Pimple scars can be improved significantly, but the right approach depends on whether you’re dealing with actual scars or leftover discoloration, and whether those scars are indented, raised, or flat. Most people with acne scarring see meaningful improvement through a combination of at-home care and professional treatments, though deep scars rarely disappear completely.
Dark Marks vs. True Scars
Before choosing a treatment, it helps to figure out what you’re actually looking at. Many people assume they have scars when they really have post-inflammatory hyperpigmentation (PIH), which is flat discoloration left behind after a breakout. These spots range from pink or red to brown or purple, depending on your skin tone. PIH is your skin’s overproduction of pigment in response to inflammation, and the good news is it fades over time, even without treatment. Retinoid creams, chemical peels, and sun protection can speed that process considerably.
True acne scars involve structural changes in the skin. They form when deep inflammation damages the tissue and your body either produces too little collagen (creating a dent) or too much (creating a raised bump). Unlike PIH, true scars tend to stick around permanently without some form of intervention.
Types of Indented Scars
Most acne scars are atrophic, meaning they sit below the surface of surrounding skin. They fall into three categories:
- Ice pick scars: Deep and narrow, like a tiny puncture in the skin. These are the hardest to treat because the damage extends deep into the dermis.
- Boxcar scars: Broad with sharp, defined edges, almost like a small crater. They respond well to resurfacing treatments.
- Rolling scars: Broad with sloping edges that give the skin an uneven, wave-like texture. These are often caused by bands of scar tissue pulling the skin downward from beneath.
Knowing which type you have matters because each responds best to different treatments. A dermatologist can assess your scars and recommend the most effective approach, which often involves combining two or more methods.
At-Home Treatments That Help
Retinoids
Prescription retinoids like tretinoin are one of the most effective things you can use at home. They work by stimulating your skin’s collagen production and improving how new collagen organizes itself, which gradually smooths out indented scars. Retinoids also help fade post-inflammatory hyperpigmentation by reducing excess pigment production. Adapalene, available over the counter in lower concentrations, works through a similar mechanism. Results are slow. You’ll typically need several months of consistent use before noticing improvement, and retinoids can cause dryness and peeling as your skin adjusts.
Sunscreen
UV exposure darkens healing scars and breaks down collagen, which is exactly what you don’t want when your skin is trying to rebuild. Wearing SPF 30 or higher daily, especially while using retinoids or recovering from any procedure, prevents discoloration from worsening and gives treatments the best chance of working. This is particularly important if you have darker skin, where PIH tends to be more visible and longer-lasting.
Professional Treatments for Indented Scars
Microneedling
Microneedling uses a device covered in tiny needles to create controlled micro-injuries across the skin’s surface. This triggers your body’s wound-healing response, stimulating new collagen production in the scarred areas. A typical course involves three to six sessions spaced four to six weeks apart. You won’t see the full effect right away. In the months after your final session, immature collagen is gradually replaced by stronger, more structured collagen that fills in scars and thickens the skin. Peak results generally appear three to six months after completing the series.
Microneedling works well for rolling and boxcar scars and is generally safe for all skin tones, which gives it an advantage over some laser treatments that carry a higher risk of pigmentation changes in darker skin.
Fractional Laser Resurfacing
Fractional CO2 lasers remove tiny columns of damaged skin while leaving surrounding tissue intact, which speeds healing compared to older full-surface lasers. Clinical data shows patients achieve an average improvement of roughly 65 to 69 percent in scar appearance after about four sessions spaced a month apart, though some people need up to six sessions depending on severity.
The tradeoff is downtime. After CO2 laser treatment, your skin will be raw and swollen for several days. It typically dries and peels within five to seven days, and full healing takes about two weeks. The new skin underneath will look pink for two to three months, sometimes up to a year. During recovery, you’ll need to clean the treated area several times daily, keep it moisturized, avoid picking at any crusting, and wear sunscreen religiously once healed. Sleeping with your head elevated and using ice packs for the first couple of days helps with swelling.
TCA CROSS for Ice Pick Scars
Ice pick scars are notoriously resistant to surface-level treatments because they’re so narrow and deep. A technique called TCA CROSS involves applying a high-concentration acid directly into the base of each individual scar using a fine applicator. This causes controlled damage deep in the scar, which triggers collagen production that gradually fills the scar from the bottom up. Sessions are repeated monthly, and each round builds on the previous one. This is a clinic procedure, not something to attempt at home.
Subcision for Rolling Scars
Rolling scars often look the way they do because fibrous bands of tissue underneath the skin are pulling the surface downward. Subcision addresses this directly. A needle is inserted beneath the scar to cut and release those fibrous bands, allowing the skin to lift back up. The bleeding that occurs during the process forms a clot that fills the space underneath, and new collagen production further elevates the scar over time.
In a study of 45 patients, over 42 percent reported 50 percent or greater improvement in their scars from subcision combined with microneedling, and most were satisfied with the results. Downtime is minimal compared to laser treatments, with some bruising and swelling for a few days. Subcision is often combined with other treatments like fillers or microneedling to maximize results.
Treating Raised Scars
Hypertrophic and keloid scars, which sit above the skin’s surface rather than below it, require a different strategy. Silicone gel sheets are a first-line option. Applied for at least 12 hours a day over two to three months, they gradually improve scar texture first, then pigmentation, then height. Silicone sheets won’t completely flatten a keloid, but they meaningfully reduce thickness and firmness.
For more stubborn raised scars, dermatologists may use steroid injections to shrink the excess tissue, or combine injections with other approaches. Raised acne scars are less common than indented ones, but they’re more likely in people with a family history of keloids or those with darker skin tones.
What Realistic Improvement Looks Like
No treatment erases acne scars completely. The goal is to smooth the skin’s texture enough that scars are far less noticeable. Most professional treatments deliver 50 to 70 percent improvement over a full course, which in practice means scars that once caught light and cast shadows become much more subtle. Combining treatments, like subcision followed by microneedling or laser, tends to produce better results than any single method alone.
Patience matters more than most people expect. Collagen remodeling is a slow biological process. Even after your last treatment session, your skin continues improving for months. The timeline from starting treatment to seeing your best results is often six months to a year, sometimes longer for deep scarring. Sticking with sun protection and a retinoid throughout that window gives your skin the best foundation for repair.