Doctor’s Note: Your Easy Guide to Acne Scarring Treatments

As dermatologists, we understand that acne scars can be both physically and emotionally challenging. Scars can range from deep pits to small dark spots, and both can affect a person’s confidence. Different types of scars need different treatments, from creams to more advanced skin procedures.

Watch the video summary to the right, or read on for more!

What is Acne Scarring?

Acne scars go deeper than just the skin’s surface. They form in a layer called the dermis, where collagen and tissue support the skin. This makes them harder to treat than dark spots, which are only on the top layer.

Why does this matter? It affects how we treat scars! Since the dermis is deep, topicals can’t reach it well. To fix the collagen there, we need procedures. Microneedling, lasers, chemical peels, fillers, and subcision (using a needle) are all used to repair collagen in the dermis.

Types of Acne Scars

Atrophic scars are the most common type of acne scars, and they come in three main forms: boxcar scars, ice pick scars, and rolling scars. Each of these scars looks different and forms in a unique way. It’s important to understand which type of scar you have because it helps determine the best treatment. For example, some treatments work better for shallow scars, while others are more effective for deeper scars. Here’s a closer look at the most common types of acne scars:

Ice Pick Scars

Shape: Deep and narrow.
Appearance: Looks like small holes or tiny punctures in the skin, like an ice pick.
Location: Cheeks and forehead.

Rolling Scars

Shape: Wavy and uneven.
Appearance: Causes a bumpy texture because of bands pulling under the skin.
Location: Lower cheeks and jaw.

Boxcar Scars

Shape: Deep and broad.
Appearance: Looks like a missing piece of a puzzle.
Location: Lower cheeks and jaw.

Acne Scarring Treatment Overview

Skin resurfacing treatments like lasers, chemical peels, and microneedling offer effective ways to improve texture, tone, and overall skin health. These procedures target different layers of the skin, helping with issues like fine lines, pigmentation, scars, and uneven texture. Each method works differently—some remove the top layers, others heat or stimulate deeper layers, and they vary in recovery time and suitability for different skin types. Below, we'll break down the specifics of each treatment to help you understand how they work, what to expect, and which might be best for your skin concerns.

There are MANY treatments to help your acne scarring! Some treatments work better than others. We’re here to explain it all! Take a look at some of these before and after photos:

Acne Scarring CO2 Laser Before and After

Acne Scarring TCA CROSS Before and After

Acne Scarring Microneedling Before and After

Acne Scarring Subcision Before and After

Acne Scarring RF Microneedling Before and After

Acne Scarring Chemical Peel Before and After

Acne Scarring Punch Excision Before and After

As you can see, there are many effective options for treating acne scars! Each treatment works differently and targets specific types of scars. Some focus on boosting collagen, while others resurface the skin to make it smoother. Choosing the right one depends on the type of scar, skin type, and your overall goals. Let’s break down the details of each procedure and how they help improve the appearance of acne scars.

Lasers for Acne Scars

Best For: All Scars

Laser treatments use focused light to target damaged skin, creating tiny injuries that stimulate collagen production. This process helps smooth out the skin and reduce the appearance of scars. Lasers can also even out skin tone and lighten dark spots caused by acne. Popular options include Fraxel, CO2, and Clear and Brilliant. These treatments vary in intensity, with some requiring more sessions than others, depending on the scar's depth and severity. Learn more about laser treatments here.

What it Does: Lasers work by reaching the dermis, which is the deeper layer of skin where acne scars form. The laser can either heat or remove parts of this layer to help new collagen grow and make the skin smoother. Strong lasers aren’t usually recommended for darker skin because they can cause changes in skin color.

What to Expect: Laser treatments usually take about 30 minutes to an hour. A numbing cream is sometimes used to reduce pain. Recovery time depends on the type of laser. Stronger lasers, like CO2 and Erbium, need about 1-2 weeks to heal. Milder lasers, like Fraxel and Clear and Brilliant, need just a few days.

Microneedling for Acne Scars

Best For: All Scars

Microneedling uses fine needles to create tiny punctures in the skin. This helps kickstart the body’s healing process and boosts collagen, which can make the skin smoother. It also helps skincare products absorb better, making them work more effectively. You can have plain microneedling, or you can make it *fancy* (for example, you can add PRP, exosomes, or topicals). Learn more about microneedling here.

