Several treatments can significantly improve acne scars, but the right approach depends on whether your scars are indented, raised, or simply discolored. Fractional laser resurfacing, for example, can improve indented scars by 50 to 80 percent, while a prescription retinoid applied daily for six months shows visible improvement in over half of patients. The key is matching the treatment to the type of scarring you have.
Flat Marks vs. True Scars
Many people searching for acne scar treatments are actually dealing with discoloration, not textured scars. These flat marks come in two forms: red or purple spots (common on lighter skin) and brown or dark spots (more common on deeper skin tones). Both are left behind after a breakout heals, and neither involves a change in skin texture.
Discoloration is far easier to treat than true scars. Ingredients like azelaic acid, tranexamic acid, and tretinoin all target dark marks by slowing excess pigment production and speeding cell turnover. Red marks fade more slowly but respond to sun protection and time. Most flat marks resolve within 3 to 12 months without professional treatment, though the ingredients above can accelerate the process considerably. If your concern is color rather than texture, you likely don’t need the more intensive procedures described below.
Types of Indented Scars
True acne scars change the structure of your skin. Indented (atrophic) scars are the most common type and fall into three categories, each responding differently to treatment:
- Ice pick scars are narrow, deep pits with sharp edges, like a puncture wound. They extend deep into the skin and are the hardest to treat with surface-level procedures.
- Boxcar scars are wider depressions with defined, angular borders, similar to chickenpox marks.
- Rolling scars create a wave-like unevenness across the skin. They’re caused by fibrous bands pulling the surface downward from underneath.
Raised (hypertrophic) scars are less common with acne. These are firm, elevated bumps where the body overproduced collagen during healing. They’re treated with entirely different methods than indented scars.
Topical Retinoids for Mild Scarring
If your scars are shallow, a topical retinoid may be enough to see meaningful improvement without any procedures. A Johns Hopkins study found that adapalene 0.3% gel, applied once daily for four weeks and then twice daily for 20 more weeks, improved skin texture and atrophic scarring in at least half of subjects by investigator assessment. Over 80 percent of the patients themselves reported noticeable improvement.
Retinoids work by accelerating skin cell turnover and stimulating collagen production over time. They won’t fill in deep ice pick scars, but for broad, shallow texture issues, six months of consistent use can make a real difference. This is also the most accessible starting point since adapalene is available over the counter at lower concentrations (0.1%), while the 0.3% strength requires a prescription.
Microneedling for Moderate Scars
Microneedling uses a device covered in fine needles to create thousands of tiny punctures in the skin, triggering a wound-healing response that produces new collagen. For acne scars, practitioners typically use needle depths of 1.5 to 2.5 millimeters to reach the deeper layers where scar tissue forms. Shallower depths (0.5 to 1.0 mm) are reserved for sensitive skin or surface-level concerns.
Treating acne scars generally requires six or more sessions spaced four to six weeks apart. Results build gradually as collagen remodels over the months following each session. Microneedling works well for rolling and boxcar scars but is less effective for narrow ice pick scars, where the damage is too deep and too narrow for the needles to adequately reach.
Laser Resurfacing for Deeper Scars
Fractional CO2 laser resurfacing is one of the most effective single treatments for indented acne scars. The laser vaporizes tiny columns of skin tissue, leaving surrounding skin intact to speed healing. Clinical studies show improvement of 50 to 80 percent in atrophic scars, with most patients needing one to three sessions spaced four to six weeks apart.
The trade-off is a longer recovery. Expect several days of redness, swelling, and peeling after each session. The skin looks sunburned and feels raw for roughly a week before new, smoother skin emerges. Full collagen remodeling continues for three to six months after treatment, so the final result takes time to appreciate. Laser resurfacing carries a higher risk of pigment changes in darker skin tones, so discussing alternatives with a dermatologist is especially important if you have medium to deep complexion.
Treatments for Specific Scar Types
Ice Pick Scars: TCA Cross
Ice pick scars are too narrow and deep for most surface treatments to reach effectively. A procedure called TCA Cross addresses this by depositing a high-concentration acid (70 to 100 percent trichloroacetic acid) directly into each individual scar. This triggers a controlled inflammatory response deep within the scar, stimulating new collagen fibers that gradually fill and close the pit from the bottom up. Multiple sessions are usually needed, each building on the last as the scar slowly rises to meet the surrounding skin level.
Rolling Scars: Subcision
Rolling scars look wavy because fibrous bands beneath the skin are pulling the surface downward. Subcision addresses the root cause: a needle is inserted beneath the scar and moved back and forth to cut those tethering bands. Once the scar is released from the tissue below, it can rise to match the surrounding skin. The wound-healing process also deposits new collagen underneath, providing additional lift. Subcision works well for rolling and bound-down scars but is not used for deep ice pick scars. It’s often combined with microneedling or filler injections in the same visit for better results.
Raised Scars: Steroid Injections
Hypertrophic and keloid scars respond to corticosteroid injections, which break down excess collagen and flatten the raised tissue. NYU Langone Health recommends injections every four to six weeks, with a maximum of five total injections. Many raised scars flatten noticeably after just two or three sessions. Silicone scar sheets worn daily can also help soften and flatten raised scars over time, particularly when used early.
Combining Treatments
Most people with moderate to severe acne scarring have a mix of scar types, which is why dermatologists frequently combine approaches. A common strategy involves subcision to release tethered rolling scars, TCA Cross for any ice pick scars, and then a course of microneedling or laser resurfacing to smooth the overall texture. Each treatment targets a different structural problem, so layering them produces better results than relying on any single method.
Timing matters when combining treatments. Your skin needs to fully heal between procedures, which typically means waiting four to six weeks between sessions. A full treatment plan for significant scarring can span six months to a year, with results continuing to improve for several months after the final session as collagen remodeling completes. Starting with a retinoid in the months before procedural treatment can also prime the skin by increasing cell turnover and boosting baseline collagen production.