Several treatments genuinely improve pimple scars, but no single option works for every type. Indented scars, flat discoloration, and raised scars each respond to different approaches, and the best results often come from combining more than one. The evidence behind the most common treatments ranges from strong to still-emerging, which makes understanding what actually works (and what your specific scars need) worth the time before you spend money on anything.
Why the Type of Scar Matters More Than the Brand of Treatment
Acne scars fall into a few distinct categories, and figuring out which ones you have is the first real step toward treating them. Atrophic scars are the most common type and appear as depressions or dents in the skin.1PubMed Central. Effective treatments of atrophic acne scars Within that group, there are three subtypes: ice pick scars (narrow, deep, V-shaped holes), boxcar scars (wider depressions with sharp edges), and rolling scars (broad, shallow undulations that give skin a wavy texture). Each responds differently to treatment, which is why a dermatologist’s assessment usually matters more than picking a product off a shelf.
Then there are the marks that look like scars but are technically something else. Post-inflammatory hyperpigmentation (dark spots left behind after a pimple heals) and post-inflammatory erythema (flat red or pink marks) are not true scars in the structural sense. The skin surface is smooth, but the color is off. These marks often fade on their own over months, though treatments can speed that process considerably. Raised scars, including hypertrophic scars and keloids, are less common with acne but do occur, especially on the chest, back, and jawline.
Topical Treatments for Dark Spots and Mild Texture
If your “pimple scars” are mostly dark spots rather than actual dents in the skin, topical products can do a lot. Depigmenting agents work by interrupting melanin production through different pathways. Options include hydroquinone, azelaic acid, kojic acid, vitamin C, niacinamide, and retinoids, among others.2PubMed. Postinflammatory hyperpigmentation: etiologic and therapeutic considerations These are available at varying strengths over the counter and by prescription, and they tend to work best when used consistently over weeks to months.
For actual indented scars, topical products alone are rarely enough to make a dramatic difference. That said, tretinoin (a prescription retinoid) does stimulate collagen production in the skin and can modestly improve scar texture over time.3PubMed Central. Retinoic acid and glycolic acid combination in the treatment of acne scars Retinoids are more commonly used as a complement to procedures rather than as a standalone scar treatment. Think of them as maintenance: they help optimize skin turnover and collagen remodeling, but they will not fill in a deep ice pick scar on their own.
Vitamin C serums, niacinamide, and alpha hydroxy acids (like glycolic acid) can also improve the overall look of scarred skin by brightening discoloration and encouraging gentle exfoliation. These are reasonable starting points if you have mild discoloration, but set expectations accordingly. Deep textural scars need procedures.
Chemical Peels
Chemical peels use acids applied to the skin to remove damaged outer layers and stimulate new collagen growth underneath. For acne scars, glycolic acid peels are among the most studied. At lower concentrations, glycolic acid loosens dead skin cells and thins the outermost layer. At higher concentrations, it goes deeper, stimulating collagen production in the dermis. Repeated sessions can thicken the skin and improve the appearance of scars over time.4PubMed Central. Comparative Study of 35% Glycolic Acid, 20% Salicylic–10% Mandelic Acid, and Phytic Acid Combination Peels in the Treatment of Active Acne and Postacne Pigmentation
Standard peels work across a broad area, but ice pick scars often need something more targeted. That is where the CROSS technique comes in. CROSS stands for chemical reconstruction of skin scars, and it involves applying a very high concentration of trichloroacetic acid (TCA) directly into the base of individual scars rather than across the whole face. The acid triggers a controlled wound-healing response that fills in the scar from the bottom up. In a study of ice pick scars treated with 100% TCA using the CROSS technique, more than 70% improvement was seen in eight out of ten patients, with the remaining two showing 50 to 70% improvement.5PubMed Central. An Assessment of the Efficacy and Safety of CROSS Technique with 100% TCA in the Management of Ice Pick Acne Scars A separate study in patients with darker skin tones confirmed similar results: the majority achieved more than 70% improvement after four sessions.6PubMed. Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types
One caveat with CROSS: it works best on ice pick and boxcar scars. A study using 50% TCA found that ice pick and boxcar scars showed statistically significant improvements after three sessions, but rolling scars did not respond meaningfully.7Egyptian Journal of Dermatology and Venerology. Chemical reconstruction of skin scars (CROSS) technique using trichloroacetic acid 50% in different types of atrophic acne scars Rolling scars need treatments that address the tethering underneath the skin surface, not just the depth of the depression.
