How to get rid of acne scars: flat marks fade on their own, but sunken scars need treatment matched to their shape. What works, including dark skin.
To get rid of acne scars, first check that they're scars, because flat marks fade on their own and dents don't. True sunken scars need a procedure matched to their shape, and the realistic goal is a scar you notice less, not one that vanishes.
If you've spent months on brightening serums and the spots on your cheeks look the same, the product may not be the problem. It may be that the thing you're treating is a dent, and no serum reaches a dent. Or it's a flat mark that would have faded anyway, slowly, while you paid for something to speed it up.
Is It an Acne Scar or a Dark Spot?
Run a finger over it and look at it in side light. A flat mark is discoloration, and a dip or a raised bump is a scar. That one check decides almost everything else in this article.
The American Academy of Dermatology (AAD) describes the flat kind as a spot that can be pink, red, purple, black, or brown. It says these marks are often mistaken for permanent scars. Unlike scars, they eventually clear on their own, though some last a year or longer, and the darker the spot, the longer it takes.
These flat marks are called post-inflammatory hyperpigmentation. On darker skin, the AAD says such spots can last much longer than the acne did. Why acne marks last longer on dark skin covers how to fade them. The rest of this is about dents and bumps.
Plenty of faces have both at once. A dent with a brown ring around it needs two plans: one for the shape and one for the color. Treating only the color leaves the dent behind.
What Kind of Acne Scar Do I Have?
Most acne scars are sunken, and the shape of the dent tells you which tools can reach it. A 2022 review of non-energy treatments in Clinical, Cosmetic and Investigational Dermatology sorts atrophic (sunken) scars into three shapes.
- Ice pick scars are narrow and V-shaped, under 2 mm across, and can run through the full thickness of the skin's middle layer.
- Boxcar scars are round dips with steep walls and a flat floor, about 1 to 4 mm wide.
- Rolling scars are the widest, at 4 to 6 mm, but shallow. They make skin look wavy in side light.
Drawing on older work from 2001, the same review puts ice pick scars at about 60% of sunken scars. That matters, because ice pick scars are also the type that responds least to the popular options. Raised scars are a separate group, and the AAD says they're more common in people who have darker skin tones.
Why Creams Don't Fix Sunken Scars
A sunken scar forms when the skin makes too little collagen while it heals a deep breakout. The AAD says treatment for these scars works by getting the body to make more collagen to fill the dip. A cream sits on the surface, and the missing collagen sits underneath.
There's one exception for very shallow scarring. The AAD says that for mild scarring, a retinoid or salicylic acid can make scarring less noticeable. That's the ceiling for home care. Deep ice pick and boxcar scars need a dermatologist.
One prescription retinoid, trifarotene, may do more than smooth texture, though the evidence is limited. A 24-week trial took 121 people in their late teens to mid-30s with moderate to severe acne, about 73% of them women. Each used trifarotene on one side of the face and a plain gel on the other. The scar count fell by about six on the treated side and about three on the other, roughly 55% versus 30%.
That study was sponsored by the drug's maker. About 80% of participants were white, and about a third had darker skin types. It also ran on faces that were still breaking out, so it can't separate fading old scars from preventing new ones. For dark skin, using a retinoid without irritation matters, because irritated skin can darken.
The Mayo Clinic advises avoiding topical retinoids during pregnancy, even though only small amounts are absorbed. Oral isotretinoin is known to cause birth defects. It must not be taken during pregnancy or while trying to conceive. If you're pregnant or planning to be, check with your doctor before using any retinoid.
Which Acne Scar Treatment Works for Which Scar?
Match the tool to the shape, because each one works at a different depth. The 2022 review is blunt about this: some of the best-known treatments barely touch ice pick scars.
| Scar type | What tends to help | What tends not to |
|---|
| Ice pick | Repeated sessions of TCA CROSS, a strong acid placed only inside each scar. Punch excision for deep ones. | Fillers and microneedling show little improvement. |
| Boxcar | Shallow: microneedling, light peels. Deep: punch elevation or excision. The AAD says lasers are also used. | Home creams beyond very mild texture. |
| Rolling | Subcision, fillers, microneedling. | Peels alone help only partly, because they can't release the bands pulling the skin down. |
| Raised | Steroid injections, lasers, prescription medicine on the scar. | Treatments built for dents. |
For ice pick scars, the review says the most consistent results come from multiple sessions of TCA or phenol CROSS. CROSS stands for chemical reconstruction of skin scars. Deeper ice pick scars may need stronger acid, sometimes above 50% TCA, though lower strengths can work with fewer complications. This is a job for a dermatologist, never a home kit.
Rolling scars are tethered to deeper tissue by bands that pull the surface down. The review calls subcision the only approach with the mechanical force to break those tethers. A dermatologist slides a needle or blade under the scar to cut them, so the skin can lift.
Microneedling, used on its own, worked best on rolling scars, then boxcar, with little change in ice pick scars. Fillers add volume and work best on rolling scars. The AAD says most fillers give results lasting 3 months to 2 years, and most fillers need a series of treatments.
