Published on: October 15, 2026
Updated on: October 15, 2026
Written and source checked by: Adel Galal, Founder and Lead Writer at NextFitLife
If acne has left dents, small holes, or broad dips in your skin, the first step is not choosing a laser or buying a stronger cream. The first step is finding out what type of scar you have.
Pitted acne scars treatment works best when the treatment matches the structure of the scar. A deep narrow ice pick scar, a sharp boxcar scar, and a rolling scar pulled downward by fibrous tissue are different problems, so they should not all be treated the same way.
This article is for general information and education. It does not replace medical advice, diagnosis, or treatment.
If you still have deep, painful, or frequent breakouts, treat the active acne first. New inflammation can create new scars while you are trying to repair old ones.
For a wider skin health foundation, read the NextFitLife Healthy Skin 101 guide.
Table of Contents
- What pitted acne scars really are
- Scars versus flat acne marks
- Why collagen changes matter
- The 3 main pitted scar types
- Ice pick scars
- Boxcar scars
- Rolling scars
- What to treat first
- 9 professional treatment options
- Microneedling
- Radiofrequency microneedling
- Subcision
- TCA CROSS
- Chemical peels
- Laser resurfacing
- Dermal fillers
- Punch techniques
- Dermabrasion
- What skincare can and cannot do
- Darker skin tones and pigmentation risk
- How to choose treatment by scar type
- What to avoid
- When to see a dermatologist
- Frequently asked questions
What Are Pitted Acne Scars?
Pitted acne scars are depressions that sit below the surrounding skin.
The medical term is atrophic acne scars. They form when healing after acne does not replace enough of the tissue and collagen lost during inflammation.
The American Academy of Dermatology explains that depressed scars form when the skin produces too little collagen while healing.
This is why a true pit behaves differently from a dark spot.
A flat mark is not the same as a pit
After a pimple clears, you may see a brown, gray, purple, pink, or red area.
If the skin surface remains flat, you may be looking at post-inflammatory pigment or redness rather than a structural scar.
Post-inflammatory hyperpigmentation creates flat darker marks. Post-inflammatory erythema creates flat pink, red, or purplish marks.
Neither is automatically a pitted scar.
This distinction saves time because pigment treatment cannot physically raise a deep depression.
If redness is the main problem, read our Post Inflammatory Erythema Acne guide.
The 3 Main Types of Pitted Acne Scars
Most depressed acne scars fall into three broad groups: ice pick scars, boxcar scars, and rolling scars.
Many people have more than one type at the same time.
| Scar Type | Typical Look | Main Structural Issue | Options Often Considered |
|---|---|---|---|
| Ice pick | Small, narrow, deep opening | Deep vertical scar tract | TCA CROSS, punch procedures, selected resurfacing combinations |
| Boxcar | Round or oval depression with clearer edges | Loss of tissue at different depths | Microneedling, laser, selected peels, punch methods, fillers in selected cases |
| Rolling | Broad, soft edged waves or dips | Fibrous bands may pull the skin downward | Subcision, fillers, microneedling, resurfacing |
| Mixed | Several scar patterns together | More than one structural problem | A staged combination plan |
Ice pick scars are narrow and deep
An ice pick scar can look like a tiny opening in the skin, yet the scar may extend much deeper than that opening suggests.
This is why a surface treatment may not be enough.
A shallow resurfacing procedure can smooth the skin around the scar without fully addressing the deeper tract.
Boxcar scars have more visible edges
Boxcar scars are usually wider than ice pick scars. They often look like round or oval craters with clear sides.
Some are shallow and respond better to resurfacing. Others are deeper and may need a more targeted method.
Rolling scars can be tethered underneath
Rolling acne scars create broad dips or waves.
The important part can sit beneath the surface. Fibrous tissue may pull the scar downward and hold it there.
That explains why a treatment that only resurfaces the top layer may leave part of the depression unchanged.
Treat Active Acne Before Chasing Old Scars
This step is easy to skip because people naturally want to repair the scars they already see.
But if active acne is still creating deep inflammation, new scars can continue to form.
Current American Academy of Dermatology guidance says scar treatment usually begins after active acne is under control and the person is using treatment to help prevent new breakouts.
If acne is appearing on your back too, see the NextFitLife Back Acne guide.
Signs you should focus on acne control first
- Deep painful nodules or cysts are still appearing.
- New pits keep developing.
- You are frequently picking or squeezing pimples.
- Your routine causes strong irritation and peeling.
- You are not yet using an effective acne treatment plan.
If your skin is irritated from too many products, our Damaged Skin Barrier guide explains how to simplify the routine safely.
9 Effective Pitted Acne Scars Treatment Options
There is no single best procedure for every pitted scar.
The most useful way to compare treatments is to ask what physical problem each one is trying to solve.
1. Microneedling
Microneedling for acne scars uses fine needles to create controlled injuries in the skin. Healing then encourages new collagen and elastin production.
The American Academy of Dermatology includes microneedling among treatments for depressed acne scars and states that it can be used across skin tones.
Microneedling may make sense for selected shallow or broader atrophic scars, but it does not perform every job.
For example, it does not mechanically release a strong fibrous band beneath a tethered rolling scar.
2. Radiofrequency Microneedling
Radiofrequency microneedling combines needles with radiofrequency energy delivered into the skin.
