Yes, there are several effective ways to reduce and even eliminate acne scars, though the right approach depends entirely on what type of scar you’re dealing with. Some marks that look like scars are actually flat discoloration that fades on its own or responds well to topical treatments. True indented or raised scars require more involved procedures, but modern dermatology offers options that can deliver 30 to 70 percent or more improvement depending on the technique and scar type.
Flat Marks vs. True Scars
Before pursuing any treatment, it’s worth figuring out whether you have actual scars or post-inflammatory marks. These are two different problems with very different solutions.
Post-inflammatory hyperpigmentation (PIH) shows up as flat brown, tan, or dark brown spots where a breakout used to be. It’s caused by excess pigment production after inflammation, not by damaged skin structure. Deeper pigment deposits can appear blue-gray. These marks can take months to years to fade without treatment, but they do respond to topical products. Azelaic acid, available as a 15% or 20% cream, has been shown to significantly reduce pigment intensity over 24 weeks with mild, temporary side effects. It works by slowing pigment production in overactive skin cells.
Post-inflammatory erythema (PIE) appears as flat red or pink marks, more common in lighter skin tones. These are caused by damaged or dilated blood vessels beneath the surface and also fade over time without treatment, though it can take many months.
If you press a clear glass against the mark and it temporarily disappears, you’re likely dealing with redness from blood vessels (PIE). If the color stays, it’s pigment-based (PIH). Neither of these is a true scar, and neither requires procedures like lasers or subcision.
The Three Types of Indented Scars
True acne scars involve structural changes to the skin. Most are atrophic, meaning the skin has lost tissue and sits below the surrounding surface. They fall into three categories, and identifying yours matters because each responds differently to treatment.
Ice pick scars are narrow (under 2mm wide), deep, and V-shaped, extending down into the deeper layers of skin. They look like the skin was punctured with a sharp instrument. These are the most stubborn type to treat because of their depth and narrow shape.
Boxcar scars are wider, round or oval depressions with sharp vertical edges, forming a U-shape with a broad, flat base. They resemble chickenpox scars and can be shallow or deep.
Rolling scars are typically wider than 4 to 5mm and create a wave-like, undulating texture across the skin. They’re caused by fibrous bands of tissue pulling the surface of the skin downward from underneath. On their own, they give the skin a gentle hills-and-valleys appearance rather than sharp indentations.
Some people also develop hypertrophic scars, which are raised, firm, and pink. These stay within the borders of the original breakout and are caused by excess collagen production during healing.
Best Treatments by Scar Type
Rolling Scars: Subcision and Lasers
Rolling scars respond the best to treatment overall. Because they’re caused by fibrous bands tethering the skin downward, a procedure called subcision can physically break those bands apart. A small instrument is inserted beneath the skin at the level where the scar tissue connects to deeper tissue, then fanned through the fibrous tethers to release them. This allows the skin to lift back to its natural level. Subcision can be combined with fillers injected beneath the scar to maintain the lifted position.
Fractional CO2 laser also works well on rolling scars. In a split-face clinical study, rolling scars showed the greatest laser response of any scar type, with 42.9% improvement after four monthly sessions. That same study found patients rated their own improvement even higher than clinical measurements showed, with nearly 50% subjective improvement on the laser-treated side.
Boxcar Scars: Lasers and Peels
Boxcar scars respond well to resurfacing treatments that remove the sharp edges and stimulate new collagen to fill the depressed base. Fractional CO2 laser produced 36% improvement in boxcar scars over four sessions in the same study. Chemical peels that penetrate to the mid-dermis can also soften shallower boxcar scars, with skin regeneration typically starting within 24 hours and completing in 7 to 10 days.
Ice Pick Scars: TCA CROSS
Ice pick scars barely respond to surface-level treatments. Fractional CO2 laser produced only about 3% improvement in ice pick scars, essentially no meaningful change. The problem is their narrow, deep shape: lasers and microneedling work across the surface but can’t effectively reach the bottom of these deep channels.
