Several treatments can significantly reduce acne scars, but the best option depends on the type of scar you have. Indented scars, raised scars, and discolored marks each respond to different approaches. Most people see 30% to 70% improvement with professional treatments like laser resurfacing, and combining methods often produces the best results.
Why Scar Type Matters
Acne scars fall into two broad categories: atrophic (indented) and hypertrophic (raised). Most acne scars are atrophic, meaning your skin lost tissue during the healing process and now sits below the surrounding surface. Raised scars happen when your body overproduces collagen during healing, creating a bump that sits above the skin line.
Atrophic scars come in three shapes, and each responds differently to treatment:
- Ice pick scars are small, narrow, deep holes that point downward into the skin. They’re most common on the cheeks and are the hardest type to treat because of their depth.
- Boxcar scars are wider depressions with sharp, defined edges, almost like a box pressed into the skin. They tend to form on the lower cheeks and jaw where skin is thicker.
- Rolling scars have sloping edges at varying depths, giving the skin a wavy, uneven texture. These are caused by bands of scar tissue pulling the surface downward from underneath.
Knowing which type you have (and many people have a mix) helps you avoid wasting time and money on treatments that won’t work for your specific scars.
Laser Resurfacing
Fractional lasers are one of the most studied treatments for atrophic acne scars. They work by creating thousands of microscopic columns of damage in the skin, which triggers your body to rebuild that tissue with fresh collagen. A systematic review of fractional laser studies found that most patients experienced 30% to 70% improvement in scar appearance.
There are two main categories. Ablative lasers (like fractional CO2) vaporize thin layers of skin and produce more dramatic results, but they come with more downtime. Expect redness and swelling lasting up to several weeks, though the initial swelling often resolves within 24 to 48 hours. Non-ablative lasers heat tissue without removing it, so recovery is faster but results are more modest. According to the American Society of Plastic Surgeons, ablative laser resurfacing averages around $2,000 per session, while non-ablative treatments average about $1,100. Most people need multiple sessions spaced weeks apart.
Microneedling and Radiofrequency
Microneedling uses a device covered in fine needles to create controlled micro-injuries in the skin, prompting your body to produce new collagen as it heals. Radiofrequency microneedling adds heat energy delivered through the needle tips, which intensifies the collagen-building response and reaches deeper layers of skin.
Clinical studies show meaningful improvement after about four sessions, typically spaced one month apart. One study found that quality-of-life scores improved dramatically by the fourth session, with patients reporting both visible scar reduction and greater satisfaction with their skin. Radiofrequency microneedling works well for boxcar and rolling scars. It’s generally less effective for deep ice pick scars, which may need a more targeted approach.
TCA CROSS for Deep Ice Pick Scars
Ice pick scars are notoriously stubborn because they’re so narrow and deep. A technique called TCA CROSS was designed specifically for them. A dermatologist deposits a small amount of highly concentrated trichloroacetic acid (70% to 100%) directly into individual scars. The acid causes controlled destruction inside the scar, which then heals with new collagen that gradually raises the depressed area closer to the surrounding skin surface.
This is a precise, scar-by-scar treatment rather than a full-face procedure. Multiple sessions are usually needed, but it’s one of the few methods that can meaningfully improve deep, narrow scars that lasers and microneedling struggle to reach.
Subcision for Rolling Scars
Rolling scars look wavy because fibrous bands of scar tissue underneath the skin are physically pulling the surface downward. Subcision addresses this by inserting a needle beneath the scar and sweeping it back and forth to cut those tethering bands. Once released, the skin can float back up to a more even level. The wound-healing response also generates new collagen underneath, which provides additional lift over time.
Subcision works best for rolling scars and other depressed scars that move when you stretch the skin. It’s not recommended for deep ice pick scars. Dermatologists often combine subcision with fillers or microneedling in the same visit to maximize results.
Dermal Fillers
Injectable fillers can immediately raise depressed scars to the level of surrounding skin. Hyaluronic acid fillers are the most common choice. One randomized trial showed significant improvement in scar scores, and a two-year follow-up confirmed that results held without fading substantially, which was longer than many dermatologists expected.
For a more permanent option, a filler made of tiny synthetic microspheres suspended in collagen is FDA-approved specifically for acne scars. It works in two stages: the collagen provides immediate volume, while the microspheres stimulate your body to build its own collagen around them over time. Biostimulatory fillers like this offer longer-lasting correction than hyaluronic acid, though they can’t be dissolved if you’re unhappy with the result.
Treatments for Raised Scars
Hypertrophic and keloid scars require the opposite strategy. Instead of building collagen, you need to break it down. Steroid injections directly into the scar tissue are the standard first-line treatment. These injections flatten 50% to 100% of keloid scars, though recurrence rates range from 9% to 50% depending on the scar and the person.
A typical schedule involves two or three injections spaced a month apart, but treatment can continue for six months or longer for stubborn scars. The injections are painful, but they’re quick. If a raised scar is surgically removed, steroid injections are usually given at the wound edge immediately after excision and then continued weekly for several weeks to prevent the scar from growing back.
Topical Retinoids
Prescription retinoids are the most accessible starting point for mild atrophic scars. They speed up skin cell turnover and stimulate collagen production in the upper layers of skin. A clinical study at Johns Hopkins tested a prescription-strength retinoid gel applied daily (then twice daily) over 24 weeks. At the end of the study, investigators noted improvement in skin texture in 50% of subjects, while over 80% of the participants themselves reported that their scars looked better.
Retinoids won’t erase deep scars, but they can soften shallow ones and improve overall skin texture. They’re also useful as a complement to professional procedures, helping maintain and extend results between sessions. Expect at least three to six months of consistent use before judging whether they’re working.
What About At-Home Devices?
LED masks and at-home microneedling devices are widely marketed for scarring, but the evidence is thin. The Cleveland Clinic notes that at-home LED devices use much weaker energy than in-office versions, and you likely won’t see dramatic results. Subtle improvements in overall skin appearance are possible, but meaningful scar reduction requires the kind of controlled tissue injury or energy delivery that only professional-grade equipment can provide. Some at-home LED devices also require 30 to 60 minutes of use twice daily for four to five weeks, which is a significant commitment for modest results.
At-home derma rollers carry additional risks. Needles that are long enough to reach scar tissue can cause infection or worsen scarring if used incorrectly, and shorter needles don’t penetrate deeply enough to trigger real collagen remodeling.
Combining Treatments for Better Results
Most dermatologists treat acne scars with a combination approach rather than relying on a single method. A common strategy for someone with mixed scar types might involve subcision to release rolling scars, TCA CROSS for ice pick scars, and fractional laser or microneedling across the full face to improve overall texture. Fillers can provide immediate improvement while you wait for collagen-stimulating treatments to take full effect over months.
Realistic expectations matter. Even with the best combination of treatments, complete elimination of scars is rare. The goal is typically to reduce their depth and visibility enough that they’re no longer noticeable in normal lighting. Most treatment plans span six months to a year, with gradual improvement between sessions as new collagen matures and remodels.