Acne scar repair treats existing scars by choosing methods suited to the scar type. Options include subcision for rolling scars, TCA CROSS for ice-pick scars, fillers or fat grafting for volume loss, microneedling and lasers for collagen remodeling, and steroids or silicone for raised scars. Multiple treatments are often combined; results and risks vary by skin type and scar severity.

What is acne scar repair?

Acne scar repair refers to treatments aimed at improving or reducing visible acne scars that have already formed. These approaches differ from acute acne therapies (which stop new scars by treating active disease). Repair focuses on restoring skin texture, volume, and color to make scars less noticeable.

Common scar types

Understanding scar type guides treatment choice. The main categories are:

  • Ice-pick scars: Narrow, deep tracts that penetrate into the dermis. Common on the cheeks.
  • Boxcar scars: Sharply demarcated, wider depressions with vertical edges.
  • Rolling scars: Shallow, sloping depressions caused by tethering of skin to deeper tissues.
  • Atrophic macules/soft scars: Superficial depressions with gentle edges.
  • Hypertrophic and keloid scars: Raised scars from excess collagen formation.
Knowing which type predominates on your face helps your clinician recommend the most effective repair options.

Current repair options and when they help

  • Subcision: A minor surgical technique that frees tethered (rolling) scars and often combined with fillers or microneedling.
  • Fillers (hyaluronic acid, calcium hydroxylapatite) and autologous fat grafting: Add volume to depressed scars. Fat grafting can give longer-lasting volume but may require repeat procedures because some fat resorption can occur.
  • Chemical reconstruction (TCA CROSS): High-concentration trichloroacetic acid placed into ice-pick scars stimulates remodeling and can improve very narrow, deep pits.
  • Microneedling (with or without platelet-rich plasma): Creates controlled micro-injuries that stimulate collagen remodeling, useful for broad atrophic scars.
  • Laser resurfacing: Fractional non-ablative and ablative lasers (e.g., fractional CO2, Er:YAG) remodel collagen and improve texture. Choice depends on scar depth and skin type; deeper ablative lasers give stronger results but have longer downtime and greater pigment risk.
  • Dermabrasion and microdermabrasion: Mechanical resurfacing; dermabrasion can be effective for some surface irregularities but carries a higher risk of pigment changes, especially in darker skin tones.
  • Surgical excision and punch techniques: Used for certain deep boxcar or ice-pick scars. For keloids, simple excision can provoke recurrence and is often combined with intralesional steroids, silicone, or radiotherapy.
  • Intralesional corticosteroids, silicone gel, and cryotherapy: First-line for hypertrophic and keloid scars to flatten and soften raised tissue.

Realistic expectations

No single procedure fixes every scar. Combinations (e.g., subcision + filler + laser) often bring the best improvement. Some scars respond poorly to excess resurfacing, and procedures carry risks - pigment changes, texture shifts, or recurrence of keloids. Younger skin may remodel more over time, but many people seek active treatment for faster, more noticeable improvement.

Discuss goals, downtime, costs, and risks with a board-certified dermatologist or plastic surgeon to build a staged plan tailored to your scar pattern and skin type.

FAQs about Acne Scar Repair

Can all acne scars be completely erased?
No. Many scars can be substantially improved, but complete erasure is uncommon. Treatment aims to reduce visibility and restore contour. Combining procedures increases the chance of meaningful improvement.
Which treatment is best for ice-pick scars?
TCA CROSS (focal high-strength chemical reconstruction) and punch excision are commonly used for narrow, deep ice-pick scars. Microneedling and lasers may help overall texture but are often less effective for very narrow pits alone.
Are lasers safe for darker skin tones?
Some fractional non-ablative and certain ablative lasers can be used safely with experienced clinicians, but darker skin has higher pigment-change risk. Clinician experience and conservative settings reduce complications.
Do steroid injections work for keloids?
Yes. Intralesional corticosteroids are a standard treatment to flatten hypertrophic scars and keloids. They are often combined with other measures because surgery alone can trigger recurrence.
Will fat grafting last forever?
Autologous fat transfer can provide longer-lasting volume than temporary fillers, but partial resorption is common and repeat sessions may be needed.