What acne scars are and why they form

Acne scars are permanent indentations or raised marks left behind after severe acne heals. They form because acne inflammation damages the collagen in your skin — the protein that gives skin its structure and firmness. When the skin heals, it does not always rebuild that collagen evenly, leaving behind a depression (called atrophic scars) or sometimes a raised bump (called hypertrophic scars).

Not everyone who has acne develops scars. Scarring is more common after severe cystic acne, after picking at pimples, or when acne goes untreated for a long time. The deeper and more inflamed the acne was, the more likely scarring will occur. Some people are also genetically more prone to scarring than others.

The good news is that acne scars can be reduced or improved with treatment, though they cannot always be erased completely. The type of scar you have, how deep it is, and your skin type all affect which treatments will work best for you.

Key Takeaways

  • Acne scars form when inflammation damages collagen, and they come in two main types: indented scars (atrophic) and raised scars (hypertrophic).
  • Dermatologists can assess your scars and recommend treatments ranging from topical creams to laser therapy, chemical peels, or injectable fillers.
  • Laser treatments and microneedling are among the most effective options for indented scars, while raised scars often respond better to steroid injections or laser resurfacing.
  • Results take time — most treatments require multiple sessions over weeks or months, and improvement continues for several months after treatment ends.
  • Preventing new scars by treating active acne early and avoiding picking at pimples is often easier than treating scars after they form.

Types of acne scars and how doctors identify them

A dermatologist will examine your scars in person to determine which type you have, because the treatment depends on the scar's shape and depth. Atrophic scars are indentations or pits in the skin. They come in three subtypes: icepick scars (narrow, deep holes), boxcar scars (wider, angular depressions), and rolling scars (broad, wavy depressions). These are the most common type of acne scar.

Hypertrophic scars are raised, thickened areas of skin that stick up above the surrounding skin. They are less common than atrophic scars and occur more often on the chest, shoulders, and back. Keloid scars are a more severe form of raised scarring that extends beyond the original acne wound; they are most common in people with darker skin tones.

During your appointment, your dermatologist may take photographs to track changes over time and may ask about your skin type, any previous treatments you have tried, and whether you have a history of keloids. This information helps them recommend the treatments most likely to work for you.

Topical treatments for mild scarring

If your scars are shallow or mild, your dermatologist may start with topical treatments — creams or serums you apply at home. Retinoids (vitamin A derivatives) can improve skin texture and boost collagen production over time. Prescription retinoids like tretinoin are stronger than over-the-counter versions and require a prescription from your doctor.

Silicone-based products and scar creams are widely available without a prescription, though evidence for their effectiveness on acne scars specifically is mixed. They may help with hydration and appearance but are unlikely to significantly reduce deeper scars on their own. Vitamin C serums and niacinamide products may also support skin health, though they work best as part of a broader treatment plan rather than as standalone solutions.

Topical treatments work slowly — you typically need to use them consistently for three to six months before seeing noticeable improvement. They are most effective for very shallow scars and work best when combined with professional treatments for deeper scarring.

Laser and light-based treatments

Laser therapy is one of the most effective treatments for indented acne scars. Different lasers work in different ways. Ablative lasers (such as CO2 and erbium lasers) remove the top layer of skin to stimulate collagen remodeling beneath. Non-ablative lasers (such as fractional lasers) heat the deeper skin layers without removing the surface, causing less downtime but often requiring more sessions.

Fractional laser resurfacing is popular because it treats only a fraction of the skin at a time, leaving surrounding skin intact to heal faster. Most people need three to five sessions spaced four to six weeks apart. Results continue to improve for three to six months after your final treatment as new collagen forms.

Laser treatment does carry risks, including temporary redness, swelling, and changes in skin pigmentation, especially in darker skin tones. Your dermatologist will discuss these risks with you and may recommend a test spot first. Recovery time varies — ablative lasers require a week or more of downtime, while non-ablative treatments may allow you to return to normal activities within a day or two.

Microneedling and chemical peels

Microneedling uses tiny needles to create controlled micro-injuries in the skin, triggering your body's natural healing response and collagen production. The procedure is less aggressive than laser treatment and works well for indented scars. Most people need four to six sessions spaced four to six weeks apart, with results visible after three to six months.

Microneedling causes minimal downtime — your skin may be red and slightly swollen for a day or two, but you can usually return to normal activities immediately. It is generally safe for all skin types, including darker skin, which makes it a good option if you are concerned about pigmentation changes.

Chemical peels use acids to remove the outer layer of skin and stimulate collagen remodeling. Superficial peels (using mild acids like glycolic acid) require minimal downtime but are best for very shallow scars. Medium and deep peels are more aggressive and carry higher risks, including permanent pigmentation changes, so they are used less often for acne scars. Chemical peels work best when combined with other treatments rather than used alone.

