What acne scars are and why they form

Acne scars are permanent indentations or raised marks left behind after severe acne heals. They form when acne causes deep inflammation in the skin. As the skin repairs itself, it doesn't always rebuild the tissue evenly — sometimes it creates a depression (like a pitted or boxcar scar), and sometimes it creates extra tissue (like a raised or hypertrophic scar).

Not all acne leaves scars. Mild acne that stays near the skin's surface typically fades without permanent marks. Scarring happens most often with cystic or nodular acne — the deeper, more severe forms that penetrate into the dermis, the skin layer beneath the surface. The longer acne goes untreated, and the more you pick or squeeze lesions, the higher the risk of scarring.

The good news is that acne scars can be reduced or improved with treatment, even years after the acne itself has cleared. The type of scar you have determines which treatments work best.

Key Takeaways

  • Acne scars form when deep inflammation damages skin tissue, and they come in two main types: indented (atrophic) scars and raised (hypertrophic) scars.
  • Dermatologists use several approaches to treat scars, including laser therapy, chemical peels, microneedling, and injectable fillers, depending on scar depth and type.
  • Treatment results improve when you start with mild scars and treat them sooner rather than later, as older scars are harder to improve.
  • Most scar treatments require multiple sessions spaced weeks or months apart, and results build gradually over time.
  • Some treatments work better for specific scar types — laser works well for discoloration, while fillers work best for shallow indented scars.

Types of acne scars and how doctors tell them apart

Dermatologists divide acne scars into two main categories based on how they look and how deep they go. Atrophic scars are indentations or pits in the skin — they look like the skin has been punched or pressed inward. Hypertrophic scars are raised, thickened areas where extra tissue formed during healing. A few people develop keloid scars, which are hypertrophic scars that grow beyond the original acne area.

Within atrophic scars, there are three subtypes. Boxcar scars have sharp, defined edges and look like small rectangular pits. Rolling scars have sloped, rounded edges and give the skin a wavy appearance. Ice pick scars are very narrow and deep, like a puncture wound. Knowing which type you have matters because some treatments work better for certain scars.

Your dermatologist will examine your scars in person and may ask about your skin type, how long you've had the scars, and what treatments you've tried. They might also ask about your skin's tendency to form keloids or to darken after injury, because these factors affect which treatments are safe for you.

Laser treatments for acne scars

Laser therapy is one of the most common professional treatments for acne scars. Different laser types work in different ways. Ablative lasers remove the top layer of skin to smooth the surface and stimulate collagen production underneath. Non-ablative lasers work deeper without removing skin, heating the tissue to trigger collagen remodeling. Fractional lasers deliver the laser energy in a grid pattern so that some skin is treated while surrounding skin heals, which reduces downtime.

Ablative lasers like CO2 and erbium lasers produce faster, more dramatic results but require more recovery time — typically one to two weeks of redness, peeling, and sensitivity. Non-ablative options like Nd:YAG or diode lasers are gentler and require less downtime, but you usually need more sessions to see results. Fractional versions of both types offer a middle ground.

Laser works particularly well for scars with discoloration (red or purple marks) and for rolling scars. It is less effective for very deep boxcar or ice pick scars, which may need a combination of treatments. Most people need three to five sessions spaced four to six weeks apart. Results continue to improve for several months after treatment as collagen remodels.

Chemical peels and microneedling

Chemical peels use a chemical solution to remove the outer layers of skin and stimulate healing. For acne scars, dermatologists typically use medium to deep peels rather than light ones. A medium peel removes skin down to the upper dermis and requires a few days of downtime. A deep peel removes more layers and produces more dramatic results but carries higher risks and requires longer recovery.

Microneedling uses a device with tiny needles to create controlled micro-injuries in the skin. This triggers the body's natural healing response and stimulates collagen production. Microneedling works well for rolling and boxcar scars and is gentler than laser for people with darker skin tones, which can be prone to discoloration after laser treatment. You typically need four to six sessions spaced four to six weeks apart.

Both treatments cause temporary redness, swelling, and peeling. Microneedling usually has less downtime than chemical peels. Results from both build gradually as collagen increases, and you may not see full improvement for three to six months after your final session.

