Acne Scar Treatments Compared by Scar Type

Know your acne scar type first

You cleared your acne, but the marks it left are still there when you look in the mirror. Before comparing treatments, it helps to know what kind of marks you have, because the American Academy of Dermatology (AAD) says different types of acne scars need different treatment. Many people have more than one type.

• Ice pick scars: small openings that go deep into the skin. The AAD says this is the most common type of acne scar.
• Boxcar scars: round or oval dents, wider than ice pick scars but narrower than rolling scars.
• Rolling scars: wide, shallow dips that can give the skin a wavy look.
• Raised scars: firm bumps that form when the skin makes too much collagen. The AAD says they are more common in people with darker skin tones. They include hypertrophic scars and keloids, which are treated differently, as the guide keloid vs. hypertrophic scar explains.
• Flat brown, red or light spots: usually not scars. The AAD says these spots, such as post-inflammatory hyperpigmentation, usually fade over time, and treatment can help them fade faster.

Get active acne under control first

If you still get breakouts, the AAD says a treatment plan will likely begin with acne treatment, because stopping breakouts reduces inflammation and prevents new scars. Scar treatment typically starts after acne is under control and you are using acne medicine to prevent new breakouts. A dermatologist is often the right first stop for active acne.

Tell whoever treats your scars about every acne treatment you are using or have used in the last two years. The AAD warns that starting some scar treatments while using, or soon after stopping, certain acne medicines can cause unwanted side effects. Timing is covered in more depth in is your scar ready for treatment.

Treatments that resurface and rebuild collagen

Several treatments work by injuring the skin in a controlled way so it makes new collagen and elastin. Laser resurfacing is one; the AAD notes some lasers need more sessions than others. A 2018 systematic review of energy-based treatments found rolling and boxcar scars responded better to lasers than ice pick scars, and that more aggressive settings raised the risk of dark patches with some devices.

Microneedling uses tiny needles to puncture the skin and trigger new collagen. The AAD says it is safe for all skin tones and is often paired with radiofrequency, chemical peels or platelet-rich plasma. A 2022 review found microneedling helps rolling scars most, then boxcar scars, with little effect on ice pick scars.

Chemical peels also prompt new collagen. The AAD says mild and medium peels often take more than one session and that you may follow a pre-peel routine for a few weeks. For ice pick scars, the 2022 review found the most consistent results came from several sessions of a strong acid applied only inside each scar, a technique called CROSS. Radiofrequency devices use radiofrequency energy to help the skin make collagen, and the AAD says they are safe for all skin tones.

Treatments that lift, fill or remove scars

Subcision is a minor procedure in which a needle frees the scar from the bands of tissue pulling it down. The AAD describes it as surgically lifting the scar so the skin rises. The 2022 review found it helps mainly rolling scars and does little on its own for boxcar and ice pick scars, which lack that tethering.

Punch techniques use a small round tool. In punch excision, the scar is cut out and closed with stitches or a small skin graft, which the AAD includes under scar surgery. The 2022 review calls punch techniques useful for deep ice pick and boxcar scars that resist other treatments, with the trade-off of leaving a small, less noticeable line.

Fillers add volume under a dent and can prompt some collagen. The AAD says most give temporary results lasting from 3 months to 2 years, so touch-ups are needed. The 2022 review found fillers help rolling scars most and did little for ice pick scars.

What the evidence can and cannot tell you

A Cochrane review of 24 randomized trials, summarized in 2022, found moderate support for injectable fillers and limited support for lasers, chemical peels, radiofrequency and skin needling. The authors could not recommend one treatment over another because the studies were small and often at risk of bias. The AAD notes that dermatologists often combine treatments, such as lifting sunken scars with minor surgery and then adding a filler.

Before you choose, the AAD suggests thinking about how you want to look afterward, how much downtime you can take, and how much time you can give to treatment and skin care. Some treatments make scars less noticeable, while others mainly smooth a wavy texture. The AAD also notes that medical insurance does not cover acne scar treatment.

Your skin tone matters too. Some treatments carry a higher risk of dark patches in darker skin, so careful settings and test spots are worth asking about. The guide scar and pigment treatment for darker skin covers this.

Creams, pregnancy and where Laser Eraser fits

For mild acne scarring, the AAD says a retinoid or salicylic acid applied to the skin can make scars less noticeable. The AAD suggests creams only for mild scarring, so they are unlikely to lift a deep scar. If you are pregnant, the AAD says tretinoin and adapalene are generally stopped and that tazarotene and isotretinoin should never be used. If you are planning a pregnancy, ask your doctor before using any retinoid, and plan elective procedures for after pregnancy.

Laser Eraser treats acne scars with the PicoWay picosecond laser, performed by a licensed medical provider, as described on the acne scar removal page and the atrophic scar treatment page. In one small 2021 randomized trial of 22 people, a fractional picosecond laser improved atrophic acne scars, with more temporary redness than the comparison laser. Microneedling, peels, fillers, subcision and punch techniques are general options from the AAD and medical reviews, not services listed on the practice's site.