Pockmarks are permanent indentations in the skin, usually left behind after severe acne, chickenpox, or other inflammatory skin conditions. They won’t fill in on their own because the underlying collagen structure has been destroyed. Getting rid of them requires treatments that either rebuild collagen from within, physically release the scar tissue pulling skin downward, or resurface the top layers of skin to smooth the surface. The right approach depends on the shape and depth of your scars.
Why Pockmarks Don’t Heal on Their Own
When a deep breakout or infection damages the lower layers of your skin, your body patches the area with scar tissue instead of rebuilding normal collagen. This scar tissue contracts and pulls the surface downward, creating a visible pit. Unlike a flat scar that sits on the surface, a pockmark involves structural loss beneath the skin. That’s why no amount of moisturizer or exfoliation will make it disappear. Treatments that work target either the lost volume, the fibrous bands anchoring the scar, or both.
Know Your Scar Type First
Pockmarks generally fall into three categories, and each responds best to different treatments:
- Ice pick scars: Narrow, deep pits that look like a sharp object punctured the skin. These are the hardest to treat because they extend deep into the dermis.
- Boxcar scars: Broad depressions with sharp, defined edges, similar to a chickenpox scar. They vary in depth.
- Rolling scars: Wide, shallow undulations caused by fibrous bands tethering the skin to deeper tissue. These give the skin a wavy, uneven appearance.
A dermatologist can assess which types you have. Most people have a mix, which is why combination treatments tend to produce the best results.
Fractional Laser Resurfacing
Fractional CO2 laser is one of the most effective single treatments for pockmarks. It works by destroying tiny columns of skin tissue in a controlled grid pattern, which triggers your body to produce new collagen, elastic fibers, and fresh surface skin as it heals. Each session affects roughly 10 to 70 percent of the skin’s surface, leaving the surrounding tissue intact so recovery is faster than with older full-surface lasers.
In clinical studies, patients with moderate to severe scarring saw meaningful improvement. Among those starting with the worst grade of scarring, over 80 percent improved by at least two severity grades after treatment. Patients with moderate scarring fared even better, with more than 60 percent reaching the mildest grade. These results typically require multiple sessions spaced four to eight weeks apart.
The average cost per session is around $1,829, according to the American Society of Plastic Surgeons, though prices vary by location, provider, and how much skin is being treated. Most people need two to four sessions. Downtime runs one to three weeks, with redness and peeling being the primary side effects. One common concern is post-inflammatory hyperpigmentation, where treated skin temporarily darkens. Interestingly, research has found that skin tone alone doesn’t reliably predict this risk. Studies have shown wildly different rates of hyperpigmentation across similar skin types, suggesting that individual healing response matters more than skin color. Still, if you have darker skin, discuss a test patch with your provider.
TCA CROSS for Deep Ice Pick Scars
Ice pick scars are too narrow and deep for most lasers to reach effectively. A technique called TCA CROSS uses a high concentration of trichloroacetic acid, applied with a fine wooden applicator directly into each individual scar. The acid causes controlled damage to the walls of the scar, which triggers an inflammatory response followed by new collagen production that gradually fills the pit from the bottom up.
The provider presses the applicator into each scar until a white “frost” appears on the surface, usually within 10 to 15 seconds. This frosting signals that the proteins in the skin have coagulated to the right depth. The treated spots scab over and heal within a week or two. Most people need three to six sessions, spaced about a month apart, to see significant improvement. It’s one of the more affordable in-office options and works well as a targeted add-on alongside broader treatments like laser resurfacing.
Subcision for Rolling Scars
Rolling scars look the way they do because tough fibrous bands beneath the skin pull the surface downward, like tiny anchors. Subcision directly addresses this. A doctor inserts a needle or small cannula beneath the scar and physically cuts those fibrous attachments, releasing the skin so it can rise back to its normal level. The minor bleeding that occurs underneath also creates a pocket of blood that eventually converts into new connective tissue, adding volume.
Multiple sessions are typically needed for optimal results, as the fibrous bands can partially reform during healing. Recovery involves swelling and bruising that resolves within one to two weeks. Subcision is particularly effective when combined with other treatments. Releasing the tethered skin first means that follow-up procedures like laser or fillers can produce better, more even results.
Dermal Fillers for Immediate Volume
Injectable fillers can physically raise depressed scars to the level of surrounding skin, offering the most immediately visible improvement of any treatment. Several types are used for pockmarks, and they differ mainly in how long they last:
- Hyaluronic acid fillers provide immediate volume. While traditionally considered temporary (three to six months), follow-up studies have shown sustained improvement at two years without significant fading.
- Calcium hydroxylapatite uses tiny microspheres that provide initial volume and then attract your body’s own collagen-producing cells, creating durable results beyond six months.
- Poly-L-lactic acid works primarily as a collagen stimulator rather than a direct filler. Results develop gradually over weeks but can last two to four years.
- Polymethylmethacrylate (PMMA) offers the most permanent option. The microspheres remain in place and stimulate ongoing collagen production around them. Studies show significant improvement sustained at 24 months.
Fillers work best for broader boxcar and rolling scars. They’re less practical for numerous small ice pick scars. Your provider can inject filler as a standalone treatment or use it alongside procedures that rebuild collagen for a layered approach.
Topical Retinoids: Helpful but Limited
Prescription retinoids like tretinoin (typically at 0.05% strength) can modestly improve pockmarks over time by shifting how your skin produces collagen. Instead of laying down the parallel, rigid collagen fibers found in scar tissue, retinoids encourage a more normal lattice pattern that better resembles healthy skin. This can soften the edges of shallow scars and improve overall skin texture.
The improvement from retinoids alone is subtle and won’t fill deep pockmarks. Where they shine is as a supporting treatment. Using a retinoid for several weeks before and after procedures like laser resurfacing can prime the skin for better collagen remodeling and enhance your overall results. Over-the-counter retinol products have a weaker effect than prescription-strength tretinoin but follow the same principle.
Combining Treatments for Best Results
Because most people have a mix of scar types at different depths, the best outcomes come from combining approaches rather than relying on a single treatment. A common strategy is to start with subcision to release tethered rolling scars, follow with TCA CROSS for any deep ice pick scars, and then use fractional laser resurfacing across the entire area to smooth the overall texture. Fillers can be added at any point to boost volume in the deepest depressions.
Expect the full process to take six months to over a year when accounting for healing time between sessions. Most procedures require one to three weeks of downtime per session, and collagen remodeling continues for months after each treatment. The skin keeps improving between appointments, so final results aren’t visible until several months after your last session. Setting realistic expectations matters: most treatments produce 50 to 70 percent improvement in scar appearance rather than complete elimination, though combining methods pushes results further.
What to Expect Cost-Wise
Professional scar treatment is rarely covered by insurance since it’s classified as cosmetic. Laser resurfacing averages around $1,829 per session, and you may need two to four sessions. Subcision and TCA CROSS are generally less expensive per session, often in the $200 to $500 range depending on the area treated. Fillers vary widely by type and volume, typically running $600 to $1,500 per syringe. A full combination treatment plan can range from $2,000 to over $10,000 depending on severity, scar types, and your geographic area. Many dermatology practices offer payment plans, and starting with the most impactful treatment for your specific scar type helps you get the most value from your first sessions.