Getting rid of acne scars is possible, but the right approach depends entirely on what type of scarring you have. Flat discoloration and deep textural indentations are fundamentally different problems that require different solutions. Most people with moderate to severe scarring see the best results from combining two or three professional treatments rather than relying on a single method.
Discoloration vs. True Scarring
Before investing in treatment, it’s worth figuring out whether you’re dealing with actual scars or post-inflammatory marks. After a breakout heals, many people are left with flat red or brown spots that look like scars but are really just lingering inflammation or pigment deposits. These marks, called post-inflammatory erythema (the red kind) or post-inflammatory hyperpigmentation (the brown kind), fade on their own over months. Topical vitamin C can speed the process by lowering inflammation and supporting collagen production. Niacinamide and hyaluronic acid also help improve skin tone and texture during this healing window.
True acne scars involve a structural change in the skin. When a deep breakout destroys collagen or elastin, the skin can’t rebuild itself evenly, leaving a permanent indentation or raised bump. If you press a finger near the mark and the skin smooths out, you likely have a depressed scar. If the mark stays visible regardless of how you stretch the skin, it may be a flat discoloration that will resolve with time and sun protection alone. This distinction matters because topical products do very little for structural scars.
Types of Depressed Scars
Most acne scars fall into the depressed (atrophic) category, meaning tissue was lost during healing. They break down into three subtypes, and each responds best to different treatments:
- Ice pick scars are deep and narrow, like a small puncture in the skin. They’re the hardest to treat because they extend far below the surface.
- Boxcar scars are broad with sharp, defined edges, almost like a chickenpox mark. They respond well to resurfacing treatments.
- Rolling scars are broad with sloping edges, giving the skin a wavy, uneven texture. These are often caused by fibrous bands pulling the skin down from underneath.
On the other end of the spectrum, hypertrophic scars are thickened, raised bumps where the body overproduced collagen during healing. These are more common on the jawline, chest, and back.
Fractional CO2 Laser Resurfacing
Fractional CO2 laser is one of the most effective single treatments for atrophic acne scars, with studies showing 50 to 80 percent improvement in scar appearance. The laser creates microscopic columns of damage in the skin, leaving surrounding tissue intact so it can heal quickly. This triggers a robust collagen remodeling response that gradually fills in depressed areas.
Most people need one to three sessions spaced four to six weeks apart, though deeper scarring may require more. Recovery involves several days of redness, swelling, and peeling, similar to a bad sunburn. The skin continues remodeling for months after the final session, so full results aren’t visible right away. According to the American Society of Plastic Surgeons, ablative laser resurfacing averages around $2,000 per session out of pocket. Non-ablative lasers, which are gentler with less downtime, average about $1,100 but typically produce more modest improvements.
Microneedling and RF Microneedling
Standard microneedling uses fine needles to create tiny punctures in the upper layers of skin, triggering a healing response that builds new collagen. It works well for mild scarring and overall texture improvement, but it typically takes four to six sessions to see visible results. For deeper scars, it has real limitations because the needles primarily affect the epidermis.
Radiofrequency (RF) microneedling goes further. The needles deliver controlled heat energy into the dermis, the deeper layer where structural collagen lives. This thermal energy causes a stronger healing cascade, producing more collagen remodeling than needles alone. Most patients see significant improvement in three to four sessions, with initial changes appearing within a few weeks and continued progress over two to three months as new collagen forms. RF microneedling is particularly effective for boxcar and rolling scars where the damage sits in those deeper tissue layers.
Treatments for Specific Scar Types
TCA CROSS for Ice Pick Scars
Ice pick scars are notoriously resistant to broad resurfacing treatments because they’re so narrow and deep. The TCA CROSS technique targets them individually. A dermatologist applies a high concentration of trichloroacetic acid (70 to 100 percent) directly into the base of each scar using a fine applicator. This triggers a controlled inflammatory reaction deep within the scar, stimulating new collagen that gradually raises the depressed area. Multiple sessions are usually needed, spaced several weeks apart, with each round bringing the scar closer to the surrounding skin level.
Subcision for Rolling Scars
Rolling scars often look worse than their actual depth because fibrous bands beneath the skin are pulling the surface downward. Subcision directly addresses this. A doctor inserts a needle beneath the scar and uses its sharp edge to sever those tethering strands. Once released, the skin lifts, and the wound-healing response deposits new collagen in the space. This works well for rolling scars and other depressed scars that flatten when you stretch the skin around them. It’s not effective for deep ice pick scars. Subcision is frequently combined with other treatments, like filler or microneedling, for better results.
Dermal Fillers for Depressed Scars
Fillers offer an immediate improvement for depressed scars by physically lifting the indentation from below. Bellafill is the only filler with FDA approval specifically for acne scars, and it generally lasts around 12 months. Hyaluronic acid fillers like Juvederm or Restylane are temporary, requiring repeat injections every few months as the body absorbs the material. Poly-L-lactic acid (sold as Sculptra) is considered semi-permanent because it stimulates your own collagen production over time rather than simply filling space.
Autologous fat transfer, where fat is harvested from another part of your body and injected beneath the scar, can produce permanent results once the transferred fat establishes a blood supply. Fillers work best for broad, shallow scars and are often used alongside resurfacing treatments for a more complete result.
Protecting Results With Sunscreen
Scar tissue is unusually vulnerable to UV damage because it lacks the normal levels of melanin that shield healthy skin. Sun exposure on healing or treated scars can cause persistent darkening or lightening that makes the scarring more visible, even after successful treatment. UV light also breaks down collagen and elastin, directly undermining the new tissue your treatments are building.
Broad-spectrum sunscreen with SPF 30 or higher is essential during any scar treatment process. This protects the collagen and elastin forming in treated areas and reduces the inflammation that leads to long-term changes in scar appearance. If you’re spending money on professional treatments, skipping sunscreen is the fastest way to compromise your results.
Building a Treatment Plan
Most dermatologists approach moderate to severe acne scarring with a combination strategy tailored to the specific scar types on your face. A common approach might pair subcision for tethered rolling scars with RF microneedling or laser resurfacing for overall texture, and TCA CROSS for any scattered ice pick scars. This layered approach addresses different depths and mechanisms of scarring simultaneously.
Realistic expectations matter. Even the most aggressive treatments rarely eliminate scars completely. The goal is typically a 50 to 80 percent improvement, which in practice means scars become shallow enough that they’re no longer visible in normal lighting. Results build gradually over months as collagen remodels, so patience between sessions is part of the process. Most treatment plans span six months to a year from start to final results.