Several treatments can significantly reduce acne scars, but the best option depends on what type of scar you’re dealing with. Shallow, wave-like scars respond well to microneedling and laser resurfacing, while deep pitted scars often need targeted chemical treatments or minor procedures. Most people see 50% to 80% improvement with the right approach, though completely erasing scars is rarely realistic.
Why Scar Type Matters
Acne scars fall into two broad categories: indented scars (where tissue was lost) and raised scars (where the body overproduced collagen during healing). Most acne scars are indented, and they come in three distinct shapes. Ice pick scars are small, narrow holes that point deep into the skin, almost like a puncture wound. Boxcar scars are wider depressions with sharp, defined edges. Rolling scars have sloped edges and varying depths, giving skin a wavy, uneven texture.
Raised scars are less common. Keloid scars grow beyond the boundaries of the original breakout and can keep expanding over time. Each scar type sits at a different depth in the skin, which is why a single treatment rarely works for everyone.
Laser Resurfacing
Fractional CO2 laser resurfacing is one of the most effective options for atrophic (indented) acne scars, with clinical studies showing 50% to 80% improvement. The laser creates thousands of tiny columns of controlled damage in the skin, triggering your body to replace scarred tissue with fresh collagen. It works especially well on boxcar and rolling scars.
Most people need one to three sessions spaced four to six weeks apart, though deeper scarring may require more. The average cost for laser skin resurfacing is about $1,829 per session, according to the American Society of Plastic Surgeons, and it’s rarely covered by insurance. Expect several days of redness, swelling, and peeling afterward, similar to a sunburn.
Microneedling and RF Microneedling
Standard microneedling uses a device covered in fine needles to create controlled micro-injuries in the upper layer of skin, prompting collagen production as the skin heals. It’s a solid option for mild to moderate scarring, with only one to two days of redness afterward.
Radiofrequency (RF) microneedling takes things further. The needles deliver heat energy into the deeper layers of skin, stimulating collagen at a level standard microneedling can’t reach. Recovery is slightly longer, typically two to three days of redness and warmth, but the deeper treatment tends to produce more noticeable results for moderate scarring. Both versions usually require a series of three to six sessions.
TCA CROSS for Deep Ice Pick Scars
Ice pick scars are notoriously stubborn because they’re so narrow and deep. Lasers and microneedling often can’t reach the bottom of them. A technique called TCA CROSS was designed specifically for this problem. A dermatologist deposits a small amount of high-concentration trichloroacetic acid (70% to 100%) directly into each individual scar. The acid causes controlled destruction of the scar tissue, and as the skin heals, new collagen fills in the depression from the bottom up.
Results are gradual. You can expect a one to two grade improvement in scar depth over about six months, and multiple sessions are typically needed. It’s one of the more affordable in-office options since it targets individual scars rather than treating the entire face.
Subcision for Rolling Scars
Rolling scars look wavy because bands of fibrous scar tissue underneath the skin are literally pulling the surface downward. Subcision addresses this directly. A doctor inserts a needle beneath the scar and moves it back and forth in a fan-like motion to physically cut those tethering bands. You can sometimes hear a snapping sound as the fibers release.
Once the bands are cut, the skin is free to lift back to its normal level. The wound-healing process also deposits new collagen in the area, which provides additional volume over time. Subcision is often combined with other treatments, like fillers or microneedling, to maximize results in a single visit.
Dermal Fillers
For scars that leave noticeable depressions, injectable fillers can restore lost volume. Two main types are used for acne scarring, and they work differently.
- Hyaluronic acid fillers provide immediate volume. The improvement in skin structure builds over the first six months and can last 9 to 12 months after an initial series of two to three sessions. Maintenance treatments are needed roughly once a year.
- Poly-L-lactic acid (Sculptra) works more gradually. Rather than filling the space directly, it triggers your body to produce its own collagen over several months, creating a more natural correction. Maintenance is typically once a year.
Fillers work best for broader, shallow depressions rather than narrow ice pick scars. They’re also useful as a complement to subcision, helping to keep released scars from re-tethering.
Combination Approaches
Most dermatologists don’t rely on a single treatment, especially when someone has a mix of scar types. A common strategy is to start with subcision for tethered rolling scars, use TCA CROSS on any ice pick scars, and then follow up with a few sessions of laser resurfacing or RF microneedling to smooth the overall texture. Spacing these treatments out over several months gives the skin time to heal and produce new collagen between sessions.
This layered approach tends to outperform any single treatment because each technique targets a different depth and type of damage. Your dermatologist can map your scars and build a plan based on what’s actually going on with your skin rather than applying one method across the board.
Important Considerations for Darker Skin
If you have a deeper skin tone, scar treatments carry additional risks. The American Academy of Dermatology warns that procedures like chemical peels, laser therapy, and microdermabrasion can cause permanent dark marks or light spots on darker skin. People with skin of color also have a higher risk of developing keloid scars from acne in the first place.
These treatments can still be effective, but the margin for error is smaller. The key is finding a dermatologist who frequently performs these procedures on patients with similar skin tones. Ask directly how many patients with skin of color they’ve treated. The right provider will adjust laser settings, choose appropriate wavelengths, and space treatments to minimize the risk of pigmentation changes.
Protecting Your Results
Scar tissue is more vulnerable to UV damage than normal skin because it lacks the usual levels of melanin that act as a natural shield. Sun exposure on healing or treated scars can cause darkening or lightening that makes scars more visible, not less. It can also break down the new collagen and elastin your skin is trying to build after treatment.
Wearing broad-spectrum sunscreen with SPF 30 or higher daily is one of the simplest things you can do to protect your investment in scar treatment. This applies year-round, not just in summer, and is especially critical in the weeks following any in-office procedure. Reapply every two hours if you’re spending time outdoors. No treatment will deliver its full results if UV exposure is undoing the repair work underneath.