AAD lists radiofrequency and radiofrequency microneedling as options used to stimulate collagen and elastin in acne scar treatment.
This can be useful when a dermatologist wants controlled collagen remodeling at deeper levels.
Device type, needle depth, energy settings, scar shape, and skin tone still matter.
3. Subcision
Subcision for acne scars is especially relevant when rolling scars are tethered below the surface.
During subcision, a clinician passes a suitable instrument beneath the scar and releases fibrous attachments.
Think of a piece of fabric being pulled downward by a thread. Polishing the top of the fabric does not cut the thread.
That is why subcision can make more structural sense than repeated surface treatment for a truly tethered scar.
A dermatologist may combine subcision with filler, microneedling, radiofrequency, or resurfacing when another problem remains after release.
4. TCA CROSS
TCA CROSS stands for chemical reconstruction of skin scars.
A clinician places a small amount of high concentration trichloroacetic acid directly into selected scars. The aim is to trigger a local healing response and new collagen formation.
DermNet lists the technique for atrophic acne scars, including ice pick scars.
5. Chemical Peels
Chemical peels for acne scars vary widely in depth and strength.
A mild peel is not the same treatment as a deeper medical peel.
AAD explains that chemical peeling can support collagen and elastin production and may make depressed scars less noticeable.
Shallow texture may respond differently from a deep narrow pit, so the word “peel” alone does not tell you whether it is the right option.
6. Laser Resurfacing
Laser resurfacing for acne scars can smooth selected scars and stimulate collagen as the skin heals.
The phrase “laser treatment” covers many different devices.
They differ in wavelength, depth, energy, whether they remove surface tissue, recovery time, and risk of pigment change.
This matters even more in skin with more melanin.
The better question is not simply, “Does laser work?”
Ask: “Which laser is being used, why does it match my scars, and how will my skin tone affect the settings and risk?”
7. Dermal Fillers
Dermal fillers for acne scars add volume beneath selected depressions.
They can help when raising the base of a scar makes structural sense.
AAD notes that several filler materials are used for depressed scars and that many provide temporary results.
A filler is not a logical solution for every scar. A narrow deep ice pick tract is very different from a broad depression that lacks volume.
Fillers may also be used after subcision when some volume loss remains.
8. Punch Techniques
Some deep scars are treated one by one.
Punch excision and related scar surgery techniques use a small surgical instrument to remove or alter an individual scar.
This can make sense for a sharply defined deep scar that is unlikely to respond enough to surface resurfacing alone.
The aim is not to pretend the skin was never scarred. It is to replace a deep and obvious depression with a flatter, less visible scar.
9. Dermabrasion
Dermabrasion is a medical resurfacing procedure that removes deeper surface layers than ordinary home exfoliation.
AAD includes dermabrasion among procedures used to smooth depressed acne scars and stimulate new collagen and elastin during healing.
Do not confuse dermabrasion with microdermabrasion.
AAD states that microdermabrasion does not treat the actual acne scar. It may improve skin tone and support the appearance of other treatment results.
Why Combination Treatment Often Makes More Sense
One face can contain several scar types at once.
You might have a deep ice pick scar near the temple, a shallow boxcar scar on the cheek, broad rolling scars lower down, and brown post acne marks around all of them.
One procedure cannot logically perform every job.
A dermatologist may therefore create a staged plan in which each treatment has a specific purpose.
| Problem | Treatment Goal | Possible Approach |
|---|---|---|
| Active acne | Prevent more inflammation and new scars | Evidence based acne treatment |
| Deep ice pick scar | Treat the individual deep tract | TCA CROSS or punch technique |
| Tethered rolling scar | Release fibrous attachment | Subcision |
| Shallow texture | Remodel collagen and smooth surface | Microneedling, laser, selected peels |
| Volume loss | Raise selected depressions | Filler in suitable scars |
| Flat dark marks | Reduce excess pigment | Pigment directed skin care or professional treatment |
| Flat red marks | Reduce persistent redness | Separate assessment and vascular treatment when appropriate |
Can Skincare Remove Pitted Acne Scars?
Deep established pits usually need more than skincare.
That is one of the most useful expectations to set early.
AAD states that retinoids or salicylic acid may make mild acne scarring less noticeable. Mayo Clinic also lists home care such as sunscreen, azelaic acid, and hydroxy acids as ways to improve the appearance of some acne scarring.
But a topical cream cannot physically cut a tether beneath a rolling scar or remove a deep scar tract.
Skincare still has an important job.
A useful routine can help you
- Control active acne.
- Reduce new breakouts.
- Manage some flat post acne marks.
- Protect skin from ultraviolet exposure.
- Reduce irritation before a procedure.
- Support healing when your dermatologist gives aftercare instructions.
For simple daily care, see Healthy Skin 101.
Does Retinol Help Pitted Acne Scars?
Retinol for acne scars is often oversold.
Topical retinoids are useful acne medicines, and AAD says a retinoid can make mild scarring less noticeable.
That does not make a retinoid equal to subcision, surgical scar treatment, or targeted resurfacing for a deep depression.
If a scar is shallow, skin texture may improve enough to look smoother over time. If it is deep or strongly tethered, a cream has a much smaller structural role.
Also tell your dermatologist which retinoids, acne medicