What’s the Best Treatment for Acne Scars?

The phrase “acne scars” covers several different problems. Some scars are narrow and deep. Some are broad. Some are pulled down by fibrous bands. Others are raised. Dark marks after acne are not true scars, although they often appear alongside them.

Start With the Scar Type

The American Academy of Dermatology recommends choosing treatment only after the scar pattern, skin tone, active acne, downtime and goals are reviewed. A treatment that is useful for one scar type may do very little for another.

Subcision: Often Important for Rolling Scars

Rolling scars can be pulled downward by fibrous bands beneath the skin. A surface treatment cannot fully correct that tethering. Subcision uses a needle or cannula under the scar to release those bands.

Subcision is often combined with another treatment after the scar has been released. Resurfacing, microneedling or filler may then address the remaining contour. Subcision has less research behind it than lasers, but it is a well-established option for selected tethered scars.

TCA CROSS: A Focal Option for Icepick Scars

TCA CROSS is different from a full-face chemical peel. A high-strength trichloroacetic acid solution is placed precisely into individual scars to create controlled remodeling.

A recent review of 34 publications found that TCA CROSS was used mainly for icepick and boxcar scars. More than one session often helped, while stronger acid also raised the risk of pigment changes.

This is a technique that depends heavily on precise application. It is not an at-home acid treatment.

Fractional CO₂ Laser: Strong Resurfacing for Selected Scars

Fractional CO₂ laser creates tiny columns of controlled injury and heat. As the skin heals, new collagen can soften scar edges and improve texture.

A 2025 systematic review found meaningful improvement with fractional CO₂, but temporary redness, swelling and post-inflammatory hyperpigmentation were common. A 2026 meta-analysis also found that CO₂ may produce somewhat stronger scar improvement than RF microneedling in some trials, but with more pain, longer redness and a higher risk of PIH.

That tradeoff matters. The strongest resurfacing treatment is not automatically the best option for every skin tone or every scar.

Microneedling: Useful for Broad Atrophic Scarring

Standard microneedling creates tiny needle channels that trigger collagen remodeling without adding heat. The AAD lists microneedling as an established treatment for depressed acne scars.

It can be useful for rolling and shallow boxcar scars, especially when a patient wants less downtime than deeper ablative laser resurfacing. It is also commonly combined with other treatments rather than expected to correct every scar by itself.

RF Microneedling: Effective, but Not Risk-Free

RF microneedling combines needles with radiofrequency energy delivered below the skin surface. Systematic reviews support its use for acne scars. It may be useful when deeper collagen remodeling is wanted with less surface injury than CO₂.

Chemical Peels: Better for Some Problems Than Others

Chemical peels can improve surface texture, post-acne discoloration and active acne in selected patients. They do not release tethered rolling scars or fill deep icepick scars.

This is an important correction to many “top acne scar treatment” lists. A peel may be very useful as part of a plan, but its value depends on what the patient actually has.

Fillers: Selected Depressed Scars

Dermal fillers can raise selected depressed scars and may help when volume loss adds to the contour problem. Some scars respond better after subcision has released the tissue first.

Filler is not appropriate for every scar, and it does not treat active acne or raised keloid scars. The AAD includes fillers among the options for depressed scars when carefully selected.

Do Facials Treat Acne Scars?

Facials can support acne control, hydration and surface exfoliation, but they do not remodel deep structural acne scars.

The older version listed medical-grade facials as a leading acne-scar treatment. That gives facials too much credit. Facials may help reduce new breakouts or improve surface appearance, but icepick, rolling and deep boxcar scars usually need procedures that reach the scar structure itself.

What About Cortisone Injections?

A corticosteroid injection into a large inflamed acne lesion can reduce inflammation and may help lower the chance of a new scar. That is prevention, not treatment of an old depressed scar.

Corticosteroid injections also have a role in some raised hypertrophic and keloid scars. That is a different use from treating icepick, rolling or boxcar scars.

Why Combination Treatment Often Works Better

Many people have more than one scar type. A good plan may therefore use several methods in sequence instead of one machine over and over.

For example, a patient with rolling scars and boxcar texture may need subcision first, then fractional resurfacing or microneedling. A patient with icepick scars plus broader texture may need TCA CROSS for the narrow pits and another treatment for the rest of the face.

How Does Skin Tone Change the Plan?

Darker skin can be treated successfully. But procedures that create heat or inflammation can raise the risk of post-inflammatory hyperpigmentation. Laser settings, treatment depth, spacing and aftercare need to be chosen with that risk in mind.

This does not mean darker skin should avoid laser or RF. It means the settings and treatment plan need to be chosen carefully.

Should Active Acne Be Treated First?

Usually, yes. Ongoing inflammatory acne can create new scars while older ones are being treated. The AAD recommends getting breakouts under control before starting most scar procedures.

Once acne is stable, scar treatment is easier to plan because old scars can be separated from new inflammation.

How Skin Works Approaches Acne Scars

Skin Works offers several acne-scar procedures, including fractional CO₂ and Erbium resurfacing, RF microneedling, subcision, TCA CROSS, chemical peels and selected filler-based correction. Not every patient needs all of them.

The commercial treatment details, current options and before-and-after examples belong on our Acne Scar Treatment page. This article is meant to help you understand why different scars need different treatments before you compare services.

Frequently Asked Questions