How to Get Rid of Acne Scars: Best Treatments

Combination treatments that pair two or more procedures tend to produce the best results for acne scars, outperforming any single therapy used alone. A recent network meta-analysis found that fractional CO2 laser combined with subcision or platelet-rich plasma (PRP) showed the most consistent benefits for moderate-to-severe atrophic scars.¹ But the right plan for you depends on the type of scars you have, your skin tone, your budget, and how much downtime you can tolerate. Here is a practical walkthrough of what works, what to expect, and how to make sense of the options.

Know Your Scar Type First

Before choosing a treatment, it helps to identify what you are working with. Acne scars fall into two broad camps: atrophic scars, where tissue has been lost, and hypertrophic or keloid scars, where excess collagen has piled up above the skin surface.² Most people dealing with acne scars have atrophic ones, and these come in three main shapes:

Ice pick: Narrow, deep, V-shaped pits that look like the skin was punctured with a sharp instrument. These are the hardest to treat because the damage extends deep into the dermis.
Boxcar: Wider depressions with sharp, well-defined vertical edges. They resemble chickenpox scars and respond to a broader range of treatments.
Rolling: Broad, shallow undulations caused by fibrous bands pulling the skin down from below. These tend to respond well to procedures that release those tethered bands.

Many people have a mix of all three, which is one reason combination treatments exist. A treatment that works well for rolling scars may barely touch ice pick scars, and vice versa. Flat discoloration left behind after acne, whether red (post-inflammatory erythema) or brown (post-inflammatory hyperpigmentation), is technically not scarring in the structural sense, though it is often lumped in as “macular” scarring. Those marks usually fade on their own over months, though certain treatments can speed that process.

Laser Resurfacing

Lasers are among the most studied treatments for atrophic acne scars, and they work by creating controlled damage in the skin to trigger collagen remodeling. The two main categories are ablative lasers, which vaporize thin layers of skin, and non-ablative lasers, which heat the deeper layers without breaking the surface.

Fractional CO2 lasers are the workhorse of scar treatment. A meta-analysis comparing fractional CO2 to fractional Er:YAG (erbium) lasers found that CO2 had a significantly higher effective rate for atrophic acne scars and shorter downtime.³ That said, “shorter downtime” for CO2 is still measured in days to a week or more of redness, peeling, and swelling. These lasers are aggressive and effective, but the recovery is real.

Non-ablative fractional lasers are the gentler cousin. They leave the skin surface intact, which means less redness and faster healing, but you typically need more sessions to see comparable results.⁴ For people who cannot take a week off work or who have darker skin tones that carry a higher risk of pigmentation changes after aggressive procedures, non-ablative lasers are often the safer starting point. The tradeoff between intensity and safety is the central tension in laser scar treatment, and a good dermatologist will navigate it based on your individual risk profile.

Microneedling

Microneedling uses a device studded with fine needles to create thousands of tiny punctures in the skin. Those controlled micro-injuries trigger the body’s wound-healing cascade, leading to increased collagen and elastin production.⁵ It is less aggressive than ablative lasers, which makes it popular for people who want gradual improvement without major downtime.

A comprehensive review covering 58 studies and over 1,800 patients found that microneedling, both standard and radiofrequency-assisted, consistently improved scar appearance from baseline with no serious adverse events. The results held across acne scars, hypertrophic scars, and surgical scars. Radiofrequency microneedling, which delivers heat energy through insulated needle tips, adds a thermal component that can tighten the skin and boost collagen production beyond what needles alone achieve. Most treatment plans involve three to six sessions spaced a month apart, and the results build gradually over the following months as new collagen matures.

Microneedling also has a practical advantage as a delivery system. The thousands of micro-channels it creates allow topical agents to penetrate much deeper than they would on intact skin, which is why many clinicians pair microneedling with PRP or growth-factor serums applied immediately after the procedure.

The CROSS Technique for Ice Pick Scars

Ice pick scars are notoriously resistant to surface-level treatments because they extend so deep. One approach that works particularly well for them is the CROSS technique, which stands for Chemical Reconstruction of Skin Scars. It involves applying a high concentration of trichloroacetic acid (TCA) directly into the base of each individual scar. Rather than peeling the entire face, the acid is dabbed precisely into the pit with a toothpick or fine applicator, causing localized destruction that the body heals by filling in with new collagen from below.

