Smoothing acne scars is possible, but the right approach depends entirely on what type of scar you’re dealing with. Most acne scars fall into two categories: indented (atrophic) scars that sit below the skin’s surface, and raised (hypertrophic) scars that sit above it. Indented scars break down further into three subtypes: ice pick scars (deep and narrow), boxcar scars (broad with sharp edges), and rolling scars (broad with sloping edges). Each responds differently to treatment, so identifying yours is the first step toward actually improving them.
Why Scar Type Determines Your Treatment
Ice pick scars are the trickiest. They’re narrow but extend deep into the skin, which means surface-level treatments like gentle peels or basic resurfacing barely reach them. Boxcar scars respond well to a wider range of options because their flat, wide base gives treatments more surface area to work with. Rolling scars are caused by fibrous bands pulling the skin downward from underneath, so they often need a technique that physically releases that tethering before other treatments can take effect.
If you have a mix of scar types, which is common, you’ll likely benefit from combining treatments rather than relying on a single one. The most effective plans layer different approaches to address depth, texture, and tethering separately.
Microneedling for Broad, Shallow Scars
Microneedling uses fine needles to create tiny controlled punctures in the skin. These micro-injuries trigger your body’s repair response, sending collagen-producing cells to the treated area to build new tissue. This process, called neocollagenesis, is what gradually fills in depressions and smooths texture over multiple sessions.
Needle depth matters. Shallow or superficial scars are typically treated at 0.5 to 1.0 mm, moderate boxcar scars at 1.0 to 1.5 mm, and deep or tethered scars at 1.5 to 2.5 mm. Professional microneedling sessions run $200 to $700 each, and most people need three to six sessions spaced four to six weeks apart to see meaningful change. At-home dermarollers use much shorter needles and won’t reach the depths needed for real scar remodeling.
Laser Resurfacing for Moderate to Severe Scars
Fractional CO2 laser is one of the most studied treatments for depressed acne scars. It works by drilling microscopic columns of heat into the skin, destroying damaged tissue and forcing the body to replace it with fresh collagen. Most clinical protocols involve three to five sessions, with studies showing an average improvement rate of roughly 38% after two rounds of treatment. That number climbs with additional sessions.
Sessions cost $1,000 to $3,500 each, making laser the most expensive per-session option. Recovery involves several days of redness, swelling, and peeling. Darker skin tones carry a higher risk of post-treatment pigmentation changes, so finding a provider experienced with your skin tone is especially important if you’re considering this route.
Subcision for Tethered, Rolling Scars
Rolling scars look wavy because fibrous bands underneath are literally pulling the skin down. Subcision addresses this mechanically: a needle is inserted beneath the scar to cut those fibrous attachments. The bleeding that follows forms a clot underneath, which lifts the skin as it heals and prevents the bands from reattaching.
On its own, subcision produces noticeable improvement, but it shines when paired with other treatments. A study of 45 patients who received subcision combined with microneedling found that 95.6% showed improvement by at least one clinical grade. About 18% of patients perceived 75 to 100% improvement in their scars, while another 24% reported 50 to 74% improvement. Sessions run $300 to $800 each. If you have rolling scars and plan to do laser or microneedling, subcision first can make those follow-up treatments far more effective.
TCA Cross for Ice Pick Scars
Ice pick scars are too narrow and deep for most surface treatments to reach. TCA Cross is a technique designed specifically for them. A concentrated acid (70% or higher) is applied directly into each individual scar using a fine applicator. This causes controlled destruction of the scar’s interior walls, prompting the body to rebuild with new collagen from the inside out. The scar gradually fills in and rises closer to the surrounding skin level.
Treatments are repeated monthly until the scar reaches its maximum improvement, usually within four to six sessions. You can expect mild redness or temporary darkening at each treated spot, both of which typically resolve within four to six weeks. This is one of the more affordable in-office procedures and is often combined with broader resurfacing treatments for patients who have ice pick scars mixed with other types.
Dermal Fillers for Immediate Volume
Fillers offer the fastest visible improvement. A provider injects material directly beneath the scar to physically push the indentation up to the level of the surrounding skin. The results are immediate, though how long they last depends on the filler material.
Hyaluronic acid fillers (brands like Restylane and Juvederm) need to be re-injected every few months as the body absorbs them. Poly-L-lactic acid (Sculptra) requires monthly treatments for about three months but is considered semi-permanent after that, with only occasional touch-ups. Fat transfer, where your own fat is harvested and injected, can be permanent once the transferred fat establishes a blood supply. One collagen-based filler, Bellafill, is FDA-approved specifically for acne scars and lasts about 12 months.
Fillers work best for broad, rolling scars and boxcar scars. They’re less practical for ice pick scars, which are too narrow to fill effectively.
Prescription Retinoids as a Long Game
Tretinoin, a prescription-strength retinoid, won’t dramatically transform deep scars, but it does improve skin texture and mildly smooth shallow scarring over time. It works by accelerating cell turnover and stimulating collagen production in the skin’s deeper layers. After about six weeks, most users notice smoother texture. By three months of daily use, collagen production ramps up enough to create firmer, more even skin. Noticeable fading of acne scars typically becomes apparent around the 12-month mark with consistent use.
Tretinoin is also commonly used as a preparation step before professional treatments like laser or microneedling, since healthier, more collagen-rich skin responds better to those procedures. If you’re planning in-office work, starting a retinoid a few months beforehand can improve your results.
Silicone Sheets for Raised Scars
If your acne scars are raised rather than indented, silicone gel sheets are the first-line at-home treatment. They work by hydrating the scar tissue and creating gentle pressure that helps flatten it over time. For best results, wear the sheet for at least four hours per day, gradually building up to longer wear as your skin adjusts. Plan on a minimum of three months of consistent use to see significant flattening, and six months to reduce the chance of the scar thickening again after you stop.
Building a Realistic Treatment Plan
No single treatment erases acne scars completely. The goal is meaningful improvement, and the most successful outcomes come from combining approaches that target different aspects of the problem. A common layered plan might look like: subcision to release tethered scars, followed by microneedling or laser to stimulate collagen across the broader area, with TCA Cross for any remaining ice pick scars. Fillers can bridge the gap for deeper depressions that don’t fully respond to collagen-building treatments.
Budget is a real factor. A full course of microneedling (four to six sessions) runs $800 to $4,200 total. Laser resurfacing for three to five sessions can cost $3,000 to $17,500. Starting with the less expensive options like microneedling and TCA Cross, then reassessing what remains, is a practical way to manage costs without compromising results. Improvement is cumulative and continues for months after your last session as new collagen matures, so patience between rounds of treatment pays off.