What acne scars are and why they form
Acne scars are permanent marks left behind after severe acne heals. They form because acne causes inflammation deep in the skin, damaging the collagen and elastin that give skin its structure. When the skin repairs itself, it does not always rebuild that tissue perfectly — sometimes it lays down too little collagen, creating a depression or pit, and sometimes too much, creating a raised bump.
Not all acne leaves scars. Mild acne that stays on the skin's surface usually fades without permanent marks. Scars are most common after cystic acne or nodular acne — the severe types that form deep under the skin. The longer acne goes untreated, and the more you pick at it, the greater the risk of scarring.
Key Takeaways
- Acne scars form when severe acne damages collagen deep in the skin, and the skin cannot rebuild it perfectly during healing.
- Several treatments can reduce the appearance of scars, including laser therapy, chemical peels, microneedling, and dermal fillers, though none erases them completely.
- Preventing new scars by treating acne early and avoiding picking is often easier than treating scars that already exist.
- A dermatologist can assess your specific scars and recommend which treatment or combination of treatments is most likely to help.
- Results vary widely depending on the depth and type of scar, your skin tone, and the treatment used.
Types of acne scars and how they look different
Atrophic scars are depressions or pits in the skin where collagen was lost. These are the most common type. They come in three subtypes: icepick scars (narrow, deep holes that look like a puncture), boxcar scars (wider, flat-bottomed depressions with sharp edges), and rolling scars (wide, shallow depressions with sloped edges that make the skin look wavy).
Hypertrophic scars are raised, thickened areas where too much collagen formed during healing. They are more common on the chest and shoulders than on the face.
Knowing which type you have matters because different treatments work better for different scars. A dermatologist can identify your scar type during an exam and discuss which options are most likely to help.
Laser treatments for acne scars
Laser therapy is one of the most common treatments for acne scars. The laser removes the outer layer of skin or heats the deeper layers to trigger collagen production and remodeling. Different lasers work in different ways, and the choice depends on your scar type and skin tone.
Ablative lasers (such as CO2 and erbium lasers) remove the top layer of skin. They work well for deeper scars but require significant downtime — your skin will be red, swollen, and peeling for one to two weeks. These lasers carry a higher risk of changing skin color, especially in darker skin tones.
Non-ablative lasers heat the skin without removing the surface layer. They require less downtime but are gentler and may need multiple sessions. Fractional lasers divide the beam into tiny columns, treating only part of the skin at a time, which reduces downtime while still being effective.
Most people need two to five sessions spaced four to six weeks apart. Results appear gradually over several months as collagen remodels. Laser treatment works best on rolling and boxcar scars and is less effective on very deep icepick scars.
Microneedling, chemical peels, and other in-office treatments
Microneedling uses a device with tiny needles to create controlled injuries in the skin, triggering the body to produce new collagen. It works for all scar types and all skin tones, with lower risk of color changes than ablative lasers. You may see mild redness and swelling for a few days. Most people need three to six sessions spaced four to six weeks apart.
Chemical peels use acids to remove the outer layer of skin and stimulate collagen production. Superficial peels (using lower-strength acids) have minimal downtime but are gentler. Medium and deep peels are stronger but require more recovery time. Chemical peels work best on shallow scars and may not be suitable for all skin tones.
Dermal fillers are injected under the skin to raise depressed scars from underneath. They work immediately but are temporary — results last three to twelve months depending on the filler type, so you need repeat injections to maintain the effect. Fillers are useful for rolling and boxcar scars but do not address the scar tissue itself.
Subcision is a procedure where a needle is inserted under a scar to break up the fibrous tissue pulling the skin down. It is often combined with other treatments like fillers or microneedling for better results.
Surgical options for severe scars
For very deep or severe scars, surgical approaches may help. Punch excision removes the scarred tissue and closes the wound with stitches, leaving a thinner line. Punch elevation removes the scar but leaves the hole, which is then filled with a graft or allowed to heal naturally. Subcutaneous incision cuts under the scar to release it from underlying tissue.
These procedures are typically done by a dermatologist or plastic surgeon under local anesthesia. They work best on icepick scars and very deep boxcar scars. Recovery takes one to two weeks, and you will have a new scar from the procedure itself — the goal is that it is thinner and less noticeable than the original.
Preventing new scars is often the best approach
Treating acne early stops it from becoming severe enough to scar. If you have acne, seeing a dermatologist for prescription treatment — such as retinoids, antibiotics, or isotretinoin for severe cases — can prevent scarring before it starts.
Avoid picking, squeezing, or scratching acne, as this deepens inflammation and increases scarring risk. If you have a tendency to pick, keeping your hands away from your face and covering blemishes with bandages or makeup can help.
Sun protection also matters. Scars are more noticeable on tanned skin, and sun exposure can darken scar tissue. Using sunscreen daily and avoiding intentional tanning helps keep scars less visible.
What to expect from scar treatment
No treatment completely erases acne scars. The goal is to make them less noticeable by smoothing the skin, raising depressions, or flattening raised areas. How much improvement you see depends on the depth and type of scar, your skin tone, your age, and how your skin heals.
Younger skin typically responds better to treatments because it has more collagen-producing capacity. Darker skin tones may see better results with non-ablative or fractional treatments, as ablative lasers carry higher risk of permanent color changes.
Most treatments require multiple sessions, and results appear gradually over weeks to months. You may need a combination of treatments — for example, laser therapy followed by fillers — to get the best result. A dermatologist can assess your scars and create a realistic plan based on what is likely to work for your specific situation.
Frequently Asked Questions
Can acne scars go away on their own?
Acne scars do not fade on their own. The skin cannot rebuild the collagen that was lost during severe acne. However, they may become slightly less noticeable over time as surrounding skin ages and changes. Treatment is needed to see meaningful improvement.
Which treatment works best for acne scars?
There is no single best treatment — it depends on your scar type, depth, skin tone, and how your skin heals. Laser therapy and microneedling are among the most popular because they work on multiple scar types. A dermatologist can recommend the best option for your specific scars after examining them.
How much does acne scar treatment cost?
Costs vary widely depending on the treatment, the number of sessions needed, and your location. Laser therapy typically ranges from several hundred to several thousand dollars per session. Microneedling, chemical peels, and fillers also vary. Most insurance does not cover scar treatment because it is considered cosmetic, so ask your provider about their fees upfront.
Can you get acne scars from picking at acne?
Yes. Picking and squeezing acne deepens inflammation and increases the risk of scarring. The more you manipulate the acne, the more likely it is to leave a permanent mark. Leaving acne alone or having a dermatologist treat it professionally reduces scarring risk.
Do acne scars get worse with age?
Scars themselves do not worsen, but they may become more noticeable as skin loses collagen and elastin with age. Treating scars earlier, when skin has more collagen-producing capacity, often gives better results than waiting.