Several treatments can meaningfully improve acne scars, but what works best depends on the type of scar you have. Shallow, discolored marks often respond to topical products you can use at home, while deeper pitted or raised scars typically need professional procedures like laser resurfacing, microneedling, or subcision. Most people see the best results from combining treatments rather than relying on a single approach.
Why Scar Type Matters
Not all acne scars form the same way, and a treatment that works well for one type can be ineffective for another. Acne scars fall into two broad categories: atrophic (indented) and hypertrophic (raised). Most acne scars are atrophic, meaning the skin lost tissue during the healing process and now sits below the surrounding surface.
Within the indented category, there are three distinct shapes. Ice pick scars are narrow, less than 2 mm wide, and extend deep into the skin in a V shape. Boxcar scars are wider (1.5 to 4 mm) with sharp vertical edges, forming a U shape with a flat bottom. Rolling scars are the widest, typically over 4 to 5 mm, and create a wave-like undulation across the skin because fibrous bands underneath are pulling the surface downward.
Raised scars come in two forms. Hypertrophic scars are firm, pink, and stay within the borders of the original breakout. Keloids are more aggressive, forming reddish-purple nodules that grow beyond the original wound area. These raised scars require a fundamentally different treatment approach than indented ones, often involving steroid injections or silicone sheeting rather than the resurfacing techniques that work on pitted scars.
Topical Treatments for Mild Scarring
Retinoids are the most evidence-backed topical option for acne scars. Tretinoin, adapalene, and similar compounds work by shifting how your skin’s collagen behaves. They dial down the signaling pathway that drives fibrotic, disorganized scar tissue, while simultaneously boosting enzymes that break down old, stiff collagen. The net effect is that scarred skin gradually remodels itself, becoming softer and more even over time. This process is slow, often taking three to six months of consistent use before scars look noticeably different.
Adapalene and tazarotene tend to be better tolerated than tretinoin because they’re more selective in how they interact with skin cells, causing less irritation while still promoting collagen turnover. Over-the-counter adapalene (0.1%) is a reasonable starting point if you haven’t used retinoids before. Prescription-strength tretinoin works faster but comes with more peeling and redness during the adjustment period.
Topicals work best on shallow boxcar scars and mild rolling scars. They won’t do much for deep ice pick scars or significant tissue loss. Think of them as a foundation layer: they improve overall skin texture and can enhance the results of professional treatments, but they’re rarely sufficient on their own for moderate to severe scarring.
Microneedling
Professional microneedling uses a device studded with fine needles to create thousands of controlled micro-injuries in the skin. Your body responds by producing new collagen to repair those tiny punctures, and that fresh collagen fills in depressed scars from below. In a clinical study published in JAMA Dermatology, participants perceived a 41% mean improvement in overall scar appearance after three treatment sessions spaced two weeks apart.
That 41% figure is worth setting expectations around. Microneedling produces real, visible improvement, but it won’t erase deep scars entirely. Most people need three to six sessions, and results continue developing for several months after the final treatment as collagen remodeling continues beneath the surface. It works well for rolling and shallow boxcar scars. Deep ice pick scars respond poorly because the damage extends too far below where the needles reach.
The FDA notes that any microneedling device carries risks including bleeding, bruising, redness, and peeling that typically resolve within days to weeks. Less common side effects include dark or light spots on the skin and infection. If you own a home dermaroller, know that it won’t reach the depths needed for scar remodeling. Professional devices penetrate deeper and more precisely. Home devices should be cleaned between uses and never shared, as they can spread infection.
Laser Resurfacing
Fractional lasers are among the most effective single treatments for acne scars. They work by vaporizing tiny columns of damaged skin, triggering an aggressive healing response that replaces scar tissue with healthier, smoother skin. Two main types dominate: fractional CO2 lasers and erbium YAG lasers.
