Clearing acne scars is possible, but the right approach depends entirely on what type of scarring you have. Flat discolored marks left behind after a breakout are not true scars and often fade on their own or with topical treatments. Deeper textural scars, the ones you can feel with your fingertip, require professional procedures that rebuild or resurface the skin. Most people see meaningful improvement with the right combination of treatments, though complete elimination of deeper scars is rare.
Flat Marks vs. True Scars
Before investing in treatments, it’s worth figuring out whether you’re dealing with flat discoloration or actual scarring. They look different, behave differently, and respond to completely different treatments.
Flat red or pink marks are called post-inflammatory erythema (PIE). They result from damaged blood vessels beneath the skin’s surface and are more visible on fair to medium skin tones. If you press a clear glass against the mark and it temporarily disappears, that’s PIE. These marks fade on their own over several months, and topical treatments like vitamin C, niacinamide, and azelaic acid can speed up the process by calming residual inflammation and supporting vascular repair.
Flat brown, gray, or black marks are post-inflammatory hyperpigmentation (PIH). These form when inflammation triggers your skin cells to overproduce pigment. PIH is more common in medium to dark skin tones. Effective topicals for fading these marks include retinoids, hydroquinone, and chemical exfoliants like glycolic acid or salicylic acid. With consistent use and daily sunscreen, most PIH fades significantly within three to six months.
True acne scars are textural. They’re depressions or raised areas in the skin caused by damage to the collagen during the healing process. These don’t fade with time or topical products alone. If your skin has visible pits, craters, or raised bumps where acne once was, you’re dealing with true scars.
Types of Depressed Acne Scars
Most acne scars are depressed (atrophic), meaning the skin sits lower than the surrounding area. They fall into three categories, and knowing which type you have helps determine which treatments will work best.
- Ice pick scars are narrow, deep, and V-shaped, like a tiny hole punched into the skin. They’re the most difficult to treat because the damage extends deep into the dermis.
- Boxcar scars are wider with sharp, defined edges and a flat bottom, resembling small craters. They respond well to resurfacing treatments.
- Rolling scars are broad, shallow depressions with soft, sloping edges that give the skin a wave-like texture. They’re often caused by bands of scar tissue pulling the skin down from underneath.
Many people have a mix of all three types. A dermatologist can map your scars and recommend a combination approach tailored to each type.
Laser Resurfacing
Laser treatments work by creating controlled micro-injuries in the skin, triggering a wound-healing response that produces new collagen and resurfaces the damaged area. There are two main categories.
Ablative fractional lasers (like CO2 lasers) vaporize tiny columns of skin tissue, prompting aggressive remodeling. These deliver the most dramatic results for moderate to severe scarring but come with significant downtime. After a CO2 laser session, the treated skin turns red or darkens and forms a crust that takes one to two weeks to heal. During that time, you’ll need to keep the area clean, moisturized, and protected from sun exposure. Redness can linger for weeks to months after the crust falls off.
Non-ablative fractional lasers heat the deeper layers of skin without removing the surface, which means less downtime but more gradual results. You can typically return to normal activities within a few days. Most treatment plans involve three sessions spaced about a month apart. The tradeoff is clear: faster recovery means slower, subtler improvement.
For people with darker skin tones, ablative lasers carry a higher risk of causing new pigmentation changes. Non-ablative options or lower-energy settings are generally safer choices, but this is something to discuss with a provider experienced in treating skin of color.
Microneedling and Radiofrequency Microneedling
Microneedling uses a device studded with fine needles to create thousands of tiny punctures in the skin. This controlled damage kicks off collagen production over the following weeks and months, gradually filling in depressed scars. Standard microneedling is effective for mild to moderate scarring and works well across all skin tones because it doesn’t use light energy that could trigger pigmentation problems.