Microneedling and Radiofrequency Microneedling
Microneedling creates thousands of tiny punctures in the skin using fine needles, triggering a wound-healing cascade that produces new collagen. It works across a range of scar types and has become one of the more popular in-office treatments because it is relatively affordable, works on most skin tones, and has a manageable recovery period. A review of studies found that both standard microneedling and fractional radiofrequency microneedling improved scar appearance from baseline without serious adverse events.8PubMed Central. Microneedling for the Treatment of Scars: An Update for Clinicians
Radiofrequency microneedling adds heat energy delivered through the needles, which intensifies the collagen-remodeling response. In a study of 40 patients, the overall scar severity score dropped by about a third after treatment, with rolling and boxcar scars responding better than ice pick scars.9PubMed Central. Efficacy and safety of microneedling radiofrequency in acne scars More than half the patients rated their improvement as good, and about one in six rated it excellent. Fractional microneedling radiofrequency has also been found more effective for ice pick and boxcar scars compared to standard bipolar radiofrequency devices.10PubMed. Comparison of fractional microneedling radiofrequency and bipolar radiofrequency on acne and acne scar and investigation of mechanism
Multiple sessions are typically needed. Most treatment protocols involve three to five sessions spaced a few weeks apart, and improvement continues for months afterward as collagen remodeling progresses. Home microneedling devices exist, but they use much shorter needles and produce far less collagen stimulation than professional treatments. For meaningful scar improvement, the in-office version with longer needle depths is what the research supports.
Laser Treatments
Lasers are among the most effective tools for acne scars, but the word “laser” covers a wide range of devices that do very different things. The two main categories for textural scars are ablative and non-ablative fractional lasers. Ablative fractional lasers (most commonly CO2 lasers) vaporize tiny columns of skin tissue, prompting aggressive collagen remodeling as the skin heals. Non-ablative fractional lasers (like the 1550 nm erbium-glass laser) heat the deeper skin layers without removing the surface, producing a milder version of the same remodeling effect.
In a split-face trial comparing the two approaches, the ablative CO2 laser produced slightly better clinical improvement scores, but at a cost: crusting and scaling lasted an average of about 7 days compared to just over 2 days for the non-ablative laser, erythema lasted roughly 12 days versus 8, and pain during the procedure was nearly twice as high.11PubMed. Non-ablative 1550-nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation A retrospective analysis of patients with darker skin tones found that about a third achieved more than 50% improvement with either type, and patient satisfaction was comparable between the two groups.12PubMed. Acne scars in ethnic skin treated with both non-ablative fractional 1,550 nm and ablative fractional CO2 lasers
The choice between ablative and non-ablative often comes down to how much downtime you can tolerate and how aggressive you need to be. Deep boxcar and ice pick scars may warrant the stronger ablative approach. Shallower rolling scars and mild texture issues may respond well enough to non-ablative sessions with far less recovery time.