The most effective option is a technique called TCA CROSS, where a high-concentration acid is applied with precision directly into each individual scar using something as fine as a wooden toothpick. This triggers controlled destruction deep within the scar, prompting the body to rebuild with new collagen from the inside out. In a study of patients treated every two weeks for four sessions, 80% achieved excellent improvement (over 70% scar reduction) and the remaining 20% achieved good improvement (50 to 70% reduction).
Microneedling: What the Depth Data Shows
Microneedling uses fine needles to create controlled micro-injuries in the skin, triggering the body’s wound-healing response and new collagen production. It’s one of the more accessible professional treatments and works on multiple scar types, though results are more modest than laser resurfacing.
Needle depth matters significantly. A split-face study comparing 2.5mm depth against 1.5mm depth found that the deeper setting produced significantly better results after six sessions, both in visible improvement and in actual changes to collagen and elastic fiber structure under the skin. This is one reason clinical microneedling outperforms at-home devices, which are limited to much shallower depths.
Compared head-to-head with fractional CO2 laser, microneedling delivered about 9% improvement in overall scar grading versus the laser’s 33%. The tradeoff is that microneedling generally involves less downtime, less redness, and lower cost per session.
What Topical Products Can and Can’t Do
Prescription retinoids (tretinoin) can improve skin texture and have shown effectiveness in preventing hypertrophic scars from forming after wounds. A year-long study on facial scarring found that daily tretinoin use significantly improved skin flexibility and distensibility. Retinoids also help fade post-inflammatory hyperpigmentation.
However, no topical product can fill in a physically indented scar. If you can feel a dip or depression when you run your finger across the scar, creams and serums won’t resolve it. They can improve the surrounding skin quality, fade discoloration, and make shallow texture irregularities less noticeable, but structural scars need structural treatments.
Why At-Home Devices Carry Risk
Derma rollers and dermastamps are widely available over the counter, but using them without proper training introduces real risks. A systematic review of microneedling complications found cases of users spreading infections from one area of the face to another through self-treatment. Applying too much pressure, especially over bony areas like the jawline or forehead, has caused bruising and even a pattern of scarring called “tram-tracking” where the roller leaves visible lines.
Professional devices (particularly automated pen-type systems) reduce these risks because they control the speed, depth, and uniformity of needle penetration automatically. If you’re considering microneedling for acne scars, clinical sessions with controlled depth are both safer and meaningfully more effective than home devices.
Recovery and Downtime
Recovery varies widely depending on the procedure. Microneedling typically leaves the skin red and slightly swollen for a few days. Fractional CO2 laser involves more intense redness and peeling, generally requiring 5 to 7 days before the skin looks presentable. Chemical peels regenerate new skin within 7 to 10 days. Newer technologies like picosecond lasers with specialized lens arrays have shortened recovery to 3 to 5 days.
Most procedures require multiple sessions spaced weeks apart. Fractional CO2 laser protocols commonly involve four monthly sessions. TCA CROSS for ice pick scars uses sessions every two weeks for four rounds. Microneedling protocols often call for six sessions. Results continue developing for months after the final session as new collagen matures, so the full effect isn’t visible immediately.
Cost and Insurance Reality
Acne scar treatments are almost universally classified as cosmetic by insurance companies. An analysis of 58 American insurers found that none would cover dermabrasion or chemical peels when used specifically for acne scarring. The average cost of a single dermabrasion session was $1,786 in 2020, while chemical peels averaged $519 per session. Laser treatments fall in a similar range, typically $200 to $1,500 per session depending on the type and treatment area.
Given that most protocols require multiple sessions, total treatment costs commonly reach several thousand dollars. Some dermatology practices offer payment plans, and combining different techniques (for example, subcision for rolling scars plus TCA CROSS for ice picks) can sometimes reduce the total number of sessions needed compared to using a single approach for all scar types.