Acne scars can be significantly improved, but the right approach depends entirely on what type of scar you’re dealing with. Some scars respond well to at-home treatments over several months, while deeper ones need professional procedures, often in combination. Understanding your specific scar type is the first step toward choosing a treatment that actually works.
Identify Your Scar Type First
Acne scars fall into two broad categories: indented scars (where skin dips inward) and raised scars (where excess tissue builds up). Most people dealing with acne scarring have indented scars, which come in three distinct shapes.
Ice pick scars are small, narrow holes that point deep into the skin, almost like a puncture. They’re the most common type and also among the hardest to treat because of their depth relative to their tiny surface area.
Boxcar scars are wider depressions with sharp, defined edges, giving them a box-like appearance. They tend to sit on the cheeks and temples and vary from shallow to deep.
Rolling scars have sloping edges and varying depths, creating a wavy, uneven texture across the skin. These form because fibrous bands of tissue pull the surface of the skin downward from beneath.
Hypertrophic and keloid scars are raised lumps of scar tissue that form when the body overproduces collagen during healing. Hypertrophic scars stay within the boundaries of the original breakout, while keloids grow beyond them. These are more common on the jawline, chest, and back.
Treatments for Shallow to Moderate Scars
If your scars are relatively shallow, like mild boxcar or rolling scars, several treatments can stimulate enough collagen production to smooth the skin’s surface noticeably.
Microneedling uses a device covered in fine needles (ranging from 0.5 to 2 millimeters long) to create controlled micro-injuries across the scarred area. Your skin responds by producing fresh collagen and elastin, the proteins that keep skin firm and smooth. Deeper scars require longer needles. Most people need three to six sessions spaced about four to six weeks apart to see meaningful improvement. Professional microneedling sessions typically cost $200 to $700 each, depending on your location and provider.
Chemical peels use acid solutions to remove damaged outer layers of skin, prompting new, smoother skin to grow in. Medium-depth peels work best for shallow boxcar scars. Results build gradually over multiple sessions, and you can expect peeling and redness for several days after each treatment.
Treating Deep Ice Pick Scars
Ice pick scars are notoriously stubborn because standard resurfacing treatments can’t reach the narrow base of the scar. A technique called TCA CROSS was developed specifically for this problem. A dermatologist deposits a small amount of highly concentrated trichloroacetic acid (70 to 100%) directly into each individual scar. The acid destroys the damaged tissue at the bottom of the scar and triggers new collagen to fill it in from below.
This isn’t a one-and-done fix. You can expect a one to two grade improvement over about six months, and most people need multiple sessions. But for deep ice pick scars, TCA CROSS is one of the most effective options available, especially when combined with other treatments for surrounding scar types.
Releasing Tethered Rolling Scars
Rolling scars look wavy because fibrous bands beneath the skin are pulling the surface downward. A procedure called subcision directly addresses this. A dermatologist inserts a needle beneath the scar and moves it in a fan-like motion to physically cut those tethering bands. You can sometimes hear a snapping sound as the bands release.
Once the bands are broken, the skin is free to lift back to its natural level. The small pocket of space created beneath the skin also fills with blood, which eventually forms new connective tissue that helps keep the scar elevated. Three to six sessions handle most cases of moderate scarring. Subcision is frequently paired with microneedling or fillers for better results, since lifting the scar is only part of the equation.
Laser Resurfacing for Broader Texture Issues
Laser treatments work by removing damaged skin layers or stimulating deep collagen remodeling, depending on the type of laser used. Ablative lasers physically vaporize thin layers of scarred skin, prompting the body to replace them with new tissue. Non-ablative lasers heat the deeper layers without removing surface skin, which means less downtime but more sessions needed.
The average cost of laser skin resurfacing is $1,829 per session, according to the American Society of Plastic Surgeons, though prices vary widely based on the type of laser, the size of the treatment area, and geographic location. Recovery from ablative laser treatments typically involves a week or more of redness, swelling, and peeling. Non-ablative treatments have minimal downtime but deliver more gradual results over several months.
Fillers for Immediate Volume
Dermal fillers can plump up individual depressed scars almost instantly by injecting material beneath the scar to raise it to the level of surrounding skin. Hyaluronic acid fillers are commonly used and last several months to a year before the body gradually absorbs them.
For a longer-lasting option, Bellafill is an FDA-approved filler specifically indicated for certain types of acne scars. It delivers immediate volume and continues improving the area over time, with results lasting up to five years. Fillers work best for well-defined boxcar scars and isolated rolling scars rather than widespread textural irregularity.
What You Can Do at Home
Topical treatments won’t erase deep scars, but they can improve skin texture, fade discoloration, and enhance results from professional procedures. Retinoids (available over the counter as retinol or by prescription as tretinoin) speed up cell turnover and stimulate collagen production over time. Consistent use for several months is needed before visible changes appear.
Vitamin C serums, particularly those containing L-ascorbic acid at concentrations around 15 to 20%, help brighten post-acne marks and support collagen synthesis. These work best for the dark or red spots left behind after breakouts, which are technically post-inflammatory hyperpigmentation rather than true scars. That distinction matters because those flat discolored marks will often fade on their own over months, while actual indented or raised scars won’t.
Risks for Darker Skin Tones
If you have medium to dark skin, post-inflammatory hyperpigmentation is a real concern with any scar treatment that damages or irritates the skin. PIH causes dark patches that can last longer and appear more noticeable in skin with higher melanin content, sometimes creating a new cosmetic problem while trying to fix the original one.
Aggressive ablative lasers carry the highest risk. Non-ablative lasers, microneedling, and chemical peels at carefully chosen depths tend to be safer options, though none are completely risk-free. Getting active acne fully under control before starting any scar treatment is essential, since ongoing breakouts create new inflammation that increases the chance of hyperpigmentation. If dark marks do develop during treatment, topical brightening agents and sun protection can help speed their resolution.
Combining Treatments for Best Results
Most people with acne scarring have a mix of scar types, which is why dermatologists rarely recommend a single treatment in isolation. A typical combination approach might involve subcision to release tethered rolling scars, TCA CROSS for scattered ice pick scars, and microneedling or laser resurfacing to smooth overall texture. Treatments are usually staggered over months, with healing time between each session.
Expect the full process to take six months to over a year depending on scar severity. Improvement is measured in percentages rather than perfection. A 50 to 70% improvement is a realistic and meaningful outcome for moderate scarring, and even that degree of change can make a dramatic difference in how skin looks and feels.