Raised acne scars can be flattened, but the approach depends on the type of scar, how long you’ve had it, and how your body responds to treatment. Most people see meaningful improvement through a combination of at-home care and professional procedures, though the process typically takes several months to over a year. The two main types of raised scars, hypertrophic and keloid, behave differently and respond to different strategies.
Hypertrophic vs. Keloid: Why It Matters
Raised acne scars fall into two categories, and telling them apart is the first step toward choosing the right treatment. Hypertrophic scars stay within the borders of the original breakout. They usually appear within four to eight weeks after a deep pimple heals, grow for about six to eight months, then stop expanding on their own. Some flatten partially over time without any intervention.
Keloids are a different problem. They grow beyond the edges of the original wound, spreading into surrounding skin that was never injured. They can develop anywhere from three months to several years after the acne clears, and they rarely stop growing on their own. If your raised scar is wider than the pimple that caused it, or if it appeared long after your skin healed, you’re likely dealing with a keloid. This distinction matters because keloids are harder to treat and more prone to coming back after removal.
Silicone Sheets and Gels
Silicone-based products are the most accessible starting point and have decades of clinical use behind them. They work by creating an airtight seal over the scar that reduces water loss through the skin’s surface. This change in hydration sends chemical signals from the outer skin layer down to the deeper cells that produce collagen, essentially telling them to slow down.
Modern silicone gel sheets are designed to be worn up to 24 hours a day, then washed and reused. The catch is consistency: optimal results require 6 to 12 months of near-constant wear. Silicone gels (the liquid kind you apply like a lotion) are more practical for facial scars since sheets can be difficult to keep in place. Apply a thin layer twice daily for at least eight weeks to see initial improvement, though longer use produces better results. These products are available over the counter and cost relatively little compared to professional treatments, making them a reasonable first step while you evaluate whether you need something more aggressive.
Steroid Injections
For scars that don’t respond to silicone alone, corticosteroid injections are the standard first-line professional treatment. A dermatologist injects a small amount of steroid directly into the scar tissue, which breaks down excess collagen and reduces inflammation. The scar softens and flattens over a series of sessions, typically spaced four to six weeks apart.
Steroid injections work well for hypertrophic scars and can reduce keloids, though keloids are more likely to return after treatment stops. Side effects include temporary thinning of the surrounding skin and, in darker skin tones, lightening of the injection area. Your dermatologist will adjust the concentration based on the scar’s thickness and your response to each session.
Pulsed Dye Laser
Pulsed dye laser (PDL) targets the blood vessels feeding the scar, which reduces redness and can help flatten the tissue over multiple sessions. Research suggests PDL may be more effective than conventional treatments at improving overall scar appearance, though when individual scar characteristics like height and firmness are measured separately, results are comparable to other methods. PDL is often combined with steroid injections rather than used alone.
The average cost of a laser skin resurfacing session is around $1,829, according to the American Society of Plastic Surgeons, and most raised scars require multiple sessions. Insurance rarely covers cosmetic scar treatment unless the scar causes functional problems like restricted movement.
Injections for Stubborn Scars
When steroids alone don’t produce enough flattening, dermatologists turn to a second-line injectable that works by blocking the rapid cell growth inside scar tissue. This treatment, sometimes called chemotherapy-based injection, has shown strong results across multiple studies: an average 70% reduction in scar size and roughly 83% resolution of symptoms like itching and pain. In one study, 85% of patients saw more than 50% improvement in scar volume.
The side effects are more intense than steroid injections. Nearly all patients experience pain at the injection site lasting up to four hours. Superficial ulcerations develop in a significant portion of patients after two to three sessions, though these heal with topical treatment. No systemic side effects like blood count changes have been observed in any of the published studies. This option is typically reserved for scars that haven’t responded to steroids or that recur after initial improvement.
Cryotherapy
Cryotherapy uses extreme cold to destroy scar tissue from the inside out. The older approach, spraying liquid nitrogen on the scar’s surface, caused significant side effects including permanent skin lightening, blistering, and slow healing. The newer technique, intralesional cryotherapy, inserts a thin probe directly into the scar core. This destroys the dense collagen while leaving surface cells, including the pigment-producing cells, largely intact.
Results are promising. Studies show an average volume decrease of 51% to 63%, with facial scars responding particularly well at up to 89% volume reduction. Recurrence rates average around 7.6%, which is notably low for keloid treatment. Expect mild to moderate pain and local swelling in the first weeks after treatment. Pain and itching from the scar itself decrease by roughly 50% and 44% respectively, though symptoms rarely disappear completely.
Surgical Excision
Surgery to physically cut out a raised scar is sometimes the fastest route to a flat result, but it carries a significant risk: the healing process can trigger a new raised scar in the same spot. For keloids in particular, excision alone has historically high recurrence rates. The solution is combining surgery with an adjuvant therapy, most commonly radiation delivered in the days immediately following the procedure. With post-surgical radiation, recurrence drops to roughly 10 to 20%, and long-term studies show local control rates of 93% at one year and 68% at ten years.
Surgery is generally reserved for large or particularly dense scars that haven’t responded to less invasive options. The decision involves weighing the risk of recurrence against the potential for a significantly flatter result in a shorter timeframe.
What Helps Prevent New Raised Scars
If you’re prone to raised scarring, early intervention during the wound-healing phase makes a real difference. Silicone products applied to fresh acne wounds as soon as the surface closes can reduce the odds of excess collagen buildup. Pressure therapy, if applicable to the scar’s location, is most effective when started within two months of the injury, with sustained pressure between 20 and 30 mmHg helping regulate new blood vessel formation and reduce inflammation in the healing area.
The simplest preventive measure is avoiding picking at or squeezing deep acne lesions. Every time you rupture a cyst beneath the skin’s surface, you extend the wound area and increase the inflammatory response, both of which raise the likelihood of abnormal scarring. Treating active acne aggressively to prevent deep cysts in the first place remains the most effective long-term strategy for avoiding raised scars altogether.
Realistic Treatment Timelines
Raised acne scars don’t flatten quickly regardless of which treatment you choose. Silicone products require 6 to 12 months of daily use. Injectable treatments are spaced weeks apart and most patients need a series of four to six sessions before reaching maximum improvement. Even after successful treatment, follow-up monitoring typically continues for 12 to 18 months to watch for recurrence, especially with keloids.
Most dermatologists recommend starting with the least invasive option and escalating if needed. A common pathway looks like this: silicone products at home, then steroid injections if silicone isn’t enough, then adding laser or second-line injectables for resistant scars, with surgery and radiation as a last resort. Combining treatments often produces better results than any single approach, and your dermatologist can adjust the plan based on how your scars respond at each stage.