Treating acne scars requires matching the right procedure to the right scar type, and no single treatment works for all of them. Even the most effective options deliver partial improvement rather than complete removal. That said, combining treatments strategically can produce meaningful results, and knowing what actually works (and what doesn’t) will save you time and money.
Why Scar Type Matters
Acne scars fall into two broad categories: depressed scars that sit below the skin’s surface, and raised scars that build up above it. Most people dealing with acne scarring have depressed scars, which come in three distinct forms.
Ice pick scars are narrow, deep holes that are wide at the top and taper to a point. They typically show up on the forehead and upper cheeks, where skin is thinner. Boxcar scars are wider indentations with sharp, defined edges that cut deep into the skin. Rolling scars have sloping, uneven edges that give the skin a wavy texture. Both boxcar and rolling scars tend to appear on the lower cheeks and jaw, where skin is thicker.
Hypertrophic and keloid scars are raised tissue that forms when the body overproduces collagen during healing. They’re less common with facial acne but can develop on the chest, back, and jawline.
Identifying your scar type is the first step, because a treatment that works beautifully on rolling scars may do nothing for ice pick scars. Most people have a mix, which is why dermatologists often recommend combining procedures.
Laser Resurfacing
Lasers are among the most widely used treatments for depressed acne scars. They work by removing thin layers of skin or creating controlled micro-injuries that trigger your body’s collagen-rebuilding process. There are two main categories: ablative lasers that vaporize damaged skin, and non-ablative lasers that heat tissue without removing it.
Ablative lasers (CO2 and erbium) are more aggressive and produce stronger results, but they come with longer recovery. CO2 lasers require 7 to 14 or more days of downtime, while erbium lasers let most people return to their routine within 3 to 5 days. Non-ablative lasers have minimal downtime, often just a day or two, but typically require more sessions to achieve comparable results.
It’s worth setting realistic expectations here. In one study of 31 patients treated with fractional CO2 laser, about 23% saw no improvement at all. Among those who did improve, the change was mild in roughly a third, moderate in 29%, and significant in only about 13%. Other laser technologies have shown less than 30% improvement in patients overall. Lasers help, but they rarely erase scars completely.
Cost is another consideration. Ablative laser sessions average around $2,000, while non-ablative sessions run about $1,100. Most people need multiple sessions. Redness after treatment can take up to 10 days to fade, though pain typically resolves within an hour or two.
Radiofrequency Microneedling
This treatment combines tiny needles that puncture the skin with radiofrequency energy that heats the deeper layers, stimulating collagen production at controlled depths. The needles penetrate 2 to 3.5 millimeters into the skin on facial areas, reaching the tissue where scar damage actually lives.
Most treatment plans involve 2 to 6 sessions spaced about a month apart. Radiofrequency microneedling works well for boxcar and rolling scars and tends to have less downtime than ablative lasers. It’s particularly useful for darker skin tones, which carry a higher risk of discoloration with traditional laser treatments.
Subcision for Rolling Scars
Rolling scars look depressed because fibrous bands underneath the skin are literally pulling the surface downward, like tiny anchors. Subcision directly addresses this. A needle or cannula is inserted beneath the scar to break those tethering bands, releasing the tension so the skin can lift back up. The process also triggers collagen remodeling in the area as the tissue heals.
Subcision is often combined with dermal fillers for a more dramatic result. After the bands are released, a filler (most commonly hyaluronic acid) is injected beneath the scar to add volume and prevent the bands from reattaching. Hyaluronic acid fillers are popular for this because they’re biocompatible and reversible if needed. This combination is one of the most effective approaches for moderate to deep rolling scars.
TCA CROSS for Ice Pick Scars
Ice pick scars are notoriously difficult to treat because they’re so narrow and deep. Lasers and microneedling can’t easily reach the bottom of these scars. A technique called TCA CROSS deposits a high-concentration acid (70 to 100%) directly into individual scars, triggering new collagen formation from the bottom up.
This is a targeted, scar-by-scar treatment. Over about six months, patients can expect a 1 to 2 grade improvement in their scars, which translates to visible but not complete correction. Multiple sessions are typically needed. Because the acid is applied only to the scar itself rather than the surrounding skin, recovery is relatively quick compared to full-face treatments.
What Topical Products Can and Can’t Do
If you’re hoping a cream or serum will flatten or fill depressed scars, the honest answer is that topical products have limited power against established scarring. Retinoids (vitamin A derivatives) are the strongest topical option, and research shows that adapalene can promote some scar remodeling by stimulating new collagen and elastic tissue. Over 24 weeks, prescription-strength adapalene has demonstrated measurable reductions in scar counts compared to placebo.
That said, the improvements from topicals are subtle compared to procedures. Where retinoids genuinely shine is in prevention. Using them during active acne helps minimize the scarring that forms in the first place, which is far easier than treating scars after the fact. If you have mild, shallow scarring, a retinoid may produce enough improvement on its own. For moderate to severe scars, topicals work best as a supporting player alongside professional treatments.
Combining Treatments for Better Results
Because most people have a mix of scar types, dermatologists frequently design multi-step treatment plans. A common approach might pair subcision for rolling scars with TCA CROSS for ice pick scars, followed by a series of laser or radiofrequency microneedling sessions to improve overall texture. Fillers can add immediate volume while waiting for collagen remodeling from other treatments to take effect.
The total timeline for a comprehensive treatment plan often stretches six months to a year or longer, with sessions spaced weeks apart to allow healing between each one. Costs add up quickly across multiple procedures, and insurance rarely covers acne scar treatment since it’s considered cosmetic.
Treating Raised Scars
Hypertrophic and keloid scars require a different approach than depressed scars. These respond to treatments that reduce excess tissue rather than stimulate new collagen. Steroid injections are a first-line option, flattening raised tissue over a series of sessions. Silicone sheets and gels applied consistently over weeks can also soften and flatten newer raised scars. For stubborn keloids, treatments may include cryotherapy or careful surgical removal, though keloids have a tendency to recur.
The key distinction is that treatments designed for depressed scars, like lasers that boost collagen production, can actually worsen raised scars. Getting the right diagnosis before starting any treatment plan matters more than picking the most popular or expensive option.