The best thing for acne scars depends on what type of scars you have and how deep they go. No single treatment works for every scar. Shallow, wide scars respond well to laser resurfacing and microneedling, while deep pitted scars often need targeted techniques like chemical reconstruction or subcision. Most people get the best results from combining two or more approaches.
Why Scar Type Matters
Acne scars fall into two broad categories: depressed scars that sit below the skin’s surface, and raised scars that sit above it. The vast majority of acne scars are depressed (atrophic), caused by the skin failing to produce enough collagen while healing from a breakout. Raised (hypertrophic) scars are less common and result from too much collagen during healing.
Depressed scars come in three forms, and recognizing yours helps you choose the right treatment:
- Ice pick scars are narrow, deep puncture marks that extend well into the skin. They’re the hardest to treat with surface-level approaches because the damage runs so deep.
- Boxcar scars are wider with sharp, defined edges and a flat base. They can be shallow or deep and often respond well to resurfacing treatments.
- Rolling scars create a wavy, uneven texture. They’re caused by fibrous bands of tissue underneath the skin pulling the surface downward.
Many people have a mix of all three, which is one reason combination treatments tend to outperform any single approach.
Laser Resurfacing
Fractional CO2 lasers are one of the most effective professional options for moderate to severe acne scarring. These lasers create thousands of tiny columns of controlled damage in the skin, triggering new collagen production as the skin repairs itself. In clinical studies, patients achieved an average improvement of 65 to 69% in scar severity after about four sessions spaced four weeks apart. That’s a meaningful change, though not a complete erasure.
Most people begin seeing visible improvement within three to six months of their first session, with optimal results showing up around six to nine months as collagen continues to remodel beneath the surface. Recovery from each session typically involves redness and peeling for several days.
One important caveat: ablative lasers like CO2 carry a significantly higher risk of causing dark spots or light spots on darker skin tones. If you have medium to deep brown or black skin, ablative lasers are generally not recommended. Nonablative fractional lasers, particularly the 1540-nm erbium laser, offer a safer alternative with lower risk of pigment changes and faster recovery.
Microneedling and RF Microneedling
Microneedling creates hundreds of tiny punctures in the skin at a controlled depth, triggering the same collagen-rebuilding process as lasers but without using light energy. It’s effective for boxcar and rolling scars and works well as a maintenance treatment between more aggressive procedures.
Radiofrequency (RF) microneedling takes this a step further by delivering heat energy through the needles into deeper skin layers. This enhances the collagen remodeling effect and generally produces stronger results than standard microneedling alone. Because RF microneedling uses electrical energy rather than light, it doesn’t target melanin in the skin. That makes it one of the safest professional options for all skin tones, including darker complexions where laser treatments carry more risk.
Both forms of microneedling require multiple sessions. Expect some redness and mild swelling for a few days after each treatment.
Treatments for Deep Ice Pick Scars
Ice pick scars are too narrow and deep for lasers or microneedling to reach effectively. Two techniques work better here.
The TCA CROSS method involves applying a high-concentration acid (70 to 100%) directly into each individual scar using a fine applicator. This causes the scar walls to inflame and produce new collagen from the bottom up, gradually raising the depressed scar closer to the surrounding skin level. Visible improvement typically starts within four to eight weeks, with final results appearing after two to four months. Patients can generally expect a one to two grade improvement in scar depth over six months. It often takes multiple sessions.
Subcision targets rolling scars and some deeper boxcar scars. A needle is inserted beneath the scar to physically break the fibrous bands pulling the skin surface downward. Patients describe a tugging or pressure sensation during the procedure. Recovery takes about seven to ten days on average, and improvement continues for months afterward as new collagen fills the space created beneath the released scar.
Dermal Fillers
For depressed scars that are soft and can be stretched flat, injectable fillers offer near-immediate results. A filler is placed beneath each scar to physically raise it to the level of the surrounding skin. Most patients see improvement right away, with full results visible in one to two weeks.
Bellafill is the only filler specifically FDA-approved for moderate to severe acne scars on the cheeks. In its pivotal clinical study, about 71% of patients were classified as responders at 12 months, meaning more than half of their treated scars improved by at least two points on a standardized scale. Patient satisfaction was high: over 90% reported being satisfied or very satisfied with their results at the one-year mark. Standard hyaluronic acid fillers can also be used off-label for acne scars, though they typically last six months to a year before needing a touch-up.
What You Can Do at Home
Topical retinoids are the strongest at-home option for gradually improving acne scar texture. Prescription retinoids like tretinoin and the newer trifarotene influence how skin cells turn over and stimulate fibroblast activity and collagen remodeling in the deeper layers of skin. This won’t produce the same dramatic results as professional treatments, but consistent use over months can soften shallow scars and improve overall skin texture. Trifarotene has also shown value as a complement to professional procedures like microneedling or laser therapy, enhancing the collagen-rebuilding effects of those treatments.
Over-the-counter retinol works on the same pathway at lower potency. If you’re starting out, a retinol product can help you build tolerance before moving to a prescription-strength option. Sunscreen is also non-negotiable during scar treatment. UV exposure darkens healing scars and can worsen the pigment changes that often accompany acne scarring.
Skin Tone and Treatment Safety
If you have a darker skin tone, treatment selection matters more than it does for lighter-skinned patients. The core risk is post-inflammatory hyperpigmentation, where the treatment itself triggers dark spots that can last months.
The safest professional options for darker skin include microneedling, RF microneedling, and superficial chemical peels using salicylic acid (5 to 30%), glycolic acid (30 to 50%), or Jessner solution. Medium-depth peels require extra caution, and deep peels should be avoided entirely. For lasers, nonablative fractional devices are preferred over ablative ones, and intense pulsed light (IPL) is generally not recommended for the deepest skin tones.
Realistic Expectations and Timelines
Acne scar treatment is a process measured in months, not days. Even the most aggressive laser protocols take six to nine months to show their full effect because collagen remodeling happens slowly beneath the surface. Fillers are the exception, offering same-day improvement, but they address volume loss rather than changing the skin’s structure.
Complete scar removal is rarely realistic. A 50 to 70% improvement is a strong outcome that most people find dramatically changes how their skin looks and feels. The goal is to bring scars close enough to the surrounding skin level that they no longer catch light and shadow in a noticeable way.
The most effective approach for most people is a combination strategy: subcision or TCA CROSS to release or fill deep scars, followed by resurfacing with lasers or microneedling to smooth the overall texture, supported by a topical retinoid at home. A dermatologist can map your specific scar types and build a treatment plan that matches each scar to the technique most likely to improve it.