Treating Acne Scarring

Expert Evaluation and Evidence-Based Management

Acne scarring is one of the most frustrating reminders that a breakout ever happened. Long after the blemish itself has healed, the marks, depressions, and discoloration it leaves behind can linger for months or years. Whether you are dealing with shallow pitting that catches the light the wrong way or deeper, more defined depressions that affect the overall texture of your skin, acne scarring can make it hard to feel confident going bare-faced.

Fortunately, acne scarring is treatable, and while improving the appearance of scars takes time and the right combination of approaches, you do not have to live with the damage permanently. Whether you are managing mild post-inflammatory marks or more significant structural scarring, understanding your options is the first step toward clearer, more even skin.

In this guide, we break down how acne scarring is treated: what works best for mild versus more advanced cases, what results look like over time, and what a dermatologist can do to make your plan more effective and less frustrating.

What Is Acne Scarring and Why Is It So Stubborn? 

Acne scarring occurs when inflammation from a breakout damages the collagen and skin tissue in the dermis. As the skin attempts to repair itself, it can either produce too little collagen creating a depression in the skin or too much, forming a raised scar. The result is a textural irregularity that differs from the surrounding skin in both structure and appearance.

Acne scarring is extremely common. Studies suggest that roughly 95% of people with acne experience some degree of scarring. However, you are more likely to develop significant, lasting scarring if you experience any of the following:

• Severe or Cystic Acne: Deeper, more inflamed breakouts penetrate further into the dermis, causing greater tissue damage and a higher likelihood of scarring.
• Delayed or Inadequate Treatment: The longer active acne goes untreated, the more repeated inflammation occurs, increasing the cumulative damage to surrounding skin tissue.
• Picking and Squeezing: Manually manipulating blemishes introduces additional trauma, bacteria, and inflammation all of which increase the risk of permanent scarring.
• Genetics: Some individuals are genetically predisposed to forming more pronounced scars due to differences in how their skin heals and rebuilds collagen.
• Skin Tone: People with deeper skin tones are more prone to post-inflammatory hyperpigmentation (PIH), a form of discoloration that can accompany or follow acne scarring.
• Hormonal Factors: Hormonal fluctuations that drive persistent or recurring acne increase the number of healing cycles, which compounds scarring over time.

Why Acne Scarring Is Hard To Treat

Acne scarring is highly treatable, but meaningful improvement takes time and typically requires multiple approaches for two key reasons:

• Scars live in the dermis. Most acne scarring is structural, meaning the damage has occurred in the deeper layers of skin. Surface-level treatments alone cannot fully reach or correct this damage.
• The skin’s repair process is slow. Collagen remodeling the process that gradually fills in atrophic scars and smooths the skin unfolds over weeks and months, not days. Even aggressive treatments take time to produce their full effect.

This means results are never immediate. Topical treatments improve surface pigmentation and mild texture, while procedural treatments like microneedling and laser resurfacing stimulate the deeper collagen remodeling needed to address structural scars. The type of scar also matters greatly icepick scars, boxcar scars, and rolling scars each respond differently to different treatments.

Assess Your Skin Before Treating Acne Scarring 

Not every mark or indentation left by acne responds to the same treatment. Correctly identifying the type of scarring you have is essential for selecting the right approach:

• Atrophic Scars (Depressed): The most common type. Caused by a loss of collagen during healing. They sit below the surface of the surrounding skin and include icepick, boxcar, and rolling scar subtypes.
• Icepick Scars: Deep, narrow, pitted scars that extend into the dermis. They are the most difficult type to treat and often require targeted approaches like TCA cross or ablative laser.
• Boxcar Scars: Wider, flat-bottomed depressions with defined edges. These respond well to laser resurfacing, microneedling, and subcision.
• Rolling Scars: Broad, wave-like depressions caused by fibrous bands beneath the skin pulling the surface downward. Subcision is particularly effective for breaking these up, often paired with microneedling or filler.
• Post-Inflammatory Hyperpigmentation (PIH): Not a true scar, but flat discoloration (pink, red, or brown) left after a breakout heals. Responds well to topical retinoids, chemical peels, and brightening agents.
• Hypertrophic and Keloid Scars: Raised scars caused by excess collagen production. More common on the chest and back and treated differently from atrophic scars.

A dermatologist evaluation helps identify which scar types are present, whether active acne is still contributing, and which treatments are safe for your skin tone and type. Selecting the right treatment for the wrong scar type wastes time and can make some scar types appear worse. 

Treating Acne Scarring: Treatment Options Compared

The right treatment depends on the types of scars present, their depth and distribution, and your skin tone and overall skin health. In many cases, the best results come from a combination plan rather than a single product or procedure.