Treating Red and Pink Marks
Post-inflammatory erythema, the persistent red or pink marks left after acne heals, responds to a different set of tools than textural scars. Pulsed dye lasers, which target blood vessels in the skin, are one of the most studied options for this type of discoloration.13PubMed Central. Easy as PIE (Postinflammatory Erythema) A systematic review found that pulsed dye lasers, fractional CO2 lasers, and Nd:YAG lasers were all effective at reducing the erythematous and discolored appearance of flat acne scars.14PubMed. Lasers for the treatment of erythema, dyspigmentation, and decreased elasticity in macular acne scars
Combining a pulsed dye laser with a non-ablative fractional laser appears to be more effective than either alone. In a controlled study, the combination treatment achieved an erythema regression rate of about 89% compared to roughly 67% with the pulsed dye laser alone.15PubMed. Treatment of erythematous acne scars using 595-nm pulsed dye laser combined with 1565-nm ResurFX nonablative fractional laser If you have both red marks and indented scars, a combination laser approach can address both simultaneously.
Subcision and Fillers for Rolling Scars
Rolling scars have a feature that makes them stubborn: fibrous bands of scar tissue underneath the skin’s surface pull the scar downward, creating that undulating appearance. Treatments that work on the skin’s surface alone do not release those bands. Subcision is a minor procedure where a needle or cannula is inserted under the scar to physically cut the tethering fibers. Once released, the skin can lift back to a more normal level.
Subcision works well on its own for mild rolling scars, but combining it with a filler injected underneath keeps the released scar from re-tethering as it heals. A pilot study combining radiofrequency-assisted subcision with a dermal filler found statistically significant improvement across ice pick, rolling, and boxcar scars.16PubMed Central. Radiofrequency-assisted subcision combined with polycaprolactone-based dermal fillers in the management of atrophic facial acne scars Hyaluronic acid fillers are the most commonly used option because they are temporary and reversible, but other filler materials are also used depending on the case.
Combining Treatments Gets the Best Results
Most people with acne scars have a mix of scar types scattered across their face. A deep ice pick scar next to the nose, a few boxcar scars on the cheeks, some rolling scars along the temples, and dark spots everywhere. No single treatment addresses all of these equally well. This is why dermatologists increasingly use multimodal approaches, choosing specific treatments for specific scar types and often performing them in sequence.
One combination that has shown consistently high patient satisfaction pairs CROSS for deep scars with subcision for tethered scars and microneedling over the broader area to smooth everything out. A case series using this triple approach reported strong results in photographic evidence and patient satisfaction across different skin types.17PubMed Central. A Combination Approach to Treating Acne Scars in All Skin Types The logic is straightforward: CROSS fills narrow scars from below, subcision releases tethered scars, and microneedling stimulates collagen over the whole treatment area.
A typical treatment plan might space these procedures weeks apart, often starting with subcision and CROSS for the worst individual scars, then following up with a series of microneedling or laser sessions for overall texture. Expect the full process to take several months. Scar treatment is a long game.
Skin Tone and the Risk of Making Things Worse
Darker skin tones face a specific risk with many scar treatments: post-inflammatory hyperpigmentation. The same inflammation that triggers collagen remodeling can also trigger excess melanin production, leaving you with dark patches that may last months. This risk is highest with ablative lasers and deep chemical peels, and it is a real concern for people with Fitzpatrick skin types III through V.18PubMed Central. A Novel Peel to Prevent Post-Inflammatory Hyperpigmentation After CO(2) Resurfacing for Acne Scars
This does not mean darker-skinned patients cannot get treated. It means the treatment plan needs to account for this risk. Non-ablative lasers carry somewhat lower risk than ablative ones. Microneedling tends to be relatively safe across skin tones. The CROSS technique has demonstrated good results specifically in darker skin.6PubMed. Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types Pre-treatment with depigmenting agents and post-treatment sun protection are standard precautions that reduce the risk. Recent research has also explored targeted chemical peels applied after CO2 laser resurfacing that appear to lower the rate of hyperpigmentation without compromising scar improvement.18PubMed Central. A Novel Peel to Prevent Post-Inflammatory Hyperpigmentation After CO(2) Resurfacing for Acne Scars
Raised Scars Need a Different Playbook
Everything discussed so far addresses atrophic (indented) scars and discoloration. If your scars are raised, firm, and sometimes itchy, they are hypertrophic scars or keloids, and the treatment approach is fundamentally different. Atrophic scar treatments aim to build new collagen; hypertrophic scar treatments aim to break down excess collagen.
