Several treatments can significantly reduce acne scars, but the right approach depends on the type of scar you have. Shallow, wave-like scars respond well to resurfacing treatments and microneedling, while deep pitted scars often need targeted procedures like chemical reconstruction or subcision. Raised scars require a different strategy entirely. Here’s what actually works, how long each option takes, and what to realistically expect.
Why Scar Type Matters for Treatment
Acne scars fall into two broad categories: atrophic (indented) and hypertrophic (raised). Atrophic scars are far more common and break down into three subtypes. Rolling scars create a wavy, uneven texture caused by fibrous bands pulling the skin downward. Boxcar scars are wider depressions with defined edges, almost like small craters. Icepick scars are narrow and deep, reaching up to 2mm into the skin, making them the most stubborn to treat.
The distinction matters because a treatment that works beautifully on rolling scars may do nothing for icepick scars. Many people have a mix of types across their face, which is why dermatologists often combine multiple treatments in a single plan rather than relying on one approach.
Microneedling and Radiofrequency
Microneedling works by creating tiny punctures in the skin, triggering your body to produce new collagen as part of the healing response. The controlled damage stimulates skin cells to multiply and migrate, gradually filling in depressed scars from below. When combined with radiofrequency energy, the needles also deliver electrical currents into the deeper layers of the skin, boosting collagen and elastin production without damaging the surface.
Professional microneedling devices penetrate 1.6 to 2.0mm deep and typically require three sessions spaced four weeks apart. Results continue to improve for months after the final treatment as new collagen matures. For acne scars specifically, the combination of radiofrequency microneedling followed by laser resurfacing has shown particularly strong results, because the microneedling breaks up the scar tissue underneath while the laser smooths the surface.
Home dermarollers are a different story. The FDA has not authorized any microneedling medical devices for over-the-counter sale. Products sold for home use generally have shorter, blunter needles designed for exfoliation rather than collagen remodeling. Professional devices reach nerves and blood vessels, which is why the FDA recommends working with a trained provider. Risks from any microneedling include bleeding, bruising, redness, and in less common cases, dark or light spots on the skin or infection.
Laser Resurfacing
Laser treatments resurface the skin by removing damaged outer layers and heating the tissue beneath, which stimulates new collagen growth. Two main types of ablative lasers are used for acne scars. CO2 lasers are the more aggressive option, penetrating deeper into the skin with a recovery period of 7 to 14 days or longer. Erbium lasers are gentler, with most people returning to their routine in 3 to 5 days.
The average cost for a laser resurfacing session is around $1,829, though the price varies widely based on the type of laser, the size of the treatment area, and your geographic location. Additional costs can include facility fees, anesthesia, and prescription medications for recovery. Most people need more than one session, and improvements may require maintenance treatments over time.
Laser resurfacing works well for rolling and boxcar scars but is less effective on deep icepick scars, which often need a more targeted approach first.
TCA CROSS for Deep Icepick Scars
For narrow, deep scars that don’t respond well to surface-level treatments, a technique called TCA CROSS uses a highly concentrated acid (70 to 100%) applied precisely into each individual scar. The acid triggers an intense healing response at the base of the scar, prompting new collagen to build up from the bottom and gradually raise the indentation closer to the surrounding skin level.
This isn’t a one-and-done treatment. Patients can expect a one to two grade improvement in their scars over a six-month period, and multiple sessions are usually needed. But for icepick scars specifically, it’s one of the few treatments that reaches deep enough to make a real difference. It’s often used as a first step before broader resurfacing treatments like lasers or microneedling.
Subcision and Fillers
Rolling scars are caused by fibrous bands pulling the skin downward, creating that bound-down, shadowed appearance. Subcision addresses this directly by releasing those tethered bands beneath the skin, allowing the surface to lift back up. On its own, subcision produces visible improvement in about 53% of patients. But when combined with injectable fillers, that number jumps to 94%.
Hyaluronic acid fillers provide immediate volume beneath depressed scars, and the results are visible right away. The tradeoff is that fillers are temporary, typically lasting several months to a year before the body absorbs them. For people who want quick, noticeable improvement without more invasive procedures, the subcision-plus-filler combination is one of the most effective options available.
Topical Treatments That Build Over Time
Prescription retinoids won’t erase deep scars, but they can meaningfully improve skin texture and shallow scarring over time. A study using 0.05% tretinoin for one year on scarred skin found significant improvements in skin flexibility and texture, as measured by biomechanical testing. Retinoids work by accelerating cell turnover and promoting collagen remodeling in the upper layers of skin.
Retinoids also help reduce the dark marks (post-inflammatory hyperpigmentation) that often accompany acne scars, particularly in people with darker skin tones. Azelaic acid is another topical option that targets both discoloration and mild textural irregularities. These treatments are slow, requiring months of consistent use, but they’re a practical starting point for mild scarring or as a complement to in-office procedures.
Treating Raised Scars
Hypertrophic scars and keloids need a fundamentally different approach than indented scars. Silicone gel sheets are the most accessible first-line treatment. They work by mimicking the skin’s outer barrier, trapping moisture and reducing the overactive collagen production that creates raised tissue. The key is consistency: wearing the sheets at least four hours per day produces the best results, and most protocols continue for several months.
For raised scars that don’t respond to silicone, steroid injections can flatten the tissue by reducing collagen buildup. These are typically done in a dermatologist’s office every few weeks until the scar softens and flattens.
Special Considerations for Darker Skin
People with deeper skin tones (Fitzpatrick types IV through VI) face a higher risk of post-inflammatory hyperpigmentation from scar treatments, meaning a procedure could leave behind dark patches that look as noticeable as the original scars. Ablative lasers pose the greatest risk and are generally best avoided. If laser treatment is needed, low-energy pulsed lasers are safer options.
Topical treatments are recommended as first-line therapy for darker skin tones. Daily broad-spectrum sunscreen with SPF 50+ is essential during any scar treatment to prevent dark spots from worsening, and tinted sunscreens containing iron oxides provide added protection against visible light. Applying treatments only in the evening and avoiding rubbing or massaging the skin helps minimize irritation, which itself can trigger new pigmentation. Anti-pigmentation products used twice daily can help prevent discoloration throughout the treatment process.
Combining Treatments for Best Results
The most effective scar treatment plans layer multiple approaches based on scar type. A common strategy starts with subcision or TCA CROSS to address the deepest scars, follows with a series of microneedling or laser sessions to improve overall texture, and uses topical retinoids between sessions to support ongoing collagen remodeling. Realistic timelines run six months to over a year from start to final results, since collagen remodeling continues long after the last procedure.
No treatment erases acne scars completely, but the right combination can reduce their appearance by enough that they’re no longer the first thing you notice. The starting point is identifying what types of scars you’re dealing with, which determines which treatments are worth the investment of time and money.