Acne scars can be significantly improved, but the right approach depends on what type of scar you’re dealing with. Indented scars, raised scars, and dark marks left behind after breakouts each respond to different treatments. Most people see 50 to 70% improvement with professional procedures, and even at-home options can make a meaningful difference over time.
Identify Your Scar Type First
Not all acne scars are the same, and knowing which kind you have narrows your treatment options considerably. Acne scars fall into two broad categories: atrophic (indented) and hypertrophic (raised).
Atrophic scars are the most common type. They form when the skin can’t regenerate enough tissue during healing, leaving a depression behind. Within this group, there are three distinct shapes:
- Ice pick scars are small, narrow indentations that point deep into the skin, like a puncture wound.
- Boxcar scars are broader depressions with sharp, defined edges, almost like a crater.
- Rolling scars have sloping edges at varying depths, giving the skin a wavy, uneven texture.
Raised scars happen when the skin overproduces collagen during healing. Hypertrophic scars stay within the boundaries of the original blemish. Keloid scars grow beyond the original spot and can continue expanding over time. These two types require a completely different treatment strategy than indented scars.
Laser Resurfacing for Deeper Scars
Fractional laser treatments are one of the most effective options for atrophic acne scars. These lasers create tiny columns of controlled damage in the skin, triggering your body’s natural repair process and stimulating new collagen production. As the skin rebuilds, scars become shallower and less visible.
Clinical data on fractional CO2 lasers shows a mean improvement of roughly 65 to 69% in scar severity scores after a course of treatment. Most people need two to six sessions spaced about four weeks apart, depending on how deep their scarring is. The average cost of a laser resurfacing session is around $1,829, according to the American Society of Plastic Surgeons, though prices vary widely by location and the size of the area treated.
There are two main types: ablative lasers, which vaporize the top layer of skin, and non-ablative lasers, which heat the tissue underneath without breaking the surface. Ablative treatments deliver stronger results per session but come with more downtime, typically a week or more of redness and peeling. Non-ablative options have a quicker recovery but usually require more sessions to reach the same level of improvement. Combined approaches that use both modalities in a single session show slightly better outcomes, with around 69% improvement compared to 65% for ablative alone.
Microneedling and RF Microneedling
Microneedling uses a device covered in fine needles to create thousands of tiny punctures in the skin. This activates fibroblasts, the cells responsible for producing collagen, which gradually fills in depressed scars from below. Clinical studies report 51 to 60% improvement in acne scars after about three months, and 80 to 85% of patients report being very satisfied with their results.
Radiofrequency (RF) microneedling adds heat energy delivered through the needles, pushing collagen stimulation deeper into the skin. This makes it particularly useful for rolling and boxcar scars that extend below the surface. RF microneedling tends to cost less per session than laser resurfacing, and downtime is typically limited to a day or two of redness. Most treatment plans call for three to four sessions spaced four to six weeks apart.
Chemical Peels and the TCA CROSS Technique
Chemical peels remove damaged surface skin to reveal smoother layers underneath. For mild, shallow scarring, a series of medium-depth peels can soften scar edges and even out texture. But for deep ice pick scars, there’s a more targeted approach called TCA CROSS.
This technique involves applying a high concentration (70 to 100%) of trichloroacetic acid directly into individual ice pick scars. The acid causes the scar walls to frost and then heal with new collagen, gradually raising the base of the scar closer to the surrounding skin. After treatment, the skin around each spot stays red and sore for one to two days. A small scab forms after two to three days and falls off within a week. Multiple sessions, spaced at least a month apart, are usually needed. TCA CROSS works well as a first step before broader resurfacing treatments, since it can convert deep ice pick scars into shallower ones that respond better to lasers or microneedling.
Subcision for Tethered Scars
Rolling scars often look worse than they are because fibrous bands underneath the skin pull the scar downward, creating that wavy appearance. Subcision is a minor procedure that breaks these bands using a needle inserted beneath the scar. Once the tethering strands are released, the skin lifts back toward the surface. New collagen deposits during healing help maintain the improvement.
Recovery is relatively quick. Pressure and ice are applied immediately afterward to control bruising, and makeup can be used to cover any discoloration. Sessions are spaced at least one month apart, and most people benefit from two to three rounds. Subcision is frequently combined with other treatments like microneedling or fillers for a more complete result.
Dermal Fillers for Volume Loss
For individual deep scars, especially boxcar and rolling types, injectable fillers made of hyaluronic acid can physically raise the depressed area to match the surrounding skin. The result is immediate, which makes fillers appealing for people who want a visible change without waiting months for collagen remodeling.
Fillers were once considered temporary, but newer research shows hyaluronic acid fillers used for acne scars can last as long as 10 years after injection. This likely happens because the filler acts as a scaffold for your body’s own collagen production over time. Fillers work best for a limited number of well-defined scars rather than widespread shallow scarring.
Topical Treatments That Work Over Time
Prescription retinoids are the most evidence-backed topical option for acne scars. Adapalene at 0.3% concentration, applied twice daily, improved atrophic acne scars in at least 50% of patients over 24 weeks in clinical studies. Retinoids work by accelerating skin cell turnover and boosting collagen production in the deeper layers of skin. They won’t erase deep scars, but they can noticeably soften texture and reduce shallow scarring over several months of consistent use.
For raised scars, silicone gel sheets are a well-studied, low-risk option. In a study of 224 patients, consistent use of silicone sheets significantly improved scar color, thickness, and elasticity for both hypertrophic scars and keloids. The key is wearing them at least four hours per day for a minimum of three months. Side effects were uncommon, with only about 11% of patients reporting mild itching or skin irritation.
Special Considerations for Darker Skin Tones
If you have a medium to deep skin tone (Fitzpatrick types IV through VI), acne scars often come with an added challenge: post-inflammatory hyperpigmentation, the dark marks that linger long after a breakout heals. These aren’t true scars, but they can be just as frustrating, and treating them incorrectly can make them worse.
Topical treatments should be the first line of defense for dark marks. Superficial peels using salicylic acid or glycolic acid, alone or combined, can help fade hyperpigmentation without significant risk. For marks that resist topical treatment, certain laser types are safer than others. Low-energy pulsed lasers and fractional non-ablative systems can be used carefully with the right settings. Ablative lasers should generally be avoided on darker skin tones because they carry a higher risk of triggering more pigmentation changes.
Combining Treatments for Better Results
Most dermatologists take a layered approach to acne scarring rather than relying on a single treatment. A typical plan might start with subcision to release tethered rolling scars, follow with TCA CROSS to raise the base of ice pick scars, then finish with a series of fractional laser or microneedling sessions to smooth the overall texture. Fillers can be added at any point for stubborn individual depressions.
This combination strategy often produces results that no single treatment could achieve alone. The process takes time, usually six months to a year from start to finish, and the total cost can range from a few hundred dollars for topical and microneedling approaches to several thousand for a full course of laser resurfacing. Results continue improving for months after the last session as new collagen matures and tightens the skin.