Topical Prescription Treatments

Prescription topicals are typically used to manage post-inflammatory hyperpigmentation, improve surface texture, and prepare the skin for procedural treatments. Retinoids accelerate cell turnover and stimulate collagen, making them the most evidence-backed topical option for acne-related skin changes. Prescription brightening agents may also be used to address discoloration alongside texture.

Tips to improve topical results:

• Apply to clean, dry skin as directed typically at night
• Use SPF every day; sun exposure worsens hyperpigmentation and slows healing
• Be consistent topical improvement in pigmentation and texture takes months
• Do not pick at healing skin, as this restarts the damage cycle

Microneedling

Microneedling creates controlled micro-injuries in the dermis, triggering a wound-healing response that stimulates new collagen and elastin production. It is particularly effective for rolling and boxcar scars, enlarged pores, and overall skin texture. Results build over a series of treatments spaced 4 to 6 weeks apart, and improvement continues for months after each session as collagen remodeling progresses.

Laser Resurfacing

Laser treatments address acne scarring by resurfacing the skin and stimulating significant collagen remodeling. Non-ablative fractional lasers improve texture with minimal downtime, while ablative fractional lasers produce more dramatic results for deeper or more significant scarring with a longer recovery period. Laser selection depends on scar depth, skin tone, and downtime tolerance.

Chemical Peels

Chemical peels use controlled exfoliating acids to remove damaged surface skin and stimulate new cell growth. Light to medium peels are particularly helpful for post-inflammatory hyperpigmentation and mild surface texture. Deeper peels can address more significant textural changes with more recovery time.

Subcision and Dermal Fillers

Subcision is a minor in-office procedure where a small needle is inserted beneath a depressed scar to break up the fibrous bands tethering the skin downward. It is especially effective for rolling scars. Dermal fillers can temporarily lift atrophic scars by restoring volume beneath the depression, producing an immediate improvement in appearance.

Combination Plans

Combination therapy typically produces the best outcomes for acne scarring. A common approach might include treating active acne first, then moving to a series of microneedling sessions paired with topical retinoids, followed by laser resurfacing for any remaining deeper scars. The goal is to address scarring from multiple angles simultaneously for more comprehensive improvement.

Quick Comparison Table

Timeline And Expectations: How Long Treatment Takes 

When treating acne scarring, the most common question is: when will my skin look even again? Setting realistic expectations requires understanding that scar improvement depends on collagen remodeling a biological process that cannot be rushed.

Treating the surface appearance of scars does not instantly correct the structural damage underneath. Instead, meaningful improvement relies on the gradual stimulation and remodeling of collagen in the dermis over multiple treatment cycles and months of healing. A realistic timeline often looks like:

Weeks 1 to 4: Following a microneedling or peel session, the skin enters an active healing phase. Redness, mild swelling, and peeling are normal. Post-inflammatory hyperpigmentation from past breakouts may begin to fade with consistent topical use and daily SPF.

Months 1 to 3: Collagen stimulation from early procedural treatments becomes visible. Surface texture begins to even out and PIH continues to fade. Scar edges may appear less defined and overall skin tone more uniform.

Months 3 to 6: Cumulative improvement from a series of treatments becomes more apparent. Rolling and boxcar scars that have been treated with microneedling or subcision typically show meaningful improvement in depth and appearance at this stage.

Months 6 to 12+: For deeper or more complex scarring, ongoing collagen remodeling continues to refine results. Laser resurfacing outcomes continue to improve for up to 12 months post-treatment. Maintenance and a consistent home care routine help protect and preserve progress. 

Preventing Recurrence After Treatment

Because ongoing acne can create new scars while old ones are still healing, managing active breakouts is the most important step in preventing further scarring. Here are tips to protect your results and reduce future damage:

• Keep active acne well controlled with a prescribed treatment plan
• Wear broad-spectrum SPF 30 or higher every day to prevent hyperpigmentation from worsening
• Use a prescription retinoid consistently as part of your daily routine
• Never pick, pop, or squeeze active blemishes this is the single most preventable cause of new scarring
• Follow all post-procedure care instructions carefully to support proper healing

How Connolly Dermatology Helps With Treating Acne Scarring

At Connolly Dermatology, we take a clinical, comprehensive approach to acne scarring. We do not guess. We begin with a thorough evaluation of your scar types, skin tone, and active breakout activity before recommending any treatment. Once we have a clear picture of what we are working with, our team will work with you to build a safe, effective, and personalized plan that addresses your specific scars and fits your lifestyle.

If you are ready to take the first step toward clearer, smoother skin, let’s begin your journey. Book an appointment with Connolly Dermatology today.