No single treatment heals all acne scars, because acne leaves behind several distinct types of damage that each respond to different approaches. The good news: most scars can be significantly improved with the right combination of professional treatments and topical care. The key is identifying what kind of scarring you actually have, since a treatment that works well for one type can be ineffective for another.
Flat Marks vs. True Scars
Before investing in scar treatments, it’s worth checking whether what you’re seeing is actually a scar or a temporary mark that will fade on its own. Many people mistake post-inflammatory discoloration for permanent scarring.
If you have red, pink, or purplish flat spots where breakouts used to be, that’s post-inflammatory erythema (PIE), caused by damaged blood vessels under the skin. It’s more visible on fair to medium skin tones. If your marks are brown, gray, or black flat spots, that’s post-inflammatory hyperpigmentation (PIH), caused by excess melanin production. PIH is more common in medium to dark skin tones. Both fade over months to a year or more without treatment, and sunscreen speeds the process considerably.
True acne scars involve a change in skin texture. You can feel them. If your skin has pits, depressions, or raised bumps where acne once was, that’s structural damage to collagen, and it won’t resolve without intervention.
The Four Types of Acne Scars
Atrophic (indented) scars make up the majority of acne scars and come in three forms. Icepick scars are narrow, less than 2 mm wide, and extend deep into the skin like a puncture. Boxcar scars are wider with sharp vertical edges, resembling a chickenpox mark. Rolling scars are the broadest, typically wider than 4 to 5 mm, created by fibrous bands pulling the skin downward and giving it a wavy, uneven appearance.
The fourth type, hypertrophic scars, are the opposite: raised, firm, and pink. They form when the body overproduces collagen during healing but stay within the boundaries of the original breakout. These are more common on the jawline, chest, and back.
Most people have a mix of scar types, which is why dermatologists often recommend combining treatments rather than relying on just one.
Topical Retinoids for Mild Scarring
Prescription retinoids are the most evidence-backed topical option for acne scars. They work by accelerating skin cell turnover and, more importantly, shifting the balance of collagen in the dermis. Retinoids suppress the signals that drive excessive scarring while boosting production of enzymes that break down old, disorganized collagen. Over time, this remodeling process can soften shallow scars and improve overall skin texture.
Retinoids won’t fill in deep icepick or boxcar scars. They’re best suited for mild, shallow scarring and for maintaining results after professional procedures. Expect to use them consistently for several months before seeing noticeable changes. Over-the-counter retinol is a weaker version of the same compound and works on the same principle, just more slowly.
Microneedling
Microneedling uses a device covered in fine needles to create thousands of tiny punctures in the skin, triggering a wound-healing response that produces new collagen. It’s one of the most widely studied treatments for atrophic acne scars, with clinical trials showing average improvements of 31% to 68% in scar severity after a standard course of treatment. When combined with chemical peels, results tend to be higher, with one study finding 63% improvement with the combination versus 31% with needling alone.
A typical course involves three to six sessions spaced about four weeks apart. Recovery after each session is relatively short, usually a few days of redness similar to a sunburn. Microneedling works across all three atrophic scar types but is especially effective for rolling and shallow boxcar scars. It’s also one of the safer options for darker skin tones, since it doesn’t target pigment the way some lasers do.
Fractional Laser Resurfacing
Fractional lasers are among the most powerful tools for acne scars. They work by vaporizing tiny columns of skin tissue while leaving the surrounding skin intact, which allows faster healing than traditional full-surface lasers. The controlled damage forces the skin to rebuild with fresh collagen.
Treatment protocols typically involve around four sessions spaced four weeks apart. Downtime is more significant than microneedling: expect several days to a week of redness, swelling, and peeling after each session. Fractional lasers are effective for all three types of atrophic scars, though very deep icepick scars often need additional approaches. One important consideration is that ablative lasers carry a higher risk of pigmentation changes in darker skin tones, so your dermatologist may recommend a non-ablative laser or a different treatment entirely depending on your complexion.
The TCA CROSS Technique for Icepick Scars
Icepick scars are notoriously difficult to treat because they’re narrow and deep. The CROSS technique (chemical reconstruction of skin scars) was designed specifically for them. A dermatologist applies 100% trichloroacetic acid directly into each individual scar using a sharpened wooden applicator, pressing it into the full depth of the depression. This concentrated acid triggers intense, localized inflammation followed by new collagen formation that fills the scar from the bottom up.
Multiple sessions are needed, and the technique is only used on icepick scars, not on rolling or boxcar types. Each treated scar forms a small crust that heals over about a week. It’s a precise, targeted approach that avoids treating the surrounding healthy skin.
Subcision for Rolling Scars
Rolling scars look wavy because fibrous bands underneath the skin are literally pulling the surface downward, like tiny anchors. Subcision directly addresses this. A needle is inserted under the scar and moved in a fan-like motion to physically sever those fibrous bands, releasing the tethered skin so it can rise back to the level of the surrounding surface.
The procedure is done with a local anesthetic. Bruising afterward is common and can last a week or two. Repeat sessions every three weeks typically produce better results than a single treatment. Subcision is often combined with other treatments like microneedling or fillers for a more complete improvement.
Dermal Fillers for Volume Loss
For deeper rolling and boxcar scars, injectable fillers can physically lift the depressed area back to the level of surrounding skin. The results are immediate, which makes fillers appealing for people who want visible improvement quickly.
How long they last depends on the type. Hyaluronic acid fillers last up to 18 months. Semi-permanent options like poly-L-lactic acid, which stimulates your own collagen production over time, can last up to two years. Longer-lasting synthetic fillers exist with effects beyond three years, but they carry more risk and aren’t reversible. For most people, the temporary or semi-permanent options offer the best balance of results and safety. Fillers work best for broad, shallow depressions rather than narrow icepick scars.
Raised Scars Need a Different Approach
Everything above targets indented scars. Hypertrophic and keloid scars, which are raised above the skin surface, require the opposite strategy: reducing excess collagen rather than building more.
Silicone gel sheets are the most common at-home option for raised scars. They’re placed over the scar for hours at a time and are thought to hydrate and flatten the tissue. However, a Cochrane review of 13 studies found limited and low-quality evidence for their effectiveness, with uncertain results on whether they actually reduce scar severity. They may slightly reduce pain associated with raised scars, but the evidence for cosmetic improvement is weak. Professional treatments for raised scars include steroid injections, which shrink the scar tissue, and certain laser therapies.
Combining Treatments for Best Results
Because most people have more than one scar type, the most effective approach is usually a combination. A common treatment plan might use subcision to release tethered rolling scars, the CROSS technique for icepick scars, and fractional laser or microneedling across the broader area to improve overall texture. Fillers can address any remaining volume loss. Retinoids are used throughout to support collagen remodeling between sessions.
Complete elimination of acne scars is rarely realistic. The goal is significant improvement, and with the right combination of treatments, 50% to 70% improvement in scar appearance is achievable for most people. Results develop gradually over months as collagen remodeling continues long after the last treatment session.