Acne scars can remain long after breakouts are under control and can be frustrating when makeup or skin care does not change the texture.
We assess indented (atrophic) scars—rolling, boxcar and ice-pick—and match treatment to their depth, your skin tone and healing history.
The best results often come from a thoughtful combination rather than one device, with downtime and skin tone guiding the plan.
Quick decision guide
- Best starting point: Confirm whether the main issue is active acne, flat post-acne marks, depressed scars, raised scars or a combination.
- Options to compare: Acne control, microneedling, RF microneedling, resurfacing, selected peels, injectable treatment or focused scar procedures may play different roles depending on scar type.
- Recovery: Microneedling may leave redness for a few days to a week; CO2 resurfacing often needs 1–2 weeks or longer of visible healing.
- Results: Scar improvement develops over months, often across a staged treatment plan. Early swelling can temporarily soften depressions.
- Skin tone and pigment: A history of darkening, lightening, keloids or raised scars changes treatment planning. Melanin-rich skin requires particular attention to post-inflammatory pigment change.
- What it will not do: No procedure can guarantee complete scar removal, and surface facials should not be expected to correct established deep depressions.
Scar Type Guides Treatment
- Rolling: Broad, wave-like depressions. Tethered scars may need release beneath the skin before surface treatment.
- Boxcar: Depressions with defined edges. Depth helps determine whether resurfacing or a focused scar procedure is appropriate.
- Ice-pick: Deep, narrow pits that often need a targeted approach beyond microneedling alone.
Scars versus post-acne marks
Depressed scars include rolling, boxcar and ice-pick patterns. Raised scars and keloids require a different approach. Flat brown, purple or red marks after a breakout may represent pigment or vascular changes rather than a permanent depression or raised scar. More than one type can occur on the same face.
Our hyperpigmentation page covers dark marks, while our scar and keloid information addresses raised scars. Treating the wrong category can waste time or aggravate the skin.
Control active acne first
Preventing new scars is part of the plan. If acne remains active, we may prioritize medical treatment before a resurfacing series. Picking, repeated irritation and poorly tolerated skin-care combinations can undermine progress. See our acne treatment information for that first step.
Procedures we may discuss
CO2 and fractional resurfacing
CO2 laser resurfacing may be considered for selected textural scars. Treatment intensity must be balanced against healing time and pigment risk. It should not be assumed that the strongest laser is the best choice.
Microneedling and RF microneedling
Conventional microneedling and RF microneedling are distinct options. The RF approach adds heat and has additional risks, including the serious complications described in the FDA’s safety communication linked on that treatment page.
Other targeted approaches
Some scars need a focused procedure in addition to resurfacing. We discuss suitable treatment or referral after examination; one device rarely addresses every scar type.
Skin tone and recovery matter
Melanin-rich skin can develop persistent discoloration after inflammation. A history of darkening, lightening or raised scars is important when choosing a procedure. Your plan should include expected recovery, sun protection and what to do if healing is not progressing normally. Depending on the procedure, risks include irritation, infection, burns, new scarring and pigment changes.
Frequently asked questions
Can acne scars be completely removed?
The realistic goal is improvement in appearance and texture, not guaranteed erasure. Some people need more than one type of treatment, and reassessment between sessions helps guide the next step.
Will a facial treat deep acne scars?
A facial can address surface care but should not be expected to correct established deep depressions. Match the appointment to the depth and nature of the concern.
How do we measure progress?
Discuss consistent photographs, the specific scars being targeted and when the result should be reassessed. Early swelling can temporarily soften a depression and should not be mistaken for lasting improvement.
Plan your visit
Acne-scar treatment is often staged. Bring a list of prior acne treatments and procedures so the plan can account for active acne, scar type, skin tone, downtime, and the possibility of combining techniques over time.
Who performs this treatment?
Your care is provided by Borealis Dermatology clinicians with experience in medical and aesthetic dermatology. Depending on the treatment and office, this may include Navin S. Arora, DO, FAAD, Lydia Lee, MSPA, PA-C, Luke Renda, MSPA, PA-C, Elaine Lai, MSPA, PA-C, and Pamela Lachs, MSPA, PA-C. Specific procedure availability varies by clinician and location; our team will match your request to the appropriate provider when scheduling.