Several treatments can meaningfully improve acne scars, but the right approach depends on the type of scar you’re dealing with. Fractional laser resurfacing, microneedling, chemical reconstruction, subcision, and injectable fillers all have clinical evidence behind them. Some work best for deep narrow scars, others for broad depressions, and still others for raised tissue. Understanding your scar type is the first step toward choosing a treatment that actually delivers results.
Why Scar Type Matters
Acne scars fall into two broad categories: atrophic (indented) and hypertrophic (raised). Most people searching for scar treatments have atrophic scars, which form when the skin loses collagen during the healing process and can’t rebuild itself to its original level. These come in three distinct shapes, and each responds differently to treatment.
Ice pick scars are narrow, deep, and V-shaped, almost like a puncture wound. Boxcar scars are wider with sharp, defined edges, resembling a small crater. Rolling scars create a wave-like unevenness across the skin because fibrous bands tether the surface down to deeper tissue. Many people have a mix of all three.
Hypertrophic scars are pink to red, slightly raised, and stay within the boundaries of the original wound. They’re caused by an overproduction of collagen and are most common on the shoulders, chest, and cheeks. Unlike keloids (which grow beyond the wound’s edges and resist treatment), hypertrophic scars often improve on their own over time and respond better to intervention.
Fractional Laser Resurfacing
Fractional CO2 laser is one of the most studied and effective options for atrophic acne scars. The laser creates thousands of microscopic columns of damage in the skin, leaving surrounding tissue intact so healing is faster. As the skin repairs itself, it produces new collagen that fills in depressed scars from below.
In clinical comparisons, patients treated with fractional CO2 laser saw their scar severity scores improve by roughly 65%, while a hybrid approach combining ablative and non-ablative wavelengths pushed improvement closer to 69%. Most patients need two to six sessions spaced about four weeks apart, with the number depending on scar severity. The treatment works across all atrophic scar types but tends to produce the most dramatic results on boxcar and rolling scars.
The trade-off is downtime. Ablative lasers vaporize the outer skin layers, so you can expect several days of redness, crusting, and swelling. Sun avoidance for at least four to five days after each session is critical, and you’ll need to apply sunscreen religiously during the healing period. Complications can include infection, prolonged redness, and pigmentation changes, which brings up an important consideration for darker skin tones.
Laser Options for Darker Skin
Fractional CO2 lasers carry a higher risk of post-inflammatory hyperpigmentation in darker skin. Picosecond lasers offer a safer alternative. These devices use ultra-short energy pulses (measured in trillionths of a second) that stimulate collagen remodeling through pressure waves rather than heat. Because there’s minimal thermal damage, the risk of pigmentation changes drops significantly. Picosecond lasers are suitable for all skin tones and often require fewer sessions, though they may produce less dramatic improvement per session than CO2 lasers on deep scars.
Microneedling and Radiofrequency Microneedling
Microneedling uses a device covered in fine needles to create controlled micro-injuries in the skin, triggering collagen production as the skin heals. It’s effective for mild to moderate atrophic scars and has a notable advantage over more aggressive treatments: minimal side effects and shorter downtime. Most people experience redness for a day or two rather than the week-long recovery of ablative lasers.
Radiofrequency (RF) microneedling takes this a step further. The needles deliver thermal energy directly into the deeper layers of skin without damaging the surface. This overcomes a limitation of standard microneedling, which can only penetrate so deep, and a limitation of surface-level radiofrequency devices, which struggle to reach the dermis where scar tissue forms. In systematic reviews, microneedling produced results comparable to more aggressive treatments while being preferred for its gentler recovery profile. RF microneedling is particularly effective for rolling and boxcar scars.