Fractional CO2 lasers penetrate deeper and produce more dramatic results, particularly for severe scarring. Comparative studies show CO2 lasers significantly outperform erbium YAG lasers in both patient satisfaction and physician assessment scores. The tradeoff is a longer recovery. Expect about a week of downtime after fractional CO2 treatment, with redness that can linger for several weeks beyond that.
Erbium YAG lasers remove tissue with less heat damage to surrounding skin, which means faster healing and a lower risk of post-inflammatory hyperpigmentation. This makes them a better fit for darker skin tones, where excess pigmentation after treatment is a significant concern. The results are more modest, but so are the side effects.
Most people need two to four laser sessions for optimal results, spaced four to eight weeks apart. Laser resurfacing handles boxcar and rolling scars well. For ice pick scars, it’s often combined with other techniques.
Subcision for Rolling Scars
Rolling scars have a specific cause: fibrous bands beneath the skin that act like tiny ropes, pulling the surface downward. Subcision directly addresses this by inserting a small instrument under the skin to physically shred those fibrous attachments apart. Once the tethering bands are broken, the skin releases upward and can sit level with the surrounding tissue.
Subcision is particularly effective when combined with a filler injected immediately afterward to prevent the bands from reattaching. In one clinical study, injecting hyaluronic acid filler after subcision produced significant improvement in 94% of treated patients. Blunt cannula techniques tend to yield higher satisfaction scores than standard needle approaches, with results improving over the first three months as the area heals and collagen fills in the space created.
This procedure is specifically suited to rolling scars and won’t help with ice pick or boxcar scars, which have different structural causes.
TCA CROSS for Ice Pick Scars
Ice pick scars are notoriously difficult to treat because they’re narrow and deep. The TCA CROSS technique was designed specifically for them. A doctor applies a high concentration of trichloroacetic acid (up to 100%) directly into each individual scar using a fine applicator. The acid destroys the lining of the narrow scar tract, prompting the body to rebuild it with new collagen from the bottom up.
The procedure is precise and targeted. A crust forms over each treated scar by the next day and falls off within three to four days. Multiple sessions are needed, typically spaced several weeks apart, as each round gradually raises the scar floor closer to the surrounding skin level. It’s one of the few treatments that consistently improves ice pick scars, which don’t respond well to lasers or microneedling alone.
Dermal Fillers
Injectable fillers physically lift depressed scars by adding volume beneath them. They produce the most immediate visible results of any acne scar treatment, though most options are temporary.
Hyaluronic acid fillers last up to 18 months before the body gradually absorbs them. Poly-L-lactic acid works differently: it stimulates your own collagen production over time, with results lasting two to three years. Calcium hydroxylapatite fillers last up to 18 months as well.
Only one filler has specific FDA approval for acne scars: a polymethylmethacrylate-based product (brand name Bellafill), approved in 2014. It’s considered long-lasting, with effects persisting beyond three years, because the microspheres in the filler aren’t absorbed by the body and instead serve as a permanent scaffold for collagen growth. The other fillers are FDA-approved for soft tissue augmentation generally but are used off-label for acne scars.
Fillers work best for broad, shallow depressions like rolling and boxcar scars. They’re not practical for ice pick scars, which are too narrow to inject into effectively.
Combining Treatments for Better Results
Because most people have a mix of scar types, the most effective approach is usually a combination tailored to what’s on your face. A typical plan might pair subcision for rolling scars with TCA CROSS for ice pick scars, followed by a round of fractional laser to smooth the overall texture. Microneedling sessions can then refine the results further.
Retinoids are often used as a maintenance layer between and after procedures, keeping collagen turnover active and helping the skin continue remodeling. The full cycle from first treatment to final results can span six months to a year, since collagen remodeling is a gradual biological process that continues long after each session.
Darker skin tones need extra consideration throughout this process. CO2 lasers and deep chemical peels carry a higher risk of creating pigmentation changes in melanin-rich skin. Erbium YAG lasers, microneedling, and subcision tend to be safer choices, and your provider should factor skin tone into every treatment decision.