What to Expect: Microneedling usually takes about 30 minutes to an hour. A numbing cream is often used to reduce discomfort. Recovery includes mild redness and swelling for a day or two.

What It Does: Microneedling involves tiny needles create small injuries in this layer, which helps boost collagen growth and makes the skin smoother over time. Microneedling is generally safe for all skin tones, as it doesn’t use heat, reducing the risk of skin color changes. This also means it’s not as effective as laser treatment.

Radiofrequency Microneedling for Acne Scars

Best For: All Scars

Radiofrequency (RF) microneedling combines regular microneedling with RF energy (meaning heat 🔥). Fine needles deliver heat deep into the dermis, boosting collagen production up to 10 times more than regular microneedling! This treatment not only helps with acne scars but also tightens the skin, making it suitable for both shallow and deep scars. Some popular RF microneedling devices include Morpheus8, Infini, Genius RF, and Secret RF. Learn more about radiofrequency microneedling here.

What It Does: RF microneedling delivers radiofrequency (RF) energy to the dermis, which adds heat to boost collagen growth even more and improve skin texture. The added heat makes RF microneedling more effective than regular microneedling. It’s usually safe for all skin tones, as the heat is controlled to reduce the risk of skin color changes.

What to Expect: Before starting Morpheus8, a numbing cream is applied to your skin for comfort. The treatment takes about 30 minutes to an hour, during which you might feel warmth or mild pricking as the needles deliver heat. Afterward, your skin may be red and slightly swollen, like a mild sunburn, for a day or two. Most people see improvements over several sessions.

Chemical Peels for Acne Scars

Best For: Boxcar + Rolling Scars

Chemical peels help smooth and firm the skin by boosting collagen and elastin, making acne scars less visible. They range from mild to strong. Mild and medium peels usually need 3 to 5 treatments every 2 to 4 weeks, while stronger peels work deeper but take longer to heal. Some common peels include Glycolic Acid Peel, TCA Peel, and Jessner's Peel. Learn more about chemical peels here.

What to Expect: Your skin will be cleaned, and the peel applied. You may feel tingling. Mild peels cause redness and peeling for a few days, while deeper peels may lead to more peeling and redness for up to two weeks. Keep your skin moisturized and avoid the sun while healing. Most people see results after a few treatments.

What It Does: Chemical peels use acids to remove the top layers of skin. By removing old skin, they help new skin grow, which can make the skin look smoother. Peels also boost collagen production in the deeper layers. Only medium depth peels can dive into the dermis, making them great for acne scars but can have a longer recovery.

TCA CROSS for Acne Scars

Best For: Icepick + Boxcar Scars

TCA CROSS (Trichloroacetic Acid Chemical Reconstruction of Skin Scars) is a special treatment for acne scars using trichloroacetic acid (TCA). The acid is applied directly to the scars, helping the skin make more collagen. This new collagen acts like a natural filler, gradually smoothing the scars.

This method works well for deep scars like icepick or boxcar scars. Multiple sessions are usually needed, with each session spaced a few weeks apart. As treatment continues, scars become less visible over time. After each session, you may notice some redness and flaking, but these effects usually go away quickly.

TCA CROSS is a reliable way to reduce acne scars. It encourages the skin to heal and become smoother by boosting collagen, which helps improve scar texture and appearance.

What to Expect: The TCA CROSS treatment is quick, usually taking just a few minutes per session. It feels like a brief stinging sensation when the acid is applied. Recovery lasts about a week, with some redness and scabbing. Most people need 3 to 6 sessions, spaced 2 to 8 weeks apart.

What it Does: TCA Cross uses a strong acid called trichloroacetic acid (TCA) to treat deep acne scars, like ice-pick scars. The acid is put precisely + directly into the scar to boost the collagen just below the scar. This helps fill in the scar over time.

Filler for Acne Scars

Injectable fillers help treat acne scars by adding volume to indented areas. A substance, like hyaluronic acid, is injected beneath the scar to lift it to the level of the surrounding skin, making the scar less visible.

The results depend on the type of filler used. Hyaluronic acid fillers, such as Juvederm or Restylane, typically last 6 to 12 months. Other fillers, like Radiesse (calcium hydroxylapatite) or Sculptra (poly-L-lactic acid), can last up to 18 months or more. The duration also varies based on factors like the treated area, amount of filler used, and your metabolism.