Studies using 100% TCA with the CROSS method have reported striking results. In one trial, more than 70% improvement was seen in eight out of ten patients, with good improvement in the remaining two and no significant side effects.⁶ A separate study in patients with darker skin found excellent improvement in about three-quarters of participants after four sessions, confirming that the technique works across skin tones.⁷ When comparing concentrations, 100% TCA performed significantly better on ice pick scars than on boxcar scars, reinforcing that this method is particularly well suited to those deep, narrow pits.⁸

This is not a DIY treatment. The acid concentrations involved are far beyond what you would find in any at-home peel, and imprecise application could cause permanent damage. But in trained hands, it is one of the most cost-effective approaches to ice pick scars available.

Subcision and Dermal Fillers

Rolling scars have a specific structural problem: fibrous bands beneath the skin are pulling it down, creating those wave-like depressions. Subcision addresses this directly. A needle or small blade is inserted beneath the scar to physically cut through those tethering bands, releasing the skin so it can spring back up. The controlled injury also triggers new connective tissue growth underneath, which fills in the space and prevents the scar from re-adhering.⁹

Subcision is often paired with dermal fillers, particularly hyaluronic acid, which is injected beneath the released scar to add volume and prevent the bands from reforming. Hyaluronic acid fillers provide immediate improvement by adding thickness and hydration to the depressed area, and they also stimulate some collagen production over time.¹⁰ The filler effect is temporary, typically lasting six months to a year, but some of the collagen remodeling it kicks off persists longer.

For broad, tethered rolling scars, subcision is hard to beat as a standalone first step, and it meshes well with almost every other treatment modality. Lasers, microneedling, and chemical peels all work better on scars that are no longer pulled down from below.

Why Combining Treatments Outperforms Single Approaches

A systematic review and network meta-analysis confirmed what most experienced dermatologists already practice: combination therapies generally outperform monotherapies for moderate-to-severe atrophic acne scars.¹ This makes intuitive sense when you consider that different scar types have different underlying problems. Ice pick scars need deep collagen induction. Rolling scars need their fibrous bands severed. Boxcar scars need surface resurfacing. A single modality rarely addresses all of these mechanisms at once.

One case series demonstrated strong results from a triple approach: CROSS technique to stimulate deep collagen, subcision to release tethered scars, and microneedling to remodel the surface.¹¹ Patients reported consistently high satisfaction, and photographic evidence showed visible improvements. In practice, treatment plans are often staged over several months, with different procedures done at separate visits to allow healing between sessions.

Special Considerations for Darker Skin Tones

If you have medium to dark skin, the calculus shifts. Aggressive ablative procedures carry a meaningful risk of post-inflammatory hyperpigmentation (PIH), where the treated skin heals darker than the surrounding area, sometimes creating a new cosmetic problem while solving the old one. Non-ablative fractional lasers are generally considered first-line for acne scars in skin of color because of their better safety profile, even though they are less powerful per session.⁴ Fractional non-ablative lasers have demonstrated efficacy and safety across darker skin phototypes, with a lower risk of pigmentation changes compared to their ablative counterparts.¹²

That said, the evidence base for the darkest skin tones remains thinner than it should be. A review of fractional lasers in skin of color found level 2 evidence for their use in acne scars but noted a shortage of high-quality studies involving the darkest Fitzpatrick skin types.¹³ Chemical peels have also been studied in Asian populations with supportive results for both acne and acne scars.¹⁴ Microneedling is generally well tolerated across all skin tones because it does not target pigment the way lasers do, making it a versatile option regardless of your complexion.

Preventing Pigmentation Problems After Procedures

If you are getting any energy-based treatment for your scars, protecting against PIH afterward is not optional. A systematic review on PIH prevention found that sunscreen, either alone or combined with anti-inflammatory and antioxidant ingredients, was the most effective preventive measure. Among patients who used sunscreen daily after laser resurfacing, virtually all successfully avoided PIH at two-month follow-up.¹⁵ Topical corticosteroids alone prevented PIH in only about 58% of patients, and cooling devices actually increased the risk.

A separate network meta-analysis suggested that topical corticosteroids and intradermal tranexamic acid may offer even greater protection than sunscreen alone, though the studies were small.¹⁶ The takeaway is practical: if your provider does not discuss a post-procedure sun protection plan, bring it up yourself. Diligent daily sunscreen for at least a month after treatment is the simplest and most evidence-backed step you can take.

Adding PRP to Microneedling

Platelet-rich plasma, drawn from your own blood and spun down to concentrate growth factors, is commonly offered as an add-on to microneedling. A split-face study, where one side of each patient’s face received microneedling plus PRP and the other received microneedling alone, found a clear advantage for the combination. On the PRP side, 93% of patients showed scar reduction compared to 73% on the microneedling-only side. Roughly 43% of patients had an excellent response on the PRP side versus 20% on the other.¹⁷ Since both sides of the face received the same microneedling treatment, the difference is attributable to the PRP. It is not a magic bullet, but if you are already getting microneedling, PRP is a reasonable upgrade.

