Acne scars can be significantly improved with the right combination of treatments, though the best approach depends on whether you’re dealing with actual scarring or temporary discoloration. Most people searching for help with acne scarring have a mix of both, and telling them apart is the first step toward choosing something that works.
Dark Marks vs. True Scars
Not everything acne leaves behind is a scar. The flat dark or reddish spots that linger after a breakout are called post-inflammatory hyperpigmentation. These are caused by excess pigment production during healing, not by structural damage to the skin. The key difference: if you run your finger over the mark and the skin feels smooth, it’s pigmentation, not scarring. These spots fade on their own over weeks to months, and topical products can speed that process considerably.
True acne scars involve permanent changes in skin texture. You can feel them. They show up as depressions, pits, or sometimes raised bumps. These form when the deeper layers of skin are damaged during inflammatory breakouts, and the body either produces too little collagen (leaving an indentation) or too much (creating a raised scar). Without treatment, textural scars are permanent.
Types of Depressed Scars
Most acne scars are depressed, meaning they sit below the surrounding skin surface. They fall into three categories, and knowing which type you have matters because treatments differ in effectiveness for each one.
- Ice pick scars are narrow, deep, V-shaped pits that look like the skin was punctured with a sharp object. They’re the hardest to treat because of their depth.
- Boxcar scars are wider with sharp, defined edges and a flat bottom, almost like a small crater. They respond well to resurfacing treatments.
- Rolling scars have sloping, wave-like edges that give the skin an uneven, undulating appearance. These are often caused by bands of scar tissue pulling the skin surface downward.
Raised Scars: Keloids and Hypertrophic Scars
Some acne leaves behind raised, firm tissue instead of indentations. Hypertrophic scars stay within the boundary of the original wound, while keloids grow beyond it, sometimes significantly. Keloids tend to be firm, smooth, and purplish-red, and they can feel itchy or uncomfortable. They’re most common on the upper chest, shoulders, ears, and jawline, and they occur more frequently in people with darker skin tones. Keloids can even appear years after the original injury. These scars require different treatment strategies than depressed scars, often involving steroid injections, silicone sheeting, or specialized laser therapy.
What Topical Products Can Do
Over-the-counter products work best for pigmentation and mild texture issues. They won’t fill in deep pits, but they can meaningfully improve skin tone and accelerate fading of dark marks.
Vitamin C serums help in two ways: they inhibit excess pigment production and accelerate wound healing, which can help fade both discoloration and superficial scars over time. Niacinamide (vitamin B3) is another strong option for evening out skin tone and calming redness. It also helps regulate oil production, which can prevent future breakouts from creating new marks. You can use both in the same routine.
Retinoids, available over the counter in lower strengths, increase skin cell turnover and stimulate collagen production over months of consistent use. They’re one of the few topical ingredients with evidence for improving mild textural scarring, not just color. Sunscreen is non-negotiable during this process. UV exposure darkens pigmented marks and can undo progress from other treatments.
Microneedling
Microneedling uses tiny sterilized needles to create controlled micro-injuries across the skin’s surface. The skin responds to these pinpricks by producing new collagen-rich tissue that is more even in tone and texture. This process, sometimes called collagen induction therapy, essentially tricks the skin into repairing itself more thoroughly than it did the first time around.
Professional microneedling typically requires three to six sessions spaced four to six weeks apart. Downtime is relatively mild compared to lasers: expect redness and sensitivity for two to three days. It works well for rolling scars and shallow boxcar scars but is less effective for deep ice pick scars. At-home derma rollers exist, but they use shorter needles that can’t reach the depth needed for true scar remodeling, so professional treatments deliver noticeably better results.
Laser Resurfacing
Fractional CO2 lasers are one of the most studied treatments for depressed acne scars. They work by vaporizing tiny columns of damaged skin, triggering an aggressive healing response that replaces scar tissue with new, smoother skin. A meta-analysis of clinical studies found an average improvement rate of about 38% after two treatment courses, with most study protocols requiring three to five sessions total.
The trade-off is downtime. After a fractional CO2 session, your skin will be red, warm, and swollen on day one. By days three and four, micro-crusting darkens and starts to flake. Most visible scabbing resolves by days five to six, revealing pink, smoother skin underneath. Plan for five to seven days of noticeable downtime before you look presentable without makeup, and expect lingering redness for two to three weeks. Deeper treatment settings may require up to ten days before sun exposure or cosmetics are safe.
Non-ablative lasers offer a gentler alternative with less downtime (typically a day or two of redness) but require more sessions and produce more modest results per treatment.
Chemical Peels and the CROSS Technique
Standard chemical peels at mild to moderate strengths can help with pigmentation and shallow texture, but they don’t do much for deeper scars. The exception is a specialized technique called CROSS, which stands for chemical reconstruction of skin scars. A practitioner applies a highly concentrated acid (typically 70% to 100% strength) directly into individual scar depressions using a tiny applicator, rather than spreading it across the whole face.
This focused application stimulates intense collagen production deep within each scar, gradually building up the depressed area from below. Repeated sessions can normalize deep rolling and boxcar scars, and higher concentrations can improve even deep ice pick scars. It’s one of the more affordable in-office options and has minimal downtime since only the treated spots are affected, though you’ll see small white frost marks at each application site that crust and heal over about a week.
Subcision for Tethered Scars
Rolling scars often look depressed because fibrous bands of scar tissue underneath are physically pulling the skin’s surface downward. Subcision addresses this directly: a needle is inserted beneath the scar to cut those tethering bands, releasing the skin so it can sit at a more normal level. The procedure also triggers new connective tissue formation beneath the scar, providing additional volume over time.
Subcision is particularly effective for rolling scars and is often combined with other treatments. Pairing it with fillers or microneedling tends to produce better results than any single approach alone, because subcision handles the structural problem while other treatments address the surface texture.
Dermal Fillers
Injectable fillers can immediately lift depressed scars by adding volume beneath them. Several types are used, and they differ mainly in how long they last. Hyaluronic acid fillers provide instant improvement and have shown sustained results at two-year follow-up in clinical studies. Collagen-based fillers last about six months. A synthetic filler made of tiny microspheres in a collagen base is the only one specifically FDA-approved for acne scar treatment, and it provides long-lasting correction.
Biostimulatory fillers take a different approach. Instead of just adding volume, they trigger your skin to produce its own collagen over time. One type has shown therapeutic benefits lasting up to four years, making it especially useful for people with thin skin and widespread scarring. Fillers work best for isolated, well-defined depressed scars rather than broad areas of uneven texture.
Combining Treatments for Better Results
Most dermatologists treat moderate to severe acne scarring with a combination approach rather than relying on a single method. A typical plan might start with subcision to release tethered scars, follow with a series of laser or microneedling sessions to resurface the broader area, and use fillers or the CROSS technique to address any remaining deep individual scars. Topical retinoids and vitamin C can support the process between procedures.
Realistic expectations matter. Even the most aggressive treatments typically improve scars by 50% to 70% over a full course, not 100%. The goal is to make scars less noticeable, not to achieve perfectly smooth skin. Most treatment plans span six months to over a year when accounting for healing time between sessions. Starting with a professional assessment of your specific scar types will help you avoid spending money on treatments that aren’t well matched to what you actually have.