Acne scars can be significantly improved with the right combination of treatments, though the best approach depends on the type, depth, and number of scars you have. No single treatment erases all acne scars completely, but most people see 50% to 70% improvement with professional procedures, and even mild scarring can respond to topical treatments used consistently over several months.
Before pursuing any scar treatment, the first step is getting active breakouts under control. Treating scars while acne is still flaring leads to new inflammation, new damage, and potentially new scars. The American Academy of Dermatology recommends starting scar treatment only after acne is managed and you’re using medication to prevent new breakouts.
Identify Your Scar Type First
Acne scars fall into two broad categories: depressed (sunken into the skin) and raised (built up above the skin surface). Most acne scarring is depressed, and it comes in three distinct shapes that respond differently to treatment.
- Ice pick scars are small, narrow indentations that point deep into the skin like a puncture. They’re the hardest type to treat because of their depth.
- Boxcar scars are broader depressions with sharp, defined edges, almost like a box pressed into the skin.
- Rolling scars vary in depth with sloping edges, giving skin a wavy, uneven texture. These often respond well to treatments that release the scar tissue pulling the skin down.
Many people have a mix of all three types. A dermatologist can assess which types dominate your scarring and build a plan around that, factoring in your skin tone, budget, and how much downtime you can tolerate.
Topical Treatments for Mild Scarring
If your scars are shallow, prescription retinoids can gradually improve skin texture by accelerating cell turnover and stimulating collagen production. This isn’t a quick fix. Studies on tazarotene showed significant scar reduction after three months of daily use, and a 12-month course produced further improvement. Adapalene at prescription strength improved skin texture by one to two grades in over half of patients after 24 weeks. Trifarotene, a newer retinoid, also showed measurable scar reduction compared to placebo over a similar timeframe.
Retinoids won’t dramatically change deep scars, but they’re a reasonable starting point for mild texture issues and work well as a complement to professional procedures. Salicylic acid is another option for evening out mild scarring. Both are available through a dermatologist.
Laser Resurfacing
Fractional laser treatments are among the most effective options for moderate to severe acne scars. These lasers create tiny columns of controlled injury in the skin, triggering the body to replace damaged tissue with new collagen. Clinical studies show patients achieving around 65% to 69% improvement in scar severity scores after treatment.
Ablative lasers (which remove thin layers of skin) tend to produce the most dramatic results but come with more downtime. Swelling and redness typically resolve within one to three days, though full healing takes longer. Newer hybrid approaches that combine ablative and non-ablative wavelengths offer comparable results with a shorter, more tolerable recovery.
Results aren’t instant. After laser treatment, new collagen continues to reorganize and strengthen for months. Meaningful improvement in texture and depth typically becomes noticeable around three to six months, with the remodeling process continuing for up to a year.
Microneedling and Radiofrequency
Microneedling uses tiny needles to create controlled micro-injuries in scarred skin, prompting your body to produce fresh collagen as it heals. It’s safe for all skin tones, which is a significant advantage over some laser treatments that carry higher risks for darker skin.
Radiofrequency microneedling takes this a step further by delivering heat energy through the needles into deeper layers of skin. In clinical comparisons, radiofrequency microneedling performed as well as fractional laser treatment for atrophic acne scars, with roughly 95% of patients rating their improvement as “satisfied” or “very satisfied.” Both radiofrequency and radiofrequency microneedling are considered safe for all skin tones.
Dermatologists often pair microneedling with other treatments to boost results. Chemical peels, platelet-rich plasma (PRP, where your own blood platelets are injected into the treated area), and topical retinoids applied after the procedure can all enhance the collagen response.
Subcision for Tethered Scars
Rolling scars often look sunken because fibrous bands of scar tissue are literally pulling the skin surface downward from underneath. Subcision addresses this directly. A needle is inserted beneath the scar to cut those tethering strands, freeing the skin so it can rise back to a more even level. The wound-healing response also deposits new collagen in the area.
Subcision works best when combined with other treatments. It can be paired with microneedling (safely performed as soon as one day after subcision), chemical peels, fractional laser, or a technique called TCA CROSS for ice pick scars. This layered approach, where subcision releases the scar and a second treatment stimulates collagen remodeling, tends to produce better outcomes than any single procedure alone.
TCA CROSS for Deep Ice Pick Scars
Ice pick scars are notoriously difficult because they extend so deep into the skin. TCA CROSS is a targeted technique where a high concentration (70% to 100%) of trichloroacetic acid is deposited directly into individual ice pick scars. The acid triggers an intense healing response at the base of the scar, gradually building up new collagen from the bottom.
After the procedure, a small scab forms within two to three days and falls off within a week. Multiple sessions spaced several weeks apart are usually needed, with each round raising the scar floor a bit more. It’s a precise, scar-by-scar approach rather than a full-face treatment.
Dermal Fillers
Fillers add volume beneath depressed scars to physically raise them to the level of surrounding skin. Results are immediate but vary in how long they last depending on the material used.
Hyaluronic acid fillers (like those in the Juvederm and Restylane families) are temporary, requiring repeat injections every few months. Bellafill, the only filler with FDA approval specifically for acne scars, contains tiny microspheres suspended in collagen and typically lasts around 12 months, with results continuing to improve over time as your body builds collagen around the microspheres.
Poly-L-lactic acid (Sculptra) works differently. Rather than plumping the skin immediately, it stimulates your body’s own collagen production over several months. You’ll typically need monthly treatments for three months, after which the results are considered semi-permanent with occasional touch-ups. Autologous fat transfer, where fat from elsewhere in your body is injected into the scars, can produce permanent results once the transplanted fat establishes a blood supply, though outcomes are less predictable and multiple sessions may be needed.
Chemical Peels
Chemical peels remove the outer layers of skin to encourage new, smoother skin growth and boost collagen and elastin production. They work best for shallow, widespread scarring and uneven skin tone rather than deep individual scars. Mild and medium-depth peels typically require three to five sessions spaced two to four weeks apart. Peels are often used alongside other treatments like microneedling or laser to improve overall skin texture between more intensive procedures.
Skin Tone and Pigmentation Risks
Darker skin tones face a higher risk of post-inflammatory hyperpigmentation, where treated areas develop dark spots during healing. This is a significant concern because the whole point of treatment is to improve appearance, not create new discoloration. Studies show that acne-related hyperpigmentation affects roughly 65% of African American patients, 47% to 48% of Hispanic patients, and 25% of Caucasian patients, and aggressive treatments can trigger similar darkening.
Radiofrequency microneedling and standard microneedling are both considered safe across all skin tones because they don’t target skin pigment the way some lasers do. If you have medium to dark skin, these tend to be safer first-line options. Your dermatologist may also recommend lower-intensity settings, longer intervals between sessions, or pre-treatment with pigment-suppressing agents to minimize risk.
Setting Realistic Expectations
Collagen remodeling, the biological process that actually improves scars, is slow. The remodeling phase begins a few weeks after treatment and continues for six to twelve months. During this time, newly formed collagen reorganizes, strengthens, and aligns with surrounding tissue. Changes in scar depth, texture, and firmness become visible gradually. The best time to judge results is around three to six months after treatment, not the day the redness fades.
Most people need multiple treatment sessions, and many benefit from combining different approaches. A typical plan might involve subcision for tethered rolling scars, TCA CROSS for deep ice picks, laser or radiofrequency microneedling for overall texture, and a retinoid to maintain results. This kind of multi-modal approach, tailored to the specific scars on your face, consistently outperforms any single treatment used alone.