and even out skin tone.
Products containing vitamin C, niacinamide, or alpha hydroxy acids like glycolic acid can help fade the dark or red marks that acne leaves behind. These marks (called post-inflammatory hyperpigmentation or erythema) aren’t true scars since they involve discoloration rather than textural changes, and they respond well to topical treatment. Daily sunscreen is essential during this process because UV exposure darkens these marks and slows fading.
At-home dermarollers are widely marketed, but the FDA notes that devices with very short, blunt needles only exfoliate dead skin and don’t penetrate deep enough to trigger real collagen remodeling. Devices with longer needles carry risks including skin damage, bleeding, bruising, and infection if not properly cleaned. They can also cause lasting pigment changes or additional scarring. If you want microneedling results, professional treatment with proper needle depth and sterile equipment is safer and more effective.
Realistic Timelines by Scar Type
Patience is essential. Collagen remodeling is a slow biological process, and most people need months of treatment to see results they’re happy with. Here’s what to expect:
- Rolling scars: 3 to 6 months or longer
- Boxcar scars: 3 to 6 months
- Ice pick scars: 4 to 9 months
- Dark or red marks with texture changes: 3 to 9 months
- Darker skin tones with pigmentation concerns: 6 to 12 months
The first few weeks after any procedure may show some early improvement, but the meaningful texture changes typically emerge between 3 and 6 months as new collagen matures beneath the surface. If you have a specific event in mind, starting 6 to 9 months beforehand gives you the best chance of visible progress.
Combining Treatments for Better Results
Most dermatologists use a combination approach rather than relying on a single treatment, especially when someone has multiple scar types. A common strategy for mixed scarring might involve subcision to release rolling scars, TCA CROSS for ice pick scars, and laser resurfacing or microneedling across the broader area to improve overall texture. Fillers can address any remaining deep depressions that don’t fully respond.
The specific combination depends on your skin tone, scar depth, and how much downtime you can handle. Darker skin tones require more cautious laser settings to avoid triggering pigmentation changes, which is one reason treatment timelines run longer for these patients. Your provider should tailor the plan to your specific scarring pattern rather than offering a one-size-fits-all approach.
Complete elimination of deep scars isn’t always possible, but most people can achieve significant smoothing. Even reducing scar depth by 50 to 75 percent often makes a noticeable difference in how the skin looks under normal lighting.