Getting rid of acne scars is possible, but the right approach depends entirely on what type of scar you’re dealing with. Some marks that look like scars are actually flat discoloration that fades on its own or with simple topical treatments. True structural scars, the ones you can feel with your fingertip, typically require professional procedures to see meaningful improvement. Here’s how to figure out what you have and what actually works.
Dark Marks vs. True Scars
Before investing in any treatment, it’s worth figuring out whether you have actual scars or post-inflammatory hyperpigmentation (PIH). PIH is your skin’s reaction to inflammation after a breakout. It produces excess melanin that leaves behind flat, discolored spots ranging from pink to red, brown, or purple. These aren’t scars in the structural sense. They don’t change the texture of your skin, and they fade over months to years even without treatment.
PIH responds well to retinoid creams, chemical peels, microdermabrasion, and laser treatments designed to even out skin tone. True acne scars, on the other hand, involve actual damage to the deeper layers of skin. The body either produces too little collagen (leaving an indentation) or too much (creating a raised bump). These require more targeted therapies that physically remodel the skin’s structure. If you press your finger across the mark and feel a dip or a ridge, that’s a true scar.
Types of Acne Scars
Indented (atrophic) scars are the most common type left behind by acne, and they come in three distinct shapes:
- Ice pick scars are small, narrow indentations that point deep into the skin’s surface, like a puncture wound. They’re the hardest to treat because of their depth.
- Boxcar scars are broad, box-like depressions with sharply defined edges, similar to chickenpox scars.
- Rolling scars have varying depth with sloping edges that make skin appear wavy and uneven. They’re caused by bands of scar tissue pulling the surface downward.
Raised scars are less common but more visible. Hypertrophic scars stay within the boundary of the original breakout and are firm to the touch. Keloid scars grow beyond the sides of the original spot, creating a scar larger than the acne that caused it. Keloids are more common on the chest, back, shoulders, and jawline, and they’re more frequent in people with darker skin tones.
Topical Treatments for Mild Scarring
For shallow scars and PIH, consistent use of the right topicals can make a visible difference over several months. Two ingredients have the strongest evidence behind them: retinoids and vitamin C.
Retinoids (available over the counter as retinol or by prescription as tretinoin) work by thickening the deeper layers of skin, stimulating new collagen growth, and reducing the enzymes that break collagen down. Over time, this can soften the edges of shallow scars and improve overall skin texture. Results take 8 to 12 weeks to become noticeable, and your skin will likely peel and feel irritated during the first few weeks of use.
Vitamin C serums stimulate the genes responsible for producing new collagen while protecting existing collagen from breaking down. They also help fade discoloration by interrupting melanin production. Look for a concentration of 10 to 20 percent L-ascorbic acid for the best absorption. Both retinoids and vitamin C make your skin more sensitive to the sun, so daily sunscreen is essential while using them. Sun exposure can darken PIH and slow healing, which undermines the entire process.
Silicone gel sheets are sometimes recommended for raised or hypertrophic scars. These soft, sticky dressings are meant to soften and flatten raised tissue. However, a Cochrane review found low-certainty evidence for their effectiveness. They may slightly improve the appearance of hypertrophic scars compared to some alternatives, but the evidence that they work better than no treatment at all is uncertain.
Professional Procedures for Deeper Scars
Topicals can only do so much. If your scars are deep enough to cast shadows in certain lighting, professional treatments are where the real improvement happens. Most people need a combination of techniques rather than a single procedure.
Laser Resurfacing
Fractional CO2 laser is considered the gold standard for acne scar treatment. It works by creating thousands of microscopic columns of damage in the skin, which forces the body to rebuild with fresh collagen. A meta-analysis of eight randomized controlled trials found that fractional CO2 laser produced superior scar remodeling and higher patient satisfaction scores compared to microneedling.
The tradeoff is downtime. After CO2 laser treatment, skin typically takes one to two weeks to heal. During the first two to three days, you’ll need to ice the treated area regularly. A crust forms over the treated skin and gradually falls away over one to two weeks. During that healing window, you should avoid swimming pools, saunas, hot tubs, shaving over the area, and wearing makeup on the treated skin. Only apply what your provider specifically recommends, as over-the-counter products (even natural ones) can interfere with healing.
Ablative laser resurfacing averages around $2,000 per session. Non-ablative lasers, which are gentler and require less downtime, average around $1,100 per session. Most people need two to five sessions spaced several weeks apart.
Microneedling
Microneedling uses a device covered in tiny needles to create controlled micro-injuries in the skin, triggering the same collagen-remodeling response as lasers but with less intensity. It’s a better fit if you prioritize comfort, shorter downtime, or have a darker skin tone. Lasers carry a higher risk of causing pigmentation changes in darker skin, while microneedling is generally safer across all skin tones. Radiofrequency microneedling adds heat energy to the needle punctures, which can boost collagen production further. Sessions typically cost $200 to $700 each, and three to six sessions are common.
TCA CROSS for Ice Pick Scars
Ice pick scars are too narrow and deep for lasers or microneedling to reach effectively. The TCA CROSS technique addresses this by applying a high concentration of trichloroacetic acid (65 to 100 percent) directly into each individual scar using a small applicator. The acid causes controlled destruction deep in the scar, prompting the body to fill it in with new collagen from the bottom up.
This is not a one-and-done treatment. In one study, 70 percent of patients showed excellent improvement after six sessions. Patients treated with the highest concentration who completed five or six sessions all achieved excellent results. Sessions are typically spaced two to four weeks apart. The procedure itself causes a brief, intense sting at each scar, followed by small white dots that crust and heal over the next week.
Subcision
Rolling scars are often caused by fibrous bands of scar tissue underneath the skin that pull the surface downward. Subcision is a minor procedure where a needle is inserted beneath the scar to physically break these tethering bands, allowing the skin to lift back to its normal level. It’s frequently combined with fillers or microneedling for the best results.
Dermal Fillers
For deep rolling or boxcar scars, injectable fillers can restore volume beneath the indentation. Most hyaluronic acid fillers last 6 to 18 months before the body absorbs them, meaning you’ll need repeat treatments. Some fillers are designed to stimulate your body’s own collagen production over time rather than just adding temporary volume. Fillers work best when combined with subcision, since breaking the scar bands first gives the filler space to lift the skin properly.
Matching Treatment to Scar Type
The most effective approach pairs the right procedure with the right scar. Ice pick scars respond best to TCA CROSS. Rolling scars improve most with subcision followed by microneedling or fillers. Boxcar scars do well with fractional laser resurfacing or punch excision (where the scar is cut out and the skin stitched closed). Raised and keloid scars are typically treated with steroid injections to flatten them, sometimes combined with silicone sheeting or laser therapy.
Most dermatologists recommend a combination approach for people with mixed scar types, which is extremely common. A typical treatment plan might include subcision for tethered scars, TCA CROSS for ice picks, and a series of laser or microneedling sessions for overall texture improvement. Spacing these out over several months gives the skin time to remodel between treatments.
What Realistic Improvement Looks Like
Acne scar treatment is about significant improvement, not perfection. Most professional treatments achieve 50 to 70 percent improvement in scar appearance over a full course of sessions. The skin continues remodeling for three to six months after the final treatment as new collagen matures, so the full result takes time to show.
Younger scars generally respond better than older ones, and lighter skin tones carry less risk of pigmentation side effects from laser treatments. But even decades-old scars can improve substantially with the right combination of procedures. The single most important step is getting evaluated by a dermatologist who regularly treats acne scars, since the wrong procedure for your scar type can waste money or, in rare cases, make scarring worse.