The best treatment for acne scars depends on the type of scar you have. Ice pick scars, rolling scars, and boxcar scars each respond differently to specific procedures, and matching the right treatment to your scar type is what separates noticeable results from wasted money. Most people have a mix of scar types, which is why dermatologists often combine two or three approaches rather than relying on a single one.
Why Your Scar Type Matters
Acne scars fall into two broad categories: those that create raised tissue (hypertrophic and keloid scars) and those that cause loss of tissue, leaving depressions in the skin. The depressed type is far more common. In one study of scarring patterns, 94% of patients had ice pick scars, 86% had rolling scars, 54% had boxcar scars, and only 10% had keloid scars. Most people have more than one type at the same time.
Ice pick scars are narrow, deep holes that look like the skin was punctured with a sharp object. Boxcar scars are wider with defined, sharp edges, almost like a small crater. Rolling scars create a wave-like unevenness across the skin because bands of tissue pull the surface downward from underneath. Raised scars, including keloids, grow beyond the original wound and feel firm or rubbery to the touch. Identifying what you’re working with is the first step toward choosing a treatment that actually works.
Laser Treatments: The Most Versatile Option
Laser resurfacing is the most widely used professional treatment for acne scars, and it comes in two forms. Ablative lasers physically remove the top layer of skin, forcing the body to rebuild it with new collagen. Non-ablative lasers heat the deeper layers without breaking the surface, stimulating collagen production more gently. Both can be delivered in a “fractional” pattern, meaning the laser treats tiny columns of skin while leaving surrounding tissue intact, which speeds healing.
In a head-to-head comparison of four laser types, CO2 ablative lasers produced the highest improvement scores, followed closely by erbium ablative lasers and ablative fractional lasers. Non-ablative fractional lasers scored significantly lower, roughly a third as effective as the top performers. That said, non-ablative lasers have a real advantage: little to no downtime. After ablative treatment, expect about a week of redness, peeling, and sensitivity. Non-ablative sessions may leave you slightly pink for a day or two.
Lasers work well on boxcar and rolling scars. They’re less effective on deep ice pick scars because the narrow depth is harder to reach with surface-level energy. For most people, three to six sessions are needed, spaced several weeks apart. The average cost runs around $2,000 per session for ablative lasers and $1,100 for non-ablative, and insurance rarely covers it.
Chemical Peels and the CROSS Technique
Chemical peels use acid solutions to remove damaged skin layers and trigger new cell growth. Superficial peels cause one to two days of peeling. Medium-depth peels can mean a week or more of redness and downtime. For general skin texture improvement, peels can soften shallow scarring, but they aren’t strong enough alone to fix deep scars.
The exception is a targeted technique called CROSS, which stands for chemical reconstruction of skin scars. A dermatologist applies a high concentration of trichloroacetic acid directly into each individual scar using a fine applicator like a toothpick. This triggers a controlled inflammatory response deep within the scar, prompting the body to fill it in with new collagen from the bottom up. The technique works particularly well for ice pick scars, which resist most other treatments. Sessions are typically spaced two weeks apart, with four or more treatments needed.
In a split-face comparison, the CROSS technique outperformed fractional laser for ice pick scars, while the fractional laser proved more effective for rolling scars. This is a good example of why combining treatments often makes more sense than picking just one.
Subcision for Rolling Scars
Rolling scars have a specific structural cause: fibrous bands of scar tissue beneath the skin pull the surface downward, creating that uneven, undulating look. Subcision addresses this directly. A doctor inserts a small needle beneath the scar and moves it back and forth to break those tethering bands, releasing the skin so it can rise back to a normal level.
In a study of 40 patients, subcision produced roughly 50% improvement in rolling scars, and 90% of patients reported that their appearance had improved. When complete resolution doesn’t happen in one session, repeating the procedure or combining it with other treatments like fillers or laser can push results further. Subcision is specifically designed for rolling scars and won’t help with ice pick or boxcar types.
Dermal Fillers for Volume Loss
Fillers work by physically raising depressed scars from underneath. They’re most useful for broader, shallow depressions and rolling scars, and they provide the most immediate visible change of any treatment option.
Bellafill is the only filler with FDA approval specifically for acne scars. It contains tiny microspheres that support the skin’s structure and stimulate collagen production over time, providing results that can last years. Hyaluronic acid fillers are another common choice. They typically last 6 to 12 months and can be dissolved if you’re unhappy with the result, which makes them a lower-risk starting point. Other options include fillers that stimulate your own collagen production, with results lasting around two years, and calcium-based fillers that last 9 to 15 months.
Fillers are often paired with subcision. Breaking the tethered bands first and then injecting filler into the space prevents the scar from pulling back down, making both treatments more effective together than either one alone.
Silicone for Raised Scars
If your acne left raised, thickened scars or keloids, the treatment approach is completely different from what works on depressed scars. Current clinical guidelines recommend silicone therapy as the first-line treatment for both hypertrophic scars and keloids. Both silicone gel and silicone sheets are effective. The key is consistency: they need to be worn or applied for at least 23 hours a day, continuously, for a minimum of six months to see meaningful flattening and softening.
For more stubborn raised scars, steroid injections can break down excess collagen and flatten the scar over several sessions. These are typically administered every four to six weeks until the scar responds.
Matching Treatment to Scar Type
Because most people have a combination of scar types, the best results usually come from a multi-step plan:
- Ice pick scars: The CROSS technique with focused acid application is the most effective single option. Lasers alone struggle with these narrow, deep scars.
- Rolling scars: Subcision to release the tethered bands, often followed by filler to maintain the lift, and fractional laser to smooth the surface.
- Boxcar scars: Ablative fractional lasers work well for shallower boxcar scars. Deeper ones may benefit from fillers or punch excision, where the scar is surgically removed and the skin is stitched closed.
- Raised scars and keloids: Silicone therapy as a baseline, with steroid injections for scars that don’t respond.
What to Expect With Cost and Timeline
Professional acne scar treatment is a process, not a single appointment. Most procedures require three to six sessions, and visible improvement builds gradually over months as collagen remodels. Full results from laser treatments, for example, can take three to six months after your final session to become apparent.
Costs vary widely. A full course of ablative laser resurfacing can run $6,000 to $12,000 or more depending on the area treated and number of sessions. Non-ablative laser courses cost roughly half that. Chemical peels and subcision are generally less expensive per session. Fillers range from a few hundred to over a thousand dollars per syringe. None of these treatments are typically covered by insurance, since they’re classified as cosmetic.
The most cost-effective strategy is getting an accurate scar assessment first so you invest in the treatments that actually target your specific scar types, rather than cycling through options that were never a good match.