Subcision for Acne Scars

Best For: Rolling Scars

Subcision is a simple procedure for treating acne scars by breaking up the tough bands of tissue that pull the skin down.

A small needle is inserted under the skin to cut these bands, which releases the skin from the scar tissue. This not only smooths the skin but also boosts collagen production in the treated area. As new collagen forms, the scars become less visible over time.

Recovery is usually quick, with some swelling and bruising that fades within a few days. Multiple sessions may be needed for the best results, depending on the depth of the scars.

What to Expect: You'll get a numbing shot to reduce pain. The procedure is quick, but you may feel some pressure as the needle works under the skin. Afterward, expect some swelling and bruising, which should fade in a few days. You may need several sessions for deeper scars.

What It Does: Subcision uses a small needle to break up scar tissue under the skin. By releasing this scar tissue, it helps the skin lift up and appear smoother. Subcision boosts collagen production as the skin heals, making it especially useful for deeper scars like rolling scars. It’s safe for all skin tones, with a low risk of changing skin color.

Punch Excision for Acne Scars

Best For: Icepick + Boxcar Scars

Punch excision is a surgical treatment for small, deep acne scars. A dermatologist uses a special circular tool to cut out the scar completely. The wound is then stitched together to help the skin heal smoothly.

This method works well for ice pick scars, which are often too deep for surface treatments. As the area heals, new, smoother skin replaces the removed scar, improving the skin's appearance.

Punch excision and elevation of acne scar.jpg

What It Does: Punch excision removes deep acne scars, like ice-pick scars, by cutting out the scar with a small, circular tool. The skin is then stitched together, helping the scar heal smoother. Punch excision is best for small, deep scars and works on all skin tones, with little risk of changing skin color.

What to Expect: The doctor will use a numbing medicine on the area. After the treatment, you might have some swelling or redness. Stitches come out in about a week. A small scar may form, but it’s usually less noticeable than the original scar. Many scars can be treated in one session.

Image Above: Hurkudli DS, Sarvajnamurthy S, Suryanarayan S, Chugh VS. Novel uses of skin biopsy punches in dermatosurgery. Indian J Dermatol. 2015 Mar-Apr;60(2):170-5. doi: 10.4103/0019-5154.152519. PMID: 25814706; PMCID: PMC4372910.

Acne Scarring FAQs

Does microneedling get rid of acne scars permanently?
Microneedling can improve the appearance of acne scars but may not get rid of them permanently. Regular maintenance may be needed to keep results.

Does benzoyl peroxide help with acne scars?
No, benzoyl peroxide is great for treating active acne but doesn’t directly improve scars.

Does Accutane get rid of acne scars?
Accutane helps prevent future acne and reduces inflammation, but it doesn’t get rid of existing scars.

How effective is microneedling for acne scars?
Microneedling is effective for many people and can improve the texture of scars by boosting collagen production. Results vary depending on the severity of the scars.

Will chemical peels remove acne scars?
Chemical peels can reduce the appearance of acne scars, especially shallow ones, but they may not fully remove deeper scars.

Does Arazlo lotion help with acne scars?
Arazlo (tazarotene) can improve the appearance of acne scars over time by increasing cell turnover and stimulating collagen.

How many microneedling sessions for acne scars?
Most people need 3 to 6 sessions spaced a month apart to see noticeable improvements.

What needle length for microneedling for deep acne scars?
For deep acne scars, needles between 1.5mm and 2.5mm are typically used by professionals.

Is niacinamide good for acne scars?
Yes, niacinamide can help fade discoloration from scars and reduce redness.

Is hyaluronic acid good for acne scars?
Hyaluronic acid hydrates the skin and can make scars appear smoother but doesn’t directly treat them.

Does salicylic acid help with acne scars?
Yes, salicylic acid can help by exfoliating skin and fading discoloration over time.

Does tretinoin help acne scars?
Yes, tretinoin can improve acne scars by promoting collagen production and skin cell turnover.

Does azelaic acid help with acne scars?
Yes, azelaic acid can fade dark marks and discoloration from acne scars.

Does snail mucin get rid of acne scars?
Snail mucin may help with hydration and healing, but it won’t significantly reduce scars.

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