Acne scars can be significantly improved, but the best approach depends on what type of scar you’re dealing with. Shallow scars may respond to at-home treatments like retinoids and chemical exfoliants over several months. Deeper scars typically need professional procedures, with most patients seeing 60 to 70 percent improvement after a series of in-office treatments.
The key is matching the right treatment to the right scar. A method that works beautifully on one type can be completely ineffective on another.
Identify Your Scar Type First
Acne scars fall into two broad categories: depressed scars that sit below the skin’s surface and raised scars that build up above it. Most people dealing with acne scars have depressed ones, and these come in three distinct shapes.
- Ice pick scars look like small, narrow holes that point down into the skin. They’re most common on the cheeks and are the deepest relative to their size.
- Boxcar scars are wider depressions with sharp, defined edges, almost box-like in shape.
- Rolling scars have sloping edges and varying depths, giving the skin a wavy, uneven texture rather than distinct pits.
Raised scars happen when the body overproduces scar tissue during healing. Hypertrophic scars stay within the boundaries of the original breakout, while keloid scars grow beyond the original spot and can continue expanding. Keloids are more common on the chest, back, and jawline.
Topical Treatments That Actually Work
If your scars are mild, or if you want to start with something accessible before investing in professional procedures, a few over-the-counter and prescription options have real evidence behind them.
Retinoids are the strongest topical option for acne scars. They work by speeding up cell turnover, stimulating new collagen production, and blocking the enzymes that break down collagen and elastin. Over time, this combination thickens the deeper layers of skin and improves texture. A 2017 review found that retinoids also help lighten dark marks left by acne, including in darker skin tones. Prescription-strength retinoids are more potent than over-the-counter retinol, but both work through the same mechanism. Results take months of consistent use to become visible.
Alpha hydroxy acids (AHAs), including lactic acid and glycolic acid, act as gentle chemical exfoliants. They accelerate the rate at which your skin renews its cells and can pull away dead skin to gradually smooth shallow scarring. You’ll find these in serums, toners, and at-home peel pads at concentrations typically between 5 and 10 percent. They won’t reshape deep scars, but they can noticeably improve skin texture and tone over several weeks.
Microneedling for Moderate Scars
Microneedling uses a device covered in tiny needles to create controlled micro-injuries across the skin. Your body responds by producing new collagen to repair those injuries, and that fresh collagen fills in depressed scars from below. It works well for boxcar and rolling scars in particular.
Needle depth matters significantly. Shallow scars respond to depths of 0.5 to 1.0 millimeters, moderate boxcar scars need 1.0 to 1.5 millimeters, and deep or tethered scars require 1.5 to 2.5 millimeters. A split-face study comparing 1.5 millimeter and 2.5 millimeter depths over six sessions found that the deeper treatment produced significantly better results. Professional treatments use these deeper depths, while at-home derma rollers stay at the shallow end and are far less effective for true scarring.
Most patients need four to six sessions, spaced three to six weeks apart to allow the skin time to heal and build new collagen between appointments. Your face will be red and slightly swollen for a day or two after each session.
Laser Resurfacing
Fractional CO2 lasers are one of the most effective tools for acne scars. They vaporize tiny columns of damaged skin while leaving surrounding tissue intact, which triggers a robust healing response and significant collagen remodeling. After an average of four sessions spaced about four weeks apart, patients in clinical studies achieved roughly 65 to 69 percent improvement in scar severity.
There are two main categories. Ablative lasers (like fractional CO2) remove layers of skin and produce more dramatic results but come with more downtime. Your skin will be red, swollen, and peeling for one to two weeks. Non-ablative lasers heat tissue without removing it, meaning less downtime but more gradual improvement. Combining both approaches in the same treatment plan can enhance results further, and pairing laser treatment with platelet-rich plasma (PRP) has been shown to accelerate recovery and boost outcomes compared to laser alone.
Cost is a significant factor. 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 scar treatments since they’re considered cosmetic. Multiple sessions add up quickly.
Chemical Peels and TCA CROSS
Standard chemical peels use acids to remove damaged outer layers of skin, promoting fresh skin growth underneath. For acne scars, medium-depth peels with trichloroacetic acid (TCA) are the most studied option. In one clinical study, six out of ten patients who received TCA peels achieved at least 70 percent improvement in their scarring.
A specialized technique called TCA CROSS is particularly effective for ice pick scars, which are notoriously difficult to treat. Instead of applying acid across the whole face, a dermatologist uses a high concentration of TCA (65 to 100 percent) and applies it precisely into individual scars. This triggers collagen production deep inside the scar itself, gradually filling it from the bottom up. Repeated applications can normalize deep rolling scars, boxcar scars, and even deep ice pick scars at the highest concentrations. Because the acid is applied only to tiny, localized areas, recovery time is shorter than with a full-face peel.
Subcision for Tethered Scars
Some depressed scars, especially rolling scars, are pulled downward by fibrous bands of tissue anchoring them to deeper structures. No amount of resurfacing or collagen stimulation will fully lift these scars if the tethers remain intact.
Subcision addresses this directly. A dermatologist inserts a needle beneath the scar and uses its sharp edge to cut the fibrous strands pulling the skin down. Once released, the scar can rise to the level of surrounding skin, and the wound-healing process deposits new collagen underneath to help maintain the improvement. Three to six visits are enough for most cases of moderate scarring, though results can vary and some scars may need additional treatment.
Subcision is often combined with other methods. Releasing the tether first, then following up with microneedling or laser resurfacing, tends to produce better results than any single approach alone.
Dermal Fillers for Immediate Volume
Injectable fillers can physically lift depressed scars by adding volume beneath them. This is the fastest way to see visible improvement, sometimes in a single appointment. Fillers work best on broader, shallow depressions rather than narrow ice pick scars.
One filler is specifically FDA-approved for moderate to severe atrophic acne scars in patients 21 and older, designed to last up to a year or longer. Other common fillers can also be used off-label, but these are temporary, lasting anywhere from six months to two years depending on the product. Most need repeat injections every few months to maintain results. The upside is minimal downtime. The downside is ongoing cost and the fact that fillers treat the appearance of the scar without changing the scar tissue itself.
Matching Treatments to Scar Types
No single treatment works equally well for every scar. Ice pick scars respond best to TCA CROSS and punch excision techniques because they’re narrow and deep. Laser resurfacing and standard microneedling can’t reach their base effectively. Rolling scars almost always benefit from subcision first, since their tethered structure limits how much other treatments can improve them. Boxcar scars are the most versatile to treat, responding well to laser resurfacing, microneedling, and chemical peels depending on their depth.
Raised scars require a completely different strategy. Keloids and hypertrophic scars are typically treated with corticosteroid injections to flatten excess tissue, silicone sheets to compress the scar, or in some cases laser therapy to reduce redness and thickness. Treatments that stimulate collagen, like microneedling, can actually make raised scars worse.
Most dermatologists recommend a combination approach for people with multiple scar types. A typical plan might start with subcision for tethered scars, followed by a series of laser or microneedling sessions, with TCA CROSS targeted at any remaining ice pick scars. This layered strategy consistently outperforms relying on a single method, and a dermatologist can assess your specific scarring to build a realistic treatment plan.