Fillers and other injectable treatments

Injectable fillers can temporarily raise indented acne scars by adding volume beneath the scar. Common fillers include hyaluronic acid (Restylane, Juvéderm), calcium hydroxylapatite (Radiesse), and poly-L-lactic acid (Sculptra). Fillers work best for shallow, rolling scars and for people who want results without downtime.

The trade-off is that fillers are temporary — they break down over time and need to be repeated every six months to two years, depending on the filler type. This makes them more expensive long-term than permanent treatments like laser or microneedling, but they are a good option if you want to see results immediately or if you're not ready for more invasive procedures.

Another injectable option is subcision, where a dermatologist uses a needle to break up the fibrous tissue tethering a scar to deeper layers. This is often combined with fillers or other treatments for better results. Subcision works particularly well for rolling scars and requires minimal downtime, though you may have bruising for a week or two.

Combination treatments and what to expect

Many dermatologists use a combination approach rather than a single treatment, especially for moderate to severe scarring. For example, you might have laser treatment to address discoloration and texture, followed by microneedling to stimulate more collagen, and then fillers for any remaining indentations. Combining treatments often produces better results than any single treatment alone.

The timeline for combination treatment varies. Your dermatologist will space sessions to allow healing between treatments — typically four to six weeks apart. A full treatment plan might take three to six months from start to finish. Results continue to improve for months after your last session as collagen remodels and the skin continues to heal.

Cost varies widely depending on the treatment type, the number of sessions needed, and your location. Laser and microneedling sessions typically cost between $200 and $1,000 per session. Fillers cost $400 to $1,500 per syringe. Most insurance plans do not cover scar treatments because they are considered cosmetic, though some plans may cover treatment if scarring affects function or causes documented psychological distress.

What you can do at home and when to see a dermatologist

At-home treatments have limited effectiveness for true acne scars, but they may help with mild scarring or discoloration. Topical retinoids (like tretinoin or adapalene) can improve skin texture and may reduce the appearance of very shallow scars over months of use. Vitamin C serums and niacinamide may help with discoloration. Sunscreen is essential because sun exposure darkens scars and makes them more noticeable.

Over-the-counter products marketed for scar removal — like silicone gel or onion extract — have limited evidence for acne scars specifically. They may help with very fresh scars (weeks to a few months old) but are unlikely to improve established scars.

If you have acne scars you want to treat, schedule a consultation with a dermatologist. They can assess your scar type, skin tone, and skin sensitivity to recommend the best treatment or combination of treatments for you. Dermatologists are trained to recognize which scars will respond to which treatments and can adjust the plan based on how your skin responds.

Frequently Asked Questions

Can acne scars go away on their own?

Acne scars do not disappear on their own, though they may fade slightly over years as collagen naturally remodels. The longer you wait, the harder they become to treat. Starting treatment within a year or two of scarring typically produces better results than waiting longer.

Which treatment works best for ice pick scars?

Ice pick scars are the hardest type to treat because they are so narrow and deep. Laser and microneedling alone often cannot fully resolve them. Many dermatologists combine subcision (to release the scar from deeper tissue) with laser or filler to get the best result. Some very deep ice pick scars may need punch excision, a surgical technique where the scar is removed and the skin is stitched closed.

Is it safe to treat acne scars if I have darker skin?

Yes, but some treatments carry higher risks. Ablative lasers and deep chemical peels can cause permanent discoloration (hyperpigmentation or hypopigmentation) in darker skin tones. Microneedling, non-ablative lasers, and fillers are generally safer options. Always see a dermatologist experienced in treating darker skin, as they will know which devices and settings are safest for you.

How long does it take to see results from scar treatment?

Results depend on the treatment. Fillers show results immediately. Laser and microneedling show gradual improvement over weeks, with most visible results appearing two to three months after your final session as collagen continues to build. You may need multiple sessions before you see significant improvement.

Can I prevent acne scars if I still get acne?

The best prevention is treating acne early and aggressively to prevent deep inflammation. Do not pick, squeeze, or pop acne lesions, as this increases scarring risk. If you have cystic or nodular acne, see a dermatologist for prescription treatment rather than waiting for it to clear on its own. Early treatment of severe acne is the most effective way to prevent scarring.