Radiofrequency microneedling adds heat energy delivered through the needles, penetrating 2 to 3.5 millimeters into the skin to remodel scar tissue at a deeper level. The combination of mechanical injury and thermal energy produces more collagen remodeling than needling alone, making it a strong option for moderate boxcar and rolling scars. Most people need three to four sessions spaced four to six weeks apart. Downtime is typically two to four days of redness and mild swelling.
Chemical Peels and TCA CROSS
Surface-level chemical peels using glycolic or salicylic acid can improve skin texture and fade discoloration, but they don’t penetrate deeply enough to remodel true acne scars. For that, a more targeted technique called TCA CROSS is one of the most effective options for ice pick scars specifically.
TCA CROSS involves applying a high concentration of trichloroacetic acid (70% or higher) directly into individual scars using a small wooden applicator. The acid causes the proteins in the scar to coagulate, visible as a white “frosting” on the treated spot within about 10 seconds. As the skin heals over the following weeks, new collagen fills in the depression from the bottom up. The procedure is repeated monthly, and most people need four to six sessions to reach maximum improvement. For particularly deep ice pick scars, concentrations up to 100% may be used.
This technique works because it targets each scar individually rather than treating the entire face, minimizing damage to surrounding healthy skin. It’s particularly useful for the narrow, deep scars that don’t respond well to broader resurfacing treatments.
Subcision for Rolling Scars
Rolling scars have a unique underlying cause: fibrous bands of scar tissue beneath the skin’s surface that tether the skin downward. Subcision addresses this directly. A provider 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 to a more even level.
Subcision works best for rolling scars and is not an effective option for deep boxcar or ice pick scars. Deeper, wider rolling scars actually improve more dramatically than shallow ones because there’s more tethered tissue to release. In one study of 45 patients who received subcision combined with microneedling, 95.6% showed visible improvement. About 18% perceived a 75 to 100% improvement in their scars, while another 24% saw 50 to 74% improvement. Side effects were mild: slight redness, swelling, and tenderness lasting one to two days.
Subcision is often combined with other treatments. After releasing the tethered bands, dermal fillers can be injected beneath the scar to prevent re-tethering and add volume. Pairing subcision with microneedling or laser resurfacing in subsequent sessions tends to produce better outcomes than any single treatment alone.
Raised Scars
A smaller percentage of acne scars are raised rather than depressed. Hypertrophic scars appear pink to red, feel slightly elevated, and often itch. They develop within weeks of the original breakout and stay within the boundaries of the original wound. These scars contain an excess of collagen fibers packed densely into the skin.
Hypertrophic scars are typically treated with silicone sheets or gel, which flatten the scar over time by hydrating and compressing the tissue. Corticosteroid injections can also shrink raised scars by breaking down excess collagen. For stubborn cases, laser therapy or cryotherapy may be recommended. Unlike depressed scars, raised scars sometimes improve substantially on their own over one to two years.
Building a Realistic Treatment Plan
No single treatment clears all types of acne scars. The best results come from combining approaches based on your specific scar types. A typical plan might look like subcision for rolling scars, TCA CROSS for ice pick scars, and fractional laser or microneedling for overall texture improvement, all done in a staged sequence over several months.
Results are cumulative. Each treatment session builds on the last, with collagen remodeling continuing for three to six months after each procedure. Most people undergo a series of treatments over six months to a year before reaching their best outcome. Improvement in the range of 50 to 70% is a realistic expectation for moderate scarring. Complete elimination of deep scars is uncommon, but the texture improvement is often enough that scars become far less noticeable in everyday lighting.
Cost varies widely depending on the type and number of procedures. Laser sessions and radiofrequency microneedling tend to be the most expensive, while TCA CROSS and standard microneedling are more affordable per session. Acne scar treatments are considered cosmetic and are rarely covered by insurance. If budget is a concern, microneedling combined with subcision offers strong results at a lower price point than laser-based options.
One final consideration: active acne should be under control before starting scar treatment. New breakouts can create new scars and interfere with healing from procedures. Getting your skin stable first ensures that the investment in scar treatment actually lasts.