Getting rid of pimple scars depends on what type of scar you have and how deep it goes. Shallow marks and dark spots often fade on their own or with topical treatments, while true structural scars, the ones that leave pits or raised bumps, typically need professional procedures to see real improvement. The good news is that nearly every type of acne scar has at least one effective treatment option.
Before spending money on any treatment, it helps to figure out whether you’re dealing with an actual scar or a temporary mark. That distinction changes everything about your approach.
Dark Spots vs. True Scars
Many people searching for scar treatments are actually looking at post-inflammatory hyperpigmentation: flat dark spots left behind after a breakout heals. These spots involve excess melanin production, not permanent changes to your skin’s structure. If you run your finger over the mark and it feels smooth, level with the surrounding skin, it’s hyperpigmentation, not a scar. These marks typically fade on their own within 2 to 6 months, though sun exposure can stretch that timeline significantly or make them permanent.
True acne scars involve a physical change in your skin’s texture. You can feel them. They’re either indented (pitted) or raised above the surface, and they don’t fade with time the way dark spots do. Scars are permanent unless actively treated. If you have both dark spots and textural scars, treating the pigmentation first with simpler methods makes sense before moving on to more intensive scar procedures.
Types of Acne Scars
Knowing your scar type helps you pick the right treatment, since different procedures work better for different shapes.
- Ice pick scars are the most common type, making up 60 to 70 percent of depressed acne scars. They’re narrow, V-shaped, and extend deep into the skin. Think of the mark a thin, sharp tool would leave.
- Boxcar scars are wider, round or oval depressions with distinct, sharp edges. They look like small craters.
- Rolling scars are wide with sloping edges that give the skin an uneven, wave-like texture. If you stretch the skin and the scar flattens out, it’s likely a rolling scar.
- Keloid or hypertrophic scars are the opposite of the types above. Instead of indentations, these are raised, thickened tissue caused by overproduction of collagen. Keloids can grow larger than the original pimple and are most common along the jawline, chest, and upper back.
Topical Treatments for Mild Scars
For shallow scars and hyperpigmentation, over-the-counter and prescription topicals can make a noticeable difference over several months. They won’t fill deep pits, but they can smooth texture and even out skin tone.
Prescription retinoids are the most studied topical option for scar remodeling. They speed up cell turnover and stimulate collagen production in the skin. In one clinical study of adapalene gel used over 24 weeks, 56 percent of participants saw measurable improvement in their atrophic scars, and 83 percent reported better skin texture overall. Results take time. You’re looking at a minimum of three to six months of consistent use before the improvement becomes obvious.
For dark spots specifically, ingredients like vitamin C, niacinamide, azelaic acid, and alpha hydroxy acids can help fade pigmentation faster than waiting it out. Sunscreen is non-negotiable during this process. UV exposure turns temporary red or brown marks into lasting discoloration by triggering more melanin production in skin that’s still healing. A broad-spectrum SPF 30 or higher, applied daily, protects those healing areas and lets your other products actually work.
Microneedling
Microneedling uses a device covered in tiny needles to create controlled micro-injuries across the scarred skin. Your body responds by producing new collagen to repair those tiny punctures, and that fresh collagen fills in and smooths depressed scars over time. It works well for rolling and boxcar scars, and it’s one of the more affordable professional options.
According to the American Academy of Dermatology, treating acne scars with microneedling typically requires 3 to 5 sessions spaced 2 to 4 weeks apart. Results build gradually between and after sessions as new collagen continues forming. Redness and mild swelling last a few days after each treatment. It’s less aggressive than laser resurfacing, which means less downtime but also more gradual improvement.
Laser Resurfacing
Laser treatments fall into two categories. Ablative lasers are the more aggressive option. They remove the outer layer of skin and heat the deeper layer to stimulate new collagen and elastin production. As the skin heals, the treated area appears smoother and tighter. These lasers can produce dramatic results in a single session, but the trade-off is a longer recovery period of up to two weeks, during which the skin is raw, red, and peeling.
Non-ablative lasers work beneath the skin’s surface without removing the outer layer. Recovery is shorter (usually a few days of redness), but the results are more subtle and often require multiple sessions. For deep scarring, ablative lasers tend to deliver more significant improvement.
Cost is a real consideration. The average out-of-pocket price for ablative laser resurfacing is around $2,000 per session, while non-ablative treatments average about $1,100. Insurance rarely covers acne scar treatment since it’s considered cosmetic. Some clinics offer payment plans, and combining a less expensive treatment like microneedling with targeted laser work on the worst scars can keep costs more manageable.
Chemical Peels and TCA CROSS
Standard chemical peels use acids to remove the top layers of skin, encouraging fresher, smoother skin to grow in. They work well for shallow scarring and pigmentation but don’t reach deep enough for severe pitting.
For deeper scars, particularly ice pick scars, there’s a more targeted technique called TCA CROSS (chemical reconstruction of skin scars). A dermatologist applies a high concentration of trichloroacetic acid, typically 70 to 100 percent, directly into each individual scar using a fine applicator. This triggers intense collagen production deep within the scar, gradually building up the depressed tissue from the bottom. The improvement is proportional to the number of sessions: each round fills the scar a little more. It’s effective for all deep scar types, including ice pick, boxcar, and rolling scars, and it targets only the scarred skin, leaving the surrounding area untouched.
Subcision for Tethered Scars
Some depressed scars, especially rolling scars, are pulled downward by fibrous bands of scar tissue anchoring them to deeper layers of skin. No amount of collagen stimulation on the surface will fix a scar that’s being physically tugged from below.
Subcision addresses this directly. A doctor inserts a needle beneath the scar and uses its sharp edge to cut through those fibrous bands. You can sometimes hear a snapping sound as the strands break. Once the scar is released from underneath, it lifts to a more level position with the surrounding skin. Subcision is often combined with other treatments like microneedling or fillers for a more complete result. Injectable fillers placed beneath a released scar can add volume and prevent the bands from reattaching, though fillers are temporary and typically need to be repeated.
Matching Treatment to Scar Type
The best results usually come from combining approaches rather than relying on a single treatment. Here’s a practical starting point based on scar type:
- Ice pick scars: TCA CROSS is often the first-line approach because the acid can reach the narrow, deep base of these scars. Ablative laser resurfacing can smooth them further.
- Boxcar scars: Laser resurfacing, microneedling, or TCA CROSS, depending on depth. Shallow boxcar scars respond well to microneedling alone.
- Rolling scars: Subcision first to release the tethering, then microneedling or laser to smooth the surface. Fillers can add volume underneath.
- Keloid and hypertrophic scars: These require a different approach entirely, often involving steroid injections to flatten the raised tissue, silicone sheets, or specialized laser treatments. The standard resurfacing options described above are designed for depressed scars and can worsen raised ones.
Most professional treatments require multiple sessions spread over weeks or months, and collagen remodeling continues for up to six months after the final session. Realistic expectations help: significant improvement is the goal, not flawless skin. A combination plan developed with a dermatologist, one that addresses both the type and severity of your scars, consistently outperforms any single treatment used alone.