Several treatments can meaningfully reduce acne scars, but the right one depends on the type of scar you have and how deep it goes. Shallow scars respond well to topical treatments and light procedures, while deep or pitted scars typically need professional interventions like laser resurfacing, microneedling, or chemical reconstruction. Most people see significant improvement, though completely erasing scars to the point of invisible skin is rare.
Why Scar Type Matters
Acne scars fall into two broad categories: indented (atrophic) and raised (hypertrophic or keloid). Indented scars form when your skin loses tissue during healing. Raised scars form when your body overproduces collagen in response to the wound. Each type responds differently to treatment, so identifying what you’re working with saves time and money.
The three main types of indented scars look quite different from each other. Ice pick scars are narrow and deep, appearing like tiny puncture marks that extend well below the skin surface. Boxcar scars are wider with sharp, defined edges and flat bases, almost like small craters. Rolling scars create a wavy, uneven texture caused by fibrous bands pulling the skin downward from underneath. Many people have a mix of all three.
Keloid and hypertrophic scars are raised bumps that extend beyond the original wound edges. Keloids can continue growing over time and often feel itchy, tender, or firm. These require a completely different treatment approach from indented scars, often involving steroid injections or silicone sheeting rather than resurfacing procedures.
Topical Treatments for Mild Scarring
Retinoids are the most effective topical option for acne scars. They work by accelerating skin cell turnover and stimulating collagen production in the deeper layers of skin. The catch is patience: while active breakouts can clear within three months, the collagen remodeling that actually improves scar texture takes roughly six months of consistent use before you’ll notice a visible difference. Retinoids work best on shallow rolling and boxcar scars. They won’t fill in deep ice pick scars.
Other topical ingredients like vitamin C, niacinamide, and azelaic acid can help fade the dark marks left behind after acne (post-inflammatory hyperpigmentation), which many people confuse with true scars. These discolored patches are flat and will eventually fade on their own, though topicals speed the process. If your concern is discoloration rather than texture changes, topicals may be all you need.
Laser Resurfacing
Laser treatments are among the most effective options for moderate to severe acne scars. They work by removing damaged skin in controlled layers and triggering your body’s wound-healing response, which produces fresh collagen to fill in depressed areas.
Ablative lasers like fractional CO2 penetrate deep into the dermis, making them powerful for deep boxcar and rolling scars. More intensive ablative approaches can achieve significant results in just one to two sessions. Erbium lasers offer more superficial, precision resurfacing with less downtime, making them better suited for shallower scars. Fractional lasers (like Fraxel) treat only a fraction of the skin at a time, leaving surrounding tissue intact to speed healing. Most patients need three to six sessions spaced four to six weeks apart.
The average cost of laser skin resurfacing is around $1,829 per session, according to the American Society of Plastic Surgeons. Multiple sessions add up, so total treatment costs for a full course can range from roughly $2,000 to over $10,000 depending on scar severity and the number of sessions needed.
Recovery After Laser Treatment
CO2 laser treatment typically takes one to two weeks to heal. For the first two to three days, you’ll apply ice packs to the treated area for 15 to 20 minutes several times a day. A crust forms over the treated skin and falls off on its own within one to two weeks. Don’t pick at it. During this healing window, you’ll need to avoid pools, hot tubs, saunas, and shaving over the treated area. Sun exposure is off-limits until the skin is fully healed, and you should wear mineral sunscreen of at least SPF 30 whenever you’re outdoors for months afterward.
Microneedling
Microneedling uses a device covered in fine needles to create thousands of tiny punctures in the skin, triggering a controlled healing response that builds new collagen. It’s effective for rolling and shallow boxcar scars and works on all skin tones, which gives it an advantage over some laser treatments.
Adding platelet-rich plasma (PRP), drawn from your own blood, boosts results. A meta-analysis published in Frontiers in Medicine found that combining microneedling with PRP nearly tripled the odds of achieving greater than 50 percent clinical improvement compared to microneedling alone. The combination treatment produced significantly better scar scores across multiple studies. Most microneedling protocols involve three to six sessions spaced several weeks apart, with each session running roughly 30 to 60 minutes.
Chemical Peels and TCA CROSS
Standard chemical peels remove the outer layers of skin to promote smoother regrowth. They work well for shallow scarring and uneven pigmentation but don’t reach deep enough for severe pitting on their own.
For deep ice pick scars specifically, a technique called TCA CROSS is one of the most targeted options available. A high-concentration acid is applied with a fine applicator directly into each individual scar, causing the walls of the scar to inflame and rebuild with new collagen from the inside out. In clinical studies, 60 percent of patients showed marked improvement, 30 percent showed moderate improvement, and patients who completed five or six treatment sessions showed excellent results across the board. Sessions are spaced weeks apart, and the treated spots form small scabs that heal within a week or so.
Subcision and Fillers
Rolling scars are often tethered to deeper tissue by fibrous bands that pull the skin surface downward. Subcision involves inserting a small needle beneath the scar to physically break these bands, releasing the skin so it can sit at a more even level. It’s frequently combined with other treatments like microneedling or fillers for better results.
Dermal fillers can immediately lift depressed scars by adding volume beneath them. Most fillers are temporary, lasting anywhere from six months to two years before being absorbed by the body. One filler, Bellafill, is specifically FDA-approved for acne scars and lasts up to five years. It works by providing immediate volume while also stimulating your own collagen growth over time. Fillers are particularly useful for deep rolling scars and broad, shallow depressions.
Risks for Darker Skin Tones
If you have a medium to deep skin tone, some scar treatments carry an additional risk: post-inflammatory hyperpigmentation (PIH), where the treatment itself causes new dark patches. This happens with greater frequency and severity in darker skin, and the resulting discoloration can sometimes be more distressing than the original scars.
Aggressive chemical peels, ablative lasers, and any treatment that causes significant irritation can trigger or worsen PIH. To minimize this risk, dermatologists typically start at lower treatment intensities and gradually increase based on how your skin responds. Strict sun protection before, during, and after treatment is essential. Certain lasers, like the Nd:YAG, are considered safer for darker complexions and can treat both active acne and early scarring across all skin tones. If you have darker skin, choosing a provider experienced with your skin type matters as much as choosing the right procedure.
Matching Treatment to Scar Type
No single treatment works best for every scar. Here’s a practical guide to matching your scars with the most effective options:
- Ice pick scars: TCA CROSS, punch excision, or ablative laser. These narrow, deep scars need targeted, depth-reaching treatments.
- Boxcar scars: Laser resurfacing, microneedling, or chemical peels depending on depth. Shallow boxcar scars respond to a wider range of options than deep ones.
- Rolling scars: Subcision to release tethered tissue, often combined with microneedling, fillers, or laser treatments for the best outcome.
- Keloid or hypertrophic scars: Steroid injections, silicone sheets, or specialized laser treatments. Avoid resurfacing procedures that can worsen raised scars.
Most dermatologists recommend combination approaches for people with mixed scar types. Treating rolling scars with subcision and fillers while addressing ice pick scars with TCA CROSS in the same treatment plan, for instance, produces better overall results than relying on a single modality. Expect the full process to take six months to a year or more, factoring in treatment sessions, healing time between them, and the slow pace of collagen remodeling beneath the skin’s surface.