Getting rid of acne scars is possible, but the right approach depends entirely on what type of scar you’re dealing with and how deep it goes. Shallow scars and mild texture changes can improve significantly with topical treatments and in-office procedures, while deep or tethered scars typically need more aggressive techniques like laser resurfacing, subcision, or a combination of treatments. Most people see meaningful improvement, not total elimination, and results take months because your skin needs time to rebuild collagen from the inside out.
First, Check Whether You Have Scars or Dark Marks
Many people searching for scar treatments are actually dealing with post-inflammatory hyperpigmentation, the flat dark or reddish spots left behind after a breakout. These aren’t scars. A simple way to tell: run your finger over the area. If the skin feels smooth and flat, you’re looking at hyperpigmentation, which fades on its own over months and responds well to brightening ingredients like vitamin C, niacinamide, and sunscreen. If you feel bumps, divots, or textural changes under your fingertip, those are actual scars, and they won’t resolve without treatment.
Types of Acne Scars
Acne scars fall into two broad categories: indented (atrophic) and raised (hypertrophic or keloid). Most facial acne scars are indented, meaning the skin lost tissue during the healing process and now sits below the surrounding surface. Raised scars, where the body overproduced collagen during healing, are more common on the jawline, chest, back, and shoulders. People with darker skin tones are more likely to develop keloid scars.
Among indented scars, there are three distinct shapes, and each responds differently to treatment:
- Ice pick scars are small, narrow, and deep, like a puncture in the skin. Common on the cheeks, they’re the hardest type to treat because of their depth.
- Boxcar scars are wider depressions with sharp, defined edges, most often found on the lower cheeks and jaw where skin is thicker.
- Rolling scars have sloping edges and varying depth, giving the skin a wavy, uneven appearance. These are often caused by fibrous bands pulling the skin down from underneath.
Topical Retinoids for Shallow Scars
Prescription retinoids are the most effective topical option for mild atrophic scarring. They work by stimulating your skin’s fibroblasts, the cells responsible for producing collagen, which gradually fills in shallow depressions and improves overall texture. Tretinoin in particular has been shown to strongly stimulate the production of two key types of collagen and improve the organization of newly formed collagen bundles.
Adapalene at a higher prescription strength (0.3%) improved skin texture by one to two grades in over half of patients tested. Tazarotene and trifarotene, two newer retinoids, have also shown measurable improvements in scar appearance, though trifarotene was only approved in 2019 and has less long-term data. These aren’t overnight fixes. Expect to use a retinoid consistently for several months to a year before judging results, and they work best on shallow, broad scars rather than deep ice pick scars.
Microneedling
Microneedling uses a device covered in tiny needles to create controlled micro-injuries across the skin’s surface. This triggers your body’s wound-healing response, prompting new collagen production that gradually fills in depressed scars. It works well for rolling and boxcar scars and is generally safe across a wider range of skin tones than laser treatments.
Results vary by study, but the numbers are encouraging. In one trial, participants who received three sessions spaced two weeks apart reported a 41% mean improvement in scar appearance. Another study using five monthly sessions found that most patients achieved 50 to 75% improvement. When microneedling is combined with platelet-rich plasma (PRP), results climb higher: one study measured a 62% improvement on the side treated with PRP compared to 46% on the side without. Combining microneedling with subcision (a procedure that releases tethered scars from below) produced 75 to 100% improvement in nearly 18% of patients, with another 24% seeing 50 to 74% improvement.
Most treatment plans involve three to five sessions spaced about four weeks apart. Your skin will look red and feel tight for a few days after each session, but there’s minimal downtime compared to lasers. Collagen production continues for up to six months after your last treatment, so final results take patience.
Laser Resurfacing
Laser treatments resurface the skin by removing damaged outer layers and heating the deeper tissue to stimulate collagen remodeling. For acne scars, fractional CO2 lasers are among the most effective options. “Fractional” means the laser treats a grid of tiny columns in the skin rather than the entire surface, which speeds recovery while still delivering significant results.
Fractional CO2 lasers produce 60 to 80% improvement in skin texture, with crusting and peeling lasting about five to seven days and redness fading over two to four weeks. Fully ablative CO2 lasers (which treat the entire surface) push texture improvement to 70 to 90%, but recovery is longer: 10 to 14 days of visible healing and four to eight weeks of redness. The choice between the two comes down to how much downtime you can tolerate versus how aggressive you want results to be.
Lasers carry higher risks for people with darker skin. More melanin in the skin absorbs more heat from the laser, which can cause blistering, new scarring, or discoloration if the settings aren’t carefully controlled. If you have a medium to dark skin tone, look for a provider experienced in treating darker skin, and ask about non-ablative lasers or microneedling as safer alternatives.
Subcision for Tethered Scars
Rolling scars often look worse than they are because fibrous bands under the skin are pulling the surface downward. Subcision addresses this directly. A needle is inserted beneath the scar and moved back and forth to cut those fibrous strands, releasing the skin so it can sit at its natural level. The procedure also creates a pocket of blood underneath that helps lift the scar and triggers new collagen formation as it heals.
Subcision alone can produce noticeable improvement in rolling scars, but it’s most effective when combined with other treatments. It pairs well with microneedling (which can be done as soon as a day after subcision), fractional laser, chemical peels, and topical retinoids. Many dermatologists treat deep acne scarring with a combination approach, using subcision first to release tethered scars, then layering on microneedling or laser to refine the overall texture.
TCA CROSS for Ice Pick Scars
Ice pick scars are notoriously difficult to treat because they’re so narrow and deep. Standard resurfacing techniques often can’t reach the bottom of the scar without damaging too much surrounding skin. TCA CROSS (chemical reconstruction of skin scars) solves this by applying a high concentration of trichloroacetic acid, typically 70% or higher, directly into each individual scar using a fine-tipped applicator. The acid causes controlled destruction inside the scar, which then heals with new collagen from the bottom up, gradually raising the depressed area closer to the surrounding skin level.
Each application produces a small white “frost” on the scar within about 10 seconds as the proteins in the skin coagulate. Multiple sessions are needed, usually spaced four to six weeks apart. This technique can also normalize deep rolling and boxcar scars when repeated, though it’s primarily valued for ice pick scars where other treatments fall short.
Dermal Fillers
For individual deep scars, injectable fillers offer an immediate visible improvement. Hyaluronic acid fillers are injected beneath the depressed scar to physically lift it to the level of the surrounding skin. Results are visible right away, and in at least one documented case, a hyaluronic acid filler maintained volume and patient satisfaction for 24 months without a repeat injection. That said, fillers are a temporary solution for most people, typically lasting six months to two years depending on the product and location. They work best for a small number of isolated deep scars rather than widespread scarring.
Why Combination Treatment Works Best
Most dermatologists treating moderate to severe acne scars don’t rely on a single technique. Different scar types on the same face often need different approaches. You might need subcision for rolling scars on your cheeks, TCA CROSS for a few deep ice pick scars, and a round of microneedling or laser resurfacing to smooth the overall texture. This layered strategy addresses scarring at multiple depths and through different biological mechanisms, which consistently outperforms any single treatment used alone.
Regardless of the approach, collagen remodeling is a slow process. New collagen continues forming for up to six months after most procedures, which means your skin keeps improving long after the treated area has healed on the surface. Plan for a treatment timeline of six months to a year or more before you see your final results, and protect your skin with daily sunscreen throughout the process. UV exposure can darken healing scars and undermine the results of nearly every treatment on this list.