For raised scars, the AAD lists lasers, steroid or other injections, and prescription medicine applied to the scar. Keloids may need injections, laser, surgery or freezing, often combined.
How Do You Treat Acne Scars on Dark Skin?
Most treatments still work on brown and Black skin, but the settings, the number of sessions and the aftercare change. The main extra risk is a new dark patch left on top of the scar.
A 2023 review in the Journal of Cosmetic Dermatology looked at lasers and radiofrequency microneedling for acne scars in skin types IV to VI. It found both ablative and non-ablative lasers effective in darker skin. The chance of dark patches afterward depended on skin type, the device, the energy used and, most of all, how densely the laser treated the skin.
Non-ablative fractional lasers were the first choice for safety, but they're less effective than ablative lasers and need more sessions. That trade is worth knowing before you book, because more sessions means more cost and more appointments. The review also found that evidence for radiofrequency microneedling was limited but promising, and that skin types V and VI need head-to-head studies.
The AAD says microneedling, radiofrequency and radiofrequency microneedling are safe for all skin tones. For peels, the 2022 review says the risk of dark marks rises with skin types IV to VI. It adds that this darkening is usually temporary and can often be prevented with hydroquinone used before and after the peel, as your dermatologist directs.
Sun protection is part of the treatment, not an extra. The AAD says protecting your skin from the sun before a peel helps prevent discolored skin afterward. Sunscreen for dark skin covers which formulas suit darker skin.
Keloid Risk Before Any Procedure
If you've ever had a keloid, say so before anyone touches your face with a needle, laser or blade. The AAD lists African, Asian, or Latin-American descent as a keloid risk factor, along with being 10 to 30 years old and pregnancy.
About a third of people with keloids have a parent, sibling or child who gets them too. The AAD also lists acne and surgery among the things that can trigger a keloid. Keloids most often form on the earlobes, jawline, chest, upper back and shoulders.
This is why acne on the jaw and chest deserves early treatment when keloids run in your family. The AAD warns that people with skin of color are more likely to develop keloids when moderate to severe acne goes untreated.
How to Choose Who Treats Your Acne Scars
Book a board-certified dermatologist rather than a spa, especially for lasers, deep peels and subcision. The AAD recommends seeing a dermatologist before any peel, microdermabrasion or laser for acne. Its advice for darker skin is to ask how many people with skin of color the doctor has treated.
Ask these questions at the consultation:
- Which of these marks are dents, which are raised, and which are flat marks that will fade?
- Which treatment matches each type, and how many sessions is that likely to take?
- What settings suit this skin type, and how will the risk of dark patches be lowered?
- Is it worth starting sun protection or a prescription cream before the first session?
- How much downtime is there, and what does the full course cost?
In the US, the AAD says medical insurance does not cover the cost, so ask about the full price upfront. Most plans are a series. Mild peels, for example, usually take 3 to 5 treatments spaced 2 to 4 weeks apart.
Isotretinoin and Scar Treatment: What to Tell Your Dermatologist
If you've taken isotretinoin, tell your dermatologist when you stopped. The AAD advises mentioning any acne treatment used in the last two years. It warns that starting some scar treatments while using, or soon after stopping, certain acne medicines can cause unwanted side effects.
The evidence on timing isn't settled. The 2022 review describes case reports from 1986 of keloid scars in six people who had recently taken isotretinoin before dermabrasion. A 2010 study of seven people found no raised scarring, and the review calls the question unclear.
A 2017 expert consensus in JAMA Dermatology reviewed 32 publications. It found no good reason to delay light peels or fractional lasers. It advised against mechanical dermabrasion and fully ablative lasers while taking isotretinoin.
Can You Prevent New Acne Scars?
Yes, mostly by treating acne early and leaving it alone. The AAD says scar treatment usually begins once acne is under control, because new breakouts mean new scars. Deep, painful cysts and nodules carry the highest risk.
The AAD says picking, popping or squeezing raises your risk of scarring. Genes matter too: a close blood relative with acne scars makes you more likely to scar. If your breakouts are deep or keep coming back, hormonal acne may be part of the picture.
When to See a Doctor About Acne Scars
See a dermatologist if new scars keep forming, if your acne is deep and painful, or if over-the-counter treatment hasn't helped. Go sooner if keloids run in your family and you're breaking out on your jaw, chest or back.
See a doctor promptly if a scar grows, bleeds or changes color, since that doesn't fit an old acne scar. After any procedure, call the clinic about spreading redness, heat, pus, fever or pain that's getting worse.
Frequently Asked Questions
Do Acne Scars Go Away on Their Own?
Flat marks do, though the AAD says some take a year or longer. Sunken and raised scars don't fully go away. Treatment can make them much less noticeable.
Can Acne Scars Be Completely Removed?
Rarely. The AAD describes treatment as making scars less noticeable. Deep ice pick scars are the hardest to shift, and many people need several sessions or a mix of treatments.
Is Microneedling Safe for Acne Scars on Dark Skin?
The AAD says microneedling is safe for all skin tones. It works best on rolling and boxcar scars and does little for ice pick scars.
This article is for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making changes to your health routine.
