No single treatment completely erases acne scars, but several options can reduce their appearance by 50% to 70% depending on the scar type and technique used. The most effective approaches work by triggering your skin to rebuild collagen in the scarred area, essentially replacing damaged tissue with new, smoother skin. What works best for you depends on whether your scars are indented, raised, or primarily discolored.
Why Scar Type Matters
Acne scars fall into two broad categories: indented (atrophic) and raised (hypertrophic). Most acne scars are indented, meaning the skin lost tissue during the healing process and now sits below the surrounding surface. These include ice pick scars (narrow, deep holes), boxcar scars (wider depressions with sharp edges), and rolling scars (broad, shallow dips that give skin a wavy texture). Each responds differently to treatment.
Raised scars are less common and form when the skin overproduces collagen during healing. These firm, pink or reddish bumps contain compact collagen bundles and visible blood vessels that tend to fade as the scar matures. Many people also confuse true scars with post-inflammatory hyperpigmentation, the flat dark or red marks left after a breakout. Those marks aren’t scars at all and fade on their own over months, though certain treatments speed the process.
Laser Resurfacing
Laser treatments are among the most effective options for indented acne scars. They come in two main types: ablative and non-ablative. Ablative lasers (typically CO2 or erbium) vaporize thin layers of scarred skin, forcing the body to replace it with new, collagen-rich tissue. Non-ablative lasers heat the deeper layers without removing surface skin, stimulating collagen production with less downtime.
Ablative fractional CO2 lasers tend to deliver the strongest results. In one study of patients with atrophic acne scars, two to three sessions of fractional CO2 resurfacing produced an average improvement of nearly 67%. Sessions are typically spaced three to four weeks apart. The tradeoff is recovery time: ablative treatments leave skin red, swollen, and peeling for one to two weeks, while non-ablative options may only cause a few days of mild redness. Most people need three to five sessions of either type to see meaningful improvement.
Radiofrequency Microneedling
Radiofrequency (RF) microneedling combines two scar-remodeling techniques in one device. Tiny needles puncture the skin at controlled depths (typically 0.6 to 1 mm for acne scars), while simultaneously delivering heat energy into the deeper layers. This controlled damage triggers a wound-healing cascade that increases production of both collagen and elastin, the two proteins responsible for skin firmness and flexibility.
RF microneedling works especially well for rolling and boxcar scars because the heat reaches the mid-layers of skin where these scars form. Most treatment plans involve three to four sessions spaced four to six weeks apart. Downtime is moderate: expect redness and mild swelling for two to three days. Results develop gradually over several months as new collagen fills in the scarred areas.
Subcision and Fillers
Some indented scars are “tethered,” meaning bands of scar tissue pull the surface skin downward from underneath. No amount of resurfacing will fix this because the problem is structural. Subcision addresses it directly: a provider inserts a small needle beneath the scar to physically cut those fibrous bands, releasing the skin so it can rise back to a normal level.
Subcision alone reduces scar severity by about 44% at six months, but combining it with other treatments produces significantly better results. When paired with a hyaluronic acid filler injected beneath the scar, improvement jumps to around 62%. Combining subcision with fractional CO2 laser performs even better, reaching roughly 69% improvement, with half of patients rated as having excellent outcomes and 65% reporting marked improvement. The filler provides immediate volume under the scar while the laser rebuilds the skin’s surface texture, addressing the problem from both directions.
Chemical Peels and the CROSS Technique
Standard chemical peels use acids to remove damaged outer skin layers, which can improve mild scarring and discoloration. For deeper scars, a specialized method called CROSS (Chemical Reconstruction of Skin Scars) delivers concentrated acid directly into individual scars rather than across the entire face. This targeted application thickens the dermis and stimulates collagen production right where the scar tissue sits.
The CROSS technique typically uses high-concentration trichloroacetic acid applied with a fine applicator to each scar. Sessions are usually spaced about eight weeks apart, with most people needing two to four treatments. It’s particularly useful for ice pick scars, which are too narrow and deep for lasers to reach effectively. The treated spots form small scabs that heal over a week or so, gradually filling in the scar from the bottom up with each session.
Topical Treatments
Over-the-counter and prescription topicals won’t produce the dramatic improvements of in-office procedures, but they can meaningfully reduce mild scarring and are often used alongside professional treatments. Retinoids (tretinoin and adapalene) are the most evidence-backed option. They work by slowing the breakdown of existing collagen while boosting new collagen production, which over time can reduce scar depth. One study found tretinoin delivered via iontophoresis decreased the depth of atrophic scars in 94% of participants.
Combining retinoic acid with glycolic acid appears to enhance results further. In a clinical study of this pairing, 91.4% of patients showed improvement in their acne scars, with over 85% also seeing a noticeable reduction in dark marks left by old breakouts. The glycolic acid accelerates skin cell turnover and helps disperse excess pigment, while the retinoid handles the deeper collagen remodeling. These topicals require consistent use over several months before visible changes appear, and they can cause dryness and irritation as your skin adjusts.
At-Home vs. Professional Microneedling
Derma rollers and at-home microneedling devices are widely marketed for acne scars, but there’s an important distinction in what they can actually do. The FDA draws a clear line between devices with short, blunt needles that only exfoliate the outermost layer of dead skin and professional devices with longer needles that penetrate into living tissue where collagen remodeling happens. The at-home devices in the first category can brighten skin and improve product absorption, but they don’t reach the depth needed to restructure scar tissue.
Professional microneedling devices are motorized, pen-shaped, and reach into skin layers containing nerves, blood vessels, and the collagen matrix. The FDA recommends these only be used by trained providers because of the risk of infection, scarring, or nerve damage when needles penetrate deeper skin. If you’re considering microneedling specifically for acne scars rather than general skin texture, the at-home versions are unlikely to deliver the results you’re looking for.
Matching Treatment to Scar Type
The most effective approach often combines multiple treatments rather than relying on one. A general framework based on scar type:
- Ice pick scars: CROSS technique, sometimes followed by laser resurfacing once the scar has partially filled in.
- Boxcar scars: Fractional laser resurfacing, RF microneedling, or chemical peels depending on depth.
- Rolling scars: Subcision first (to release tethered bands), then laser or RF microneedling to smooth the surface.
- Raised scars: Corticosteroid injections to flatten excess collagen, sometimes combined with laser treatment as the scar matures.
- Dark or red marks (not true scars): Retinoids, glycolic acid, azelaic acid, or gentle chemical peels. These typically resolve within 3 to 12 months even without treatment.
Most people with moderate to severe acne scarring end up doing a series of treatments over six months to a year. Results are cumulative, with each session building on the collagen remodeling triggered by the last. Improvement continues for several months after your final session as the skin keeps producing new collagen in response to the earlier treatments.