Acne scars form when breakouts damage deeper layers of skin, and your body either produces too little new tissue (leaving a depression) or too much (creating a raised bump). Most acne scars won’t fully disappear on their own, but a wide range of treatments can significantly improve their appearance. The right approach depends on your scar type, skin tone, and budget.
Why Scar Type Matters
Not all acne scars respond to the same treatment, so identifying what you’re working with is the first step. Depressed scars, called atrophic scars, are by far the most common. They form when your body doesn’t produce enough new tissue to fill the space left by a deep breakout. These come in three varieties:
- Ice pick scars: Narrow, deep pits with sharp edges, almost like a puncture wound in the skin. They extend into the deeper layers and are the hardest type to treat.
- Rolling scars: Wider depressions with sloping, uneven edges that give the skin a wave-like texture. These are caused by fibrous bands pulling the surface down from underneath.
- Boxcar scars: Broad, rectangular depressions with defined vertical edges, similar to chickenpox marks.
Raised scars, called hypertrophic or keloid scars, happen when your body overproduces tissue during healing. Keloids grow beyond the original breakout area and are more common on the chest, back, and jawline. They require a completely different treatment strategy than depressed scars.
What Topical Products Can (and Can’t) Do
Over-the-counter products are the most accessible starting point, but it’s important to have realistic expectations. Topical treatments work best on very shallow scarring and post-acne discoloration (the red or brown marks left behind after a breakout, which aren’t true scars). For deeper depressions or raised tissue, topicals alone won’t deliver dramatic results.
Prescription retinoids are the strongest topical option. A 24-week controlled study found that a combination retinoid formula significantly reduced scar counts compared to a placebo. On the treated side, scar counts decreased over time, while on the untreated side, counts actually increased. Retinoids work by accelerating skin cell turnover and stimulating collagen production in the upper layers of skin. Over-the-counter retinol does the same thing at a lower intensity, so results take longer and are more subtle.
Other ingredients worth considering include azelaic acid and vitamin C, both of which help fade the dark marks that often accompany scarring. These won’t restructure the skin, but they can make scars less visually prominent by evening out your skin tone around them.
Professional Treatments for Depressed Scars
Microneedling
Microneedling uses a device covered in tiny needles to create controlled micro-injuries across the scarred area. Your body responds by producing new collagen to repair the damage, which gradually fills in depressed scars over multiple sessions. It’s effective for rolling and boxcar scars and is one of the safest professional options across all skin tones. Radiofrequency microneedling adds heat energy beneath the surface for a stronger collagen response. Unlike laser-based treatments, microneedling doesn’t target melanin, which makes it a particularly good choice if you have darker skin and are concerned about discoloration after treatment.
Laser Resurfacing
Lasers are among the most effective tools for acne scars, but they come in two very different categories. Ablative lasers (like CO2 lasers) remove the outer layers of skin entirely, triggering an aggressive healing response. After treatment, expect significant redness, swelling, and oozing that requires 7 to 14 days of wound care. New pink skin becomes visible after about 10 days, with substantial improvement at one month and continued collagen remodeling for 6 to 12 months afterward. The results can be dramatic, but the downtime is real.
Non-ablative lasers work beneath the surface without removing skin, so recovery is faster and side effects are milder. They typically require more sessions to achieve comparable results. The average cost for ablative laser resurfacing is around $2,000 per session, while non-ablative treatments average about $1,100.
Chemical Peels and TCA CROSS
Superficial chemical peels using glycolic acid or salicylic acid can improve mild scarring and skin texture over a series of sessions. For ice pick scars specifically, a technique called TCA CROSS involves applying a high concentration of trichloroacetic acid directly into the scar. The acid causes controlled damage inside the narrow pit, and as the skin heals, it produces new collagen that gradually raises the base of the scar. This is typically done in-office over multiple sessions spaced weeks apart.
Subcision and Fillers
Rolling scars are often tethered to deeper tissue by fibrous bands that pull the skin surface downward. Subcision uses a small needle inserted beneath the scar to break these bands, allowing the skin to lift. It’s frequently combined with dermal fillers, which add volume underneath the scar to raise it to the level of surrounding skin.
How long fillers last depends on the type used. Hyaluronic acid fillers, the most common option, typically last 3 to 18 months before the body gradually absorbs them. Semi-permanent fillers can last up to 24 months. Permanent options exist and can remain stable for 10 to 20 years, but they carry higher risks of complications and aren’t reversible if something goes wrong. Most dermatologists start with temporary fillers to assess results before considering anything longer-lasting.
Treatments for Raised and Keloid Scars
Raised scars require a different approach since the problem is excess tissue rather than missing tissue. Corticosteroid injections are the most common first-line treatment, delivered directly into the scar to soften and flatten it over several sessions. Silicone sheets or gel applied daily can also help flatten hypertrophic scars over time. For stubborn keloids, treatments may include cryotherapy (freezing the tissue) or surgical removal, though keloids have a high recurrence rate even after excision.
Special Considerations for Darker Skin
If you have medium to deep skin tones, treatment selection matters more than it does for lighter skin. The core risk is post-inflammatory hyperpigmentation, where the treatment itself leaves dark marks that can take months to fade and sometimes look worse than the original scars.
Treatments to approach with caution or avoid include ablative lasers (CO2 and erbium), deep chemical peels, and intense pulsed light (IPL). All of these interact with melanin in ways that significantly raise the risk of discoloration and burns in darker skin.
Safer alternatives with strong track records include microneedling, radiofrequency microneedling, superficial chemical peels (salicylic acid at 5 to 30 percent, glycolic acid at 30 to 50 percent), and non-ablative fractional lasers like the 1540-nm erbium. Radiofrequency microneedling is especially well-suited because it works through electrical energy rather than light, so it bypasses melanin entirely. Starting with lower-intensity treatments and building gradually is the safest strategy.
Realistic Timelines and Expectations
Acne scar treatment is not a one-session fix. Most professional treatments require 3 to 6 sessions spaced several weeks apart, and the collagen remodeling that does the real work continues for months after your last appointment. With ablative laser resurfacing, you may see improvement within a month, but the skin continues to refine for up to a year. Microneedling and non-ablative lasers show more gradual progress, often taking 3 to 6 months of consistent treatment before results become clearly visible.
Combination approaches tend to outperform any single treatment. A dermatologist might use subcision to release a rolling scar, follow up with filler for immediate volume, and then treat the surface texture with microneedling or a fractional laser. This layered strategy addresses the scar at multiple depths, which is why severe scarring almost always benefits from professional evaluation rather than a one-size-fits-all approach.
Cost adds up quickly. Budget for multiple sessions of whatever treatment you choose, and keep in mind that most acne scar treatments are considered cosmetic and aren’t covered by insurance. Starting with a retinoid and superficial peels while saving for more intensive treatments is a reasonable path if budget is a constraint.