Injectable fillers and steroid injections

For indented scars, injectable fillers can temporarily plump the skin and make scars less noticeable. Common fillers include hyaluronic acid (Restylane, Juvéderm) and calcium hydroxylapatite (Radiesse). Results are immediate but temporary — most fillers last three to twelve months depending on the type, so you need repeat injections to maintain results.

Fillers work best for rolling scars and boxcar scars. They do not address the underlying scar tissue, so they are often combined with other treatments like laser therapy or microneedling for longer-lasting improvement. Cost varies widely depending on how much filler you need and your location.

For raised scars and keloids, steroid injections (intralesional corticosteroids) can flatten and soften the tissue. These are injected directly into the scar and may need to be repeated every four to six weeks. Steroid injections work best on hypertrophic scars and keloids and are often combined with other treatments like laser therapy for better results.

Surgical options for severe scarring

For very deep or severe scars that do not respond to other treatments, your dermatologist may recommend surgical procedures. Subcision involves inserting a needle under the scar to break up the fibrous tissue pulling the skin down, allowing it to rise back to the surface. It is often combined with filler or other treatments for best results.

Punch excision removes the scar tissue entirely and closes the wound with stitches, leaving a thinner line that blends better with surrounding skin. This works well for icepick scars. Punch grafting removes the scar and fills the hole with skin from another area, useful for very deep scars.

These surgical procedures require local anesthesia and leave small scars themselves, though they are usually less noticeable than the original acne scars. Recovery takes one to two weeks, and results continue to improve as the new scar matures over several months.

What to expect during treatment and recovery

Most acne scar treatments require multiple sessions spaced weeks apart because skin needs time to heal and produce new collagen between visits. A single treatment rarely produces dramatic results — improvement is usually gradual and builds over time. Your dermatologist will discuss a treatment plan with you before starting, including how many sessions you will likely need and what results are realistic for your specific scars.

Recovery varies by treatment type. Topical treatments have no downtime. Microneedling and non-ablative lasers may cause redness for a few hours to a day. Ablative lasers and chemical peels require several days to a week of healing, during which your skin may be red, swollen, or peeling. During recovery, you will need to protect your skin from sun exposure and follow your dermatologist's aftercare instructions carefully.

Cost varies widely depending on the treatment, your location, and how many sessions you need. Insurance typically does not cover acne scar treatment because it is considered cosmetic, though some procedures may be covered if scarring affects function or causes significant distress. Ask your dermatologist's office about pricing before you start treatment.

Preventing new acne scars

The best approach to acne scars is preventing them in the first place. Treating active acne early and aggressively — before it becomes severe and inflamed — reduces the risk of scarring. If you are prone to cystic acne, talk to your dermatologist about prescription treatments like isotretinoin (Accutane), which can clear severe acne and prevent scarring.

Avoid picking, squeezing, or popping pimples, as this increases inflammation and damage to the skin. If you have acne on your back, chest, or shoulders, be especially careful because these areas are more prone to severe scarring. Use gentle skincare products, avoid irritating your skin, and use sunscreen daily — sun exposure can make scars more noticeable.

If you do develop acne scars, starting treatment sooner rather than later can be helpful. Newer scars (less than a year old) sometimes respond better to treatment than very old scars, though this varies depending on the scar type and your skin.

Frequently Asked Questions

Can acne scars go away on their own?

Acne scars do not disappear without treatment, though they may fade slightly over many years as collagen remodels naturally. Most people find that professional treatment is necessary to see meaningful improvement. Starting treatment within the first year or two after scars form may offer better results than waiting longer.

Which treatment works best for icepick scars?

Icepick scars are narrow and deep, making them challenging to treat. Punch excision (surgical removal) often works best, sometimes combined with laser resurfacing or microneedling. Your dermatologist may recommend a combination approach rather than a single treatment.

Is microneedling safe for darker skin?

Yes, microneedling is generally safer for darker skin tones than ablative lasers because it carries a lower risk of pigmentation changes. Non-ablative fractional lasers are also an option, though some people with darker skin may still experience temporary pigmentation changes. Discuss your skin type with your dermatologist before choosing a treatment.

How long do results from acne scar treatment last?

Results from laser therapy, microneedling, and chemical peels are permanent because they stimulate your body's own collagen production. Injectable fillers are temporary and last three to twelve months. Steroid injections for raised scars may need to be repeated every few months to maintain results.

Can I combine different acne scar treatments?

Yes, combining treatments often produces better results than using one treatment alone. For example, microneedling followed by laser therapy, or steroid injections combined with laser resurfacing for raised scars. Your dermatologist will recommend a combination plan based on your scar type and skin.