Intralesional corticosteroid injections are the most common first-line treatment for raised acne scars. Triamcinolone acetonide, often combined with 5-fluorouracil and a local anesthetic, is injected directly into the scar to reduce its volume and relieve symptoms like itching and pain. Response rates are high, though recurrence can happen in a meaningful percentage of cases.19PubMed Central. The application of corticosteroids for pathological scar prevention and treatment Silicone sheets and gels are another option. These products work by keeping the scar hydrated and occluded, which appears to normalize the activity of the cells driving excess scar formation.20PubMed Central. The Use of Silicone Adhesives for Scar Reduction Silicone products are over the counter, low-risk, and worth trying before committing to injections.
Timing Treatments Around Isotretinoin
If you took or are currently taking isotretinoin (Accutane or its generics), you have probably heard you need to wait six months or more before having any scar procedure. That recommendation has been standard for over two decades, but the evidence supporting it is surprisingly thin. A systematic review found insufficient evidence to justify delaying most common scar procedures, including superficial chemical peels, fractional lasers (both ablative and non-ablative), fractional radiofrequency microneedling, and laser hair removal in patients taking or recently finishing isotretinoin.21JAMA Dermatology. Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations Mechanical dermabrasion and fully ablative (non-fractional) laser resurfacing remain procedures where caution is still recommended.
A task force review reached a similar conclusion, stating that performing fractional lasers, medium-depth peels, microneedling, and radiofrequency devices is safe in patients with concurrent or recent isotretinoin use, and that the blanket six-month waiting period should be reconsidered.22PubMed Central. Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin This matters practically because many people finish isotretinoin with significant scarring and are eager to begin treatment. A conversation with your dermatologist about which procedures are actually safe to start sooner could save months of unnecessary waiting.
Emerging Regenerative Therapies
Platelet-rich plasma, stem cell-derived products, and exosome therapies are generating increasing interest for acne scars, though the evidence is still in early stages. PRP involves drawing your blood, concentrating the platelets and growth factors, and injecting or applying them to the skin after a procedure like microneedling or laser treatment. Exosomes and stem cell-conditioned media work on a similar principle, delivering growth signals that encourage tissue repair. A narrative review of available studies found potential benefits from PRP for acne scars, wound healing, and skin rejuvenation, with exosomes also showing promise for scar reduction.23Dermatological Reviews. Applications of Plasma‐Rich Plasma, Exosomes, and Stem Cells in Aesthetics: A Narrative Review
A systematic review of regenerative approaches found some encouraging numbers. Adipose tissue stem cell exosome treatment produced roughly a third reduction in scar severity scores in one study, and combining fractional CO2 laser with PRP outperformed stem cell-conditioned medium for acne scars.24PubMed. Regenerative Medicine for Atrophic Scars: A Systematic Review of Extracellular Vesicles, Conditioned Media, Stromal Vascular Fraction, and Mesenchymal Stem Cells These are promising directions, but the studies so far are small and the field is moving fast. PRP is the most accessible of these options clinically, while exosome-based treatments are available in some specialty clinics but still lack the large-scale trials that would make them standard recommendations.
The Emotional Weight of Scars
Acne scarring affects roughly 80% of people who have acne between ages 11 and 30 to some degree, though severity varies enormously. What is easy to underestimate is the psychological toll. Research on the psychosocial impact of acne scars has found that the emotional burden does not always scale neatly with the physical severity. Even people with objectively mild scarring can experience substantial quality-of-life impairment from body-image concerns.25PubMed Central. Beyond the Surface: A Deeper Look at the Psychosocial Impacts of Acne Scarring If your scars bother you, that is reason enough to explore treatment regardless of whether someone else would consider them “bad.” And if cost or access is a barrier, starting with the more affordable options like topical retinoids, chemical peels, or silicone products and working up from there is a perfectly reasonable strategy.