Chemical Reconstruction for Ice Pick Scars
Ice pick scars are notoriously difficult to treat with lasers or microneedling because they’re so narrow and deep. The CROSS method (Chemical Reconstruction of Skin Scars) targets them specifically. A dermatologist applies 100% trichloroacetic acid directly into each individual scar using a fine needle or applicator. The acid destroys the scar tissue at the bottom of the pit, and as the wound heals, new collagen fills in the depression from below.
Treatments are typically repeated every two weeks for four sessions. In one reported case, a patient with long-standing ice pick and boxcar scars saw significant improvement after six sessions. Side effects are generally limited to temporary pigmentation changes. This technique works well as a standalone treatment for scattered ice pick scars or as a first step before broader resurfacing with lasers.
Subcision for Rolling Scars
Rolling scars look uneven because fibrous bands beneath the skin pull the surface downward, like tiny anchors. Subcision addresses this directly. A dermatologist inserts a needle or small blade beneath the scar to physically cut those tethering bands. This separates the scar’s surface from the deeper attachments and triggers new connective tissue formation underneath, lifting the depressed area without injuring the skin’s surface.
Subcision is often combined with other treatments for better results. Following up with microneedling, laser resurfacing, or filler injections can maximize improvement because the scar is no longer being pulled down. It’s one of the few treatments that addresses the structural cause of rolling scars rather than just stimulating surface-level collagen.
Injectable Fillers
For individual deep scars, injectable fillers can provide immediate visible improvement by physically raising the depressed area to match the surrounding skin. Two main options exist, and they differ significantly in how long they last.
Hyaluronic acid fillers provide instant results but are temporary. The body gradually absorbs the filler over a few months, so you’ll need repeat injections to maintain the correction. Bellafill, which contains tiny polymethyl methacrylate microspheres suspended in collagen, lasts around 12 months for acne scars and sometimes longer. It’s the only filler with FDA approval specifically for acne scar correction. Fillers work best for broad, shallow depressions and boxcar scars. They’re less effective for ice pick scars, which are too narrow to inject into easily.
Topical Retinoids
Over-the-counter and prescription retinoids won’t produce the dramatic improvement of in-office procedures, but they can meaningfully improve mild scarring over time. Adapalene and tretinoin stimulate collagen production and promote scar remodeling, generating new collagen and elastic tissue in the skin. Higher-concentration formulations like adapalene 0.3% combined with benzoyl peroxide 2.5% have shown measurable reductions in scar counts over 24 weeks in controlled studies.
Retinoids are most valuable in two situations: as an early intervention while acne is still active (preventing scars from becoming permanent) and as a maintenance treatment between or after professional procedures. They won’t fill in deep ice pick scars, but they can smooth out texture irregularities and improve overall skin quality.
Costs and What to Expect
Professional scar treatments in the United States typically range from $200 to $3,400 per session, with prices varying based on the procedure, geographic location, and clinic reputation. Fractional laser sessions tend to fall on the higher end, while microneedling and chemical peels sit lower. Since most treatments require multiple sessions, total costs can add up quickly, and insurance rarely covers cosmetic scar revision.
Recovery varies widely by procedure. Microneedling and non-ablative lasers may leave you red for a day or two. Ablative CO2 laser requires several days of downtime with crusting, swelling, and strict sun avoidance. Chemical peels and the CROSS method fall somewhere in between. Across all treatments, consistent sunscreen use during the healing period is essential to prevent pigmentation problems.
Combining Treatments for Best Results
No single treatment works equally well on every scar type, which is why dermatologists often recommend a multimodal approach. A typical plan might start with subcision to release tethered rolling scars, follow with the CROSS method for ice pick scars, and then use fractional laser or RF microneedling to resurface the broader area. Fillers can address any remaining deep depressions that don’t respond to collagen-stimulating treatments.
Results from any treatment are cumulative. You won’t see the full effect after one session, and collagen remodeling continues for months after your last treatment. Most people see their best results three to six months after completing a treatment series. Setting realistic expectations matters: significant improvement is achievable, but complete elimination of deep scars is rare with any current approach.