Treating Raised Scars

Hypertrophic scars and keloids require a fundamentally different strategy from the depressed scars discussed above. While atrophic scars need collagen built up, raised scars have too much collagen and need it thinned out. First-line treatments include silicone gel or sheets, which have shown satisfactory results in flattening and softening raised scars over time. Corticosteroid injections, typically triamcinolone acetonide, are another mainstay, reducing scar bulk by suppressing collagen synthesis at the site.

For scars that resist those approaches, intralesional 5-fluorouracil injections have shown effectiveness either alone or combined with corticosteroid injections. Reviews have found that the combination reduces scar elevation and redness better than either agent used alone.¹⁸ Keloids in particular are notoriously stubborn and have high recurrence rates. If you are prone to keloid formation, any scar treatment plan needs to account for that tendency, and aggressive procedures that create new wounds should be approached cautiously.

What About Topical Retinoids

Tretinoin, the prescription retinoid most people know from acne treatment, has properties that could theoretically help with scarring. It activates fibroblasts, induces collagen synthesis, and regulates skin cell turnover.¹⁹ In practice, topical retinoids are more effective at preventing scars during active acne than at remodeling established ones. They can modestly improve skin texture and speed fading of post-inflammatory discoloration, but they will not meaningfully fill in deep ice pick or boxcar scars. Think of tretinoin as a useful background player in a broader treatment plan, not a standalone scar treatment.

Over-the-counter retinol (the weaker, non-prescription form) follows the same logic at a lower intensity. Consistent use improves skin texture and cell turnover, which can make shallow scars less noticeable, but it will not do the heavy lifting for moderate or severe scarring.

Timing Procedures Around Isotretinoin

For decades, the standard advice was to wait at least six months after finishing isotretinoin (Accutane and its generics) before doing any cosmetic procedures. The concern was that isotretinoin thins the skin and impairs healing, which could worsen scarring. That guidance is now being reconsidered. A systematic review published in JAMA Dermatology found insufficient evidence to support delaying superficial chemical peels, fractional ablative and non-ablative laser procedures, microneedling, or cutaneous surgery in patients currently taking or recently finishing isotretinoin.²⁰ The exceptions are fully ablative laser resurfacing and mechanical dermabrasion, which remain not recommended during or immediately after isotretinoin.

An expert task force reached a similar conclusion, stating that procedures like fractional lasers, radiofrequency microneedling, superficial and medium-depth peels, and microdermabrasion are safe during concurrent or recent isotretinoin use.²¹ This matters because many people finishing isotretinoin are eager to start addressing the scars that formed during their acne, and a blanket six-month wait may be unnecessarily conservative for most modern fractional procedures. Discuss the specifics with your dermatologist, but do not assume you need to wait half a year.

Emerging Regenerative Approaches

The next frontier in scar treatment involves using the body’s own fat-derived stem cells and their byproducts. One study combined autologous nanofat injections (processed fat harvested from the patient’s own body via liposuction) with fractional CO2 laser and found significant improvements in scar severity scores. Rolling scars responded best, followed by boxcar and then ice pick scars.²² That study also found a positive correlation between scar duration and severity, meaning older scars tended to be harder to treat. Starting scar treatment sooner rather than later appears to offer an advantage.

Exosomes derived from adipose (fat) stem cells are another area of active research. These tiny vesicles carry growth factors, cytokines, and signaling molecules that can stimulate collagen production and improve skin texture without requiring live cells to be injected.²³ This is genuinely promising, but the research is still early-stage. Clinics already offering exosome treatments are often ahead of the evidence, so approach those offerings with healthy skepticism until larger trials catch up.

The Psychological Weight of Acne Scars

Acne scars affect more than appearance. Research on the psychosocial impact has found elevated rates of anxiety, depression, and social sensitivity among people living with facial scarring. A study of 48 patients with depression and facial acne scars found that cognitive-behavioral psychological interventions performed alongside laser treatment significantly reduced levels of anxiety, depression, and interpersonal sensitivity beyond what the physical treatment alone achieved.²⁴ If your scars are meaningfully affecting your mental health, addressing both the physical and emotional dimensions at the same time is not indulgent — it is the approach the evidence supports. Bringing up the emotional toll with your dermatologist is worthwhile, and seeking therapy alongside treatment is a legitimate part of the plan.