Acne scars can’t be fully “cured” in the way a wound heals and disappears, but most can be significantly improved with the right combination of treatments. The key is matching the treatment to the type of scar you have. A deep, narrow ice pick scar responds to completely different approaches than a broad, rolling depression or a raised keloid. Understanding what you’re working with is the first step toward visible results.
Why Scar Type Matters
Acne scars fall into two broad categories: depressed (atrophic) and raised (hypertrophic or keloid). Depressed scars form when the skin loses tissue during healing, while raised scars form when the body produces too much scar tissue. Within the depressed category, there are three distinct shapes, and each one responds differently to treatment.
Ice pick scars are small, narrow, deep holes that point downward into the skin, most common on the cheeks. They’re the hardest type to treat and typically require aggressive, targeted approaches. Boxcar scars are wider depressions with sharp, defined edges, usually found on the lower cheeks and jawline. Rolling scars have sloping edges with no sharp drop-off, giving the skin a wavy, uneven texture. They’re caused by fibrous bands pulling the skin’s surface downward from underneath.
Raised hypertrophic scars stay within the boundaries of the original breakout, while keloids grow beyond them. Both result from excess collagen buildup during healing. Treatments for raised scars are fundamentally different from those for depressed ones, so getting the type right saves you time and money.
Treatments for Deep, Narrow Scars
Ice pick scars sit deep in the skin with a very small opening at the surface, which means broad resurfacing treatments often can’t reach them. The most effective approach is a technique called TCA CROSS, where a high concentration of trichloroacetic acid (70% or higher) is applied directly into each individual scar using a small applicator. This triggers new collagen production deep within the scar, gradually filling it from the bottom up.
In clinical studies, 60% of patients with ice pick scars showed marked improvement after TCA CROSS, and another 30% showed moderate improvement. Patients who received five or six treatment sessions with 100% concentration showed excellent results. Sessions are typically spaced several weeks apart, and each one causes a small white frost on the treated spot that heals over the following days. This is one of the more affordable in-office options, though it requires patience across multiple visits.
Treatments for Rolling and Boxcar Scars
Rolling scars respond well to subcision, a procedure where a needle is inserted beneath the scar to physically cut the fibrous bands tethering the skin downward. The needle moves in a fan-like motion beneath the surface, snapping those bands. As the area heals, new collagen fills the space, lifting the scar closer to the surrounding skin level. Subcision is often combined with other treatments like microneedling or fillers for better results.
Dermal fillers offer another option for rolling and boxcar scars. A hyaluronic acid filler injected beneath the depression physically lifts it to match the surrounding skin. A two-year clinical trial found that filler results in rolling scars were sustained through the full study period with no significant difference between results at four months and results at two years. Fillers typically cost $600 to over $1,000 per session. The only filler with full FDA approval specifically for acne scars in the U.S. is a synthetic option called polymethylmethacrylate, though hyaluronic acid fillers are widely used off-label with strong clinical support.
Laser Resurfacing
Lasers work by removing or heating layers of skin to trigger the body’s wound-healing response, which generates fresh collagen. There are two main categories: ablative lasers, which vaporize the top layer of skin, and non-ablative lasers, which heat tissue beneath the surface without removing it.
Both types produce similar improvements in acne scar severity. In a head-to-head clinical trial comparing ablative CO2 laser with non-ablative diode laser, scar scores improved significantly on both sides, with no statistically significant difference between the two. Collagen production was comparable as well (roughly 39.7% for ablative versus 37.8% for non-ablative). The meaningful difference is in recovery: ablative laser caused redness, swelling, and crusting that took five to seven days to fade, while non-ablative laser caused only mild redness that cleared within 24 hours. Interestingly, 50% of patients preferred the non-ablative side compared to just 16% who preferred the ablative side.
Costs vary widely. Ablative laser resurfacing averages around $2,509 per session, while non-ablative treatments average $1,445. Dermatologists’ fees range from $400 to $2,500 per session depending on the extent of treatment. Most people need multiple sessions spaced weeks apart.
Microneedling
Microneedling uses a device covered in tiny needles to create hundreds of controlled micro-injuries in the skin, stimulating collagen production without destroying the surface. It’s effective across all scar types, though it works best on shallow to moderate scars rather than deep ice picks.
Clinical trials consistently show that three to six sessions are needed for meaningful results, spaced two to six weeks apart. Some protocols use three sessions at monthly intervals, others use six sessions at two-week intervals. The treatment stimulates significant increases in multiple types of collagen and improves the organization of newly formed collagen bundles. Sessions start at around $300 each.
Radiofrequency microneedling adds heat energy delivered through the needle tips, which can boost collagen production further. It works through an electrical mechanism rather than a light-based one, which makes it a strong option for people concerned about pigmentation changes (more on that below).
What Topical Products Can Do
Prescription retinoids (vitamin A derivatives) are the most evidence-backed topical option for acne scars. They work by stimulating collagen production and improving the organization of collagen bundles in scar tissue. Tretinoin has been shown to boost production of multiple collagen types and improve the appearance of depressed scars over time. Adapalene at 0.3% concentration improved skin texture by one to two grades in over half of patients in one study. A newer retinoid, trifarotene, showed significant scar reduction over 24 weeks compared to placebo in a trial of more than 100 patients.
Topical retinoids won’t dramatically reshape a deep scar the way a procedure can, but they can meaningfully improve texture, smooth shallow depressions, and enhance results when used alongside in-office treatments. They’re also far more accessible and affordable than procedures, making them a reasonable starting point for mild scarring.
Safety for Darker Skin Tones
If you have medium to dark skin, treatment selection matters more, not less. Higher melanin levels mean a greater risk of post-inflammatory hyperpigmentation, where the treated area becomes darker than surrounding skin, sometimes for months. This is especially common after chemical peels and laser treatments.
Microneedling and radiofrequency microneedling are the safest procedural options for darker skin. Because microneedling creates controlled injuries without disrupting the entire skin surface (unlike peels or lasers), the risk of pigmentation changes is much lower. Radiofrequency microneedling is particularly well-suited because it uses electrical energy rather than light, so it doesn’t interact with melanin at all.
Superficial chemical peels using salicylic acid (5% to 30%) or glycolic acid (30% to 50%) have strong safety profiles in darker skin. Medium-depth peels require caution, and deep peels should be avoided. Ablative lasers carry significantly increased risk of both darkening and lightening of the skin and are generally not recommended. If laser treatment is pursued, non-ablative options with longer wavelengths are safer choices.
Recovery and Aftercare
Recovery timelines depend heavily on the treatment. After ablative laser resurfacing, expect swelling for one to two days, itching or stinging for up to 72 hours, and skin peeling around days five through seven. Full healing takes 10 to 21 days. Non-ablative procedures and microneedling have much shorter recovery, often just a day or two of redness.
Aftercare makes a real difference in outcomes. After laser resurfacing, clean the treated area after the first 24 hours and then four to five times daily. Apply petroleum jelly after each cleaning to prevent scab formation, since scabs can interfere with healing and worsen scarring. Use only oil-free makeup for at least two to three months, and keep new skin consistently moisturized. Sun protection is critical for all treatments: UV exposure on healing skin can cause permanent discoloration, especially on darker skin tones.
Combining Treatments for Best Results
Most dermatologists treat acne scars with combinations rather than a single approach. A typical plan might start with subcision for tethered rolling scars, follow with microneedling or laser sessions to build collagen across the treated area, use TCA CROSS on any remaining ice pick scars, and add a retinoid for ongoing maintenance. Fillers can provide immediate volume while waiting for collagen-building treatments to take full effect over months.
Total costs for a multi-treatment plan can range from a few hundred dollars for microneedling and retinoids to several thousand for laser and filler combinations. Insurance rarely covers scar treatments since they’re classified as cosmetic. Some clinics offer package pricing for multiple sessions, which can bring the per-session cost down significantly. Results from collagen-building treatments continue to improve for three to six months after the final session, so patience is part of the process.