Most acne scars can be significantly improved, but completely erasing them is rarely realistic. The goal with any treatment is to smooth the skin’s texture and make scars less visible, and modern options can achieve 50 to 75 percent improvement or more depending on the scar type and approach. The key is matching the right treatment to the right scar, because a technique that works well on one type can be nearly useless on another.
Why Scar Type Matters
Acne scars fall into two broad camps: indented (atrophic) scars, where tissue was lost during healing, and raised (hypertrophic or keloid) scars, where the body overproduced collagen. Most people dealing with acne scars have the indented kind, and these come in three distinct shapes that respond differently to treatment.
Ice pick scars are narrow, deep holes that are wide at the surface and taper to a point beneath it. They typically appear on the forehead and upper cheeks, where skin is thinner. These are considered the most challenging type to treat because of how deep they extend.
Rolling scars create a wavy, uneven texture on the skin’s surface. They tend to show up on the lower cheeks and jaw, where skin is thicker. Fibrous bands of tissue underneath tether the scar downward, which is why they look like gentle depressions rather than sharp holes.
Boxcar scars are wider indentations with steep, well-defined edges. They also appear on the lower cheeks and jaw and can range from shallow to quite deep. Think of them as broader craters compared to the narrow channels of ice pick scars.
Most people have a mix of all three types, which is one reason dermatologists often recommend combining treatments rather than relying on a single approach.
Topical Treatments for Mild Scarring
If your scars are shallow and your skin texture is only slightly uneven, prescription retinoids can make a noticeable difference over time. In a clinical study using a stronger-concentration adapalene gel applied daily for 24 weeks, about 56 percent of participants showed measurable improvement in scar depth. More telling, nearly 89 percent of participants reported that their scars looked better by the end of treatment, with most describing the change as “somewhat improved” and about 11 percent calling it “much improved.”
Retinoids work by accelerating skin cell turnover and stimulating collagen production in the upper layers of skin. They won’t fill in deep ice pick scars, but for shallow texture issues and mild boxcar scars, six months of consistent use can genuinely smooth things out. The tradeoff is patience: you won’t see meaningful results for at least three to four months.
Microneedling and Collagen Stimulation
Microneedling uses a device covered in fine needles to create controlled micro-injuries in the skin, triggering the body’s wound-healing response and ramping up collagen production. For acne scars, the needles need to reach the deeper structural layer of the skin (the reticular dermis) to generate enough new collagen to remodel the scar tissue.
Depth matters significantly. A split-face study compared 1.5mm needle depth on one side of participants’ faces with 2.5mm on the other, over six sessions spaced two weeks apart. The deeper treatment produced significantly better results. For boxcar scars, practitioners typically aim for 1.5 to 2.0mm depth, while rolling scars often require 1.5 to 2.5mm to break apart the fibrous bands pulling the skin downward.
Results from microneedling are described as subtle and cumulative, building over multiple sessions. Radiofrequency microneedling, which adds heat energy to the needling process, runs about $500 to $1,500 per session. Most treatment plans call for three to six sessions.
Laser Resurfacing
Fractional lasers work by drilling thousands of microscopic columns into the skin, leaving surrounding tissue intact so it can heal faster. This triggers aggressive collagen remodeling in the scarred areas while keeping recovery manageable. For mild to moderate fractional treatments, expect two to four sessions with about two to four days of downtime per session.
Costs vary widely depending on the technology. Fraxel dual laser treatments run $800 to $1,500 per session, while hybrid fractional lasers like Halo range from $1,200 to $2,500 per session. More aggressive ablative lasers remove the top layer of skin entirely and can produce more dramatic results, but with longer recovery times and higher risk of pigment changes, especially in darker skin tones.
TCA CROSS for Ice Pick Scars
Ice pick scars are notoriously resistant to broad resurfacing techniques because they’re so narrow and deep. A targeted approach called TCA CROSS uses a high-concentration chemical acid (70 to 100 percent) applied with a fine instrument like a toothpick directly to the base of each individual scar. The acid causes a controlled injury at the bottom of the scar, prompting the body to fill it in with new collagen from the inside out.
The application takes only about 10 seconds per scar. The treated spots frost white, then scab over and heal. Multiple sessions are typically needed, spaced several weeks apart. This technique is one of the few options that can meaningfully reduce ice pick scar depth, and it’s often combined with broader treatments like laser or microneedling to address surrounding texture issues.
Subcision for Rolling Scars
Rolling scars are caused by fibrous tissue bands pulling the skin’s surface downward from underneath. Subcision involves inserting a needle beneath the scar to physically cut those bands, releasing the skin so it can rise back to a normal level. In a study of 45 patients, 95.6 percent saw at least one grade of improvement. About 18 percent of patients perceived 75 to 100 percent improvement in their scars, while another 24 percent perceived 50 to 74 percent improvement. The majority saw 25 to 49 percent improvement.
Downtime is minimal, with mild redness and swelling lasting one to two days. Rolling and boxcar scars respond best to this technique, while ice pick scars show less benefit. Subcision is frequently paired with other treatments: releasing the tethered bands first, then using microneedling or fillers to further smooth the surface.
Dermal Fillers
For deeper indented scars, injectable fillers can physically plump the depressed area back to the level of surrounding skin. The FDA recognizes fillers for correcting contour deficiencies including acne scars, and some permanent (non-absorbable) fillers are approved specifically for cheek acne scars. Most commonly used fillers are temporary, meaning the body gradually breaks them down over months to a couple of years, and you’ll need repeat injections to maintain the effect.
Fillers work best on isolated, well-defined scars rather than widespread texture issues. They provide the most immediately visible results of any treatment option, but they don’t change the scar tissue itself.
Raised Scars Need a Different Approach
Hypertrophic and keloid scars, where the body deposited too much collagen during healing, require the opposite strategy. Instead of stimulating new tissue, treatment focuses on reducing inflammation and breaking down excess scar tissue. Corticosteroid injections directly into the scar are a standard first-line treatment, flattening raised tissue over a series of sessions. Silicone sheets or gel applied consistently over weeks can also soften and flatten these scars by hydrating the tissue and reducing collagen overproduction.
What Realistic Improvement Looks Like
No single treatment eliminates acne scars entirely. The Mayo Clinic describes the goal across all approaches as making scars “less noticeable” rather than invisible, and notes that surface-level scars may be completely removed by aggressive resurfacing while deeper scars will still be visible, just softened. The best outcomes typically come from combining multiple techniques: subcision to release tethered scars, followed by microneedling or laser to rebuild collagen, with targeted TCA CROSS for any remaining ice pick scars.
Skin tone also shapes which treatments are safe to use. Darker skin is more prone to post-inflammatory hyperpigmentation from lasers and deep peels, so practitioners often favor microneedling or subcision, which carry less risk of discoloring the skin. Most professional treatments require a series of sessions over several months, and collagen remodeling continues for up to six months after the final session, so full results take time to appear.
Plan to spend $1,500 to $6,000 or more for a full course of professional scar treatment, depending on the combination of procedures. Insurance rarely covers acne scar treatments since they’re considered cosmetic. Many clinics offer financing or package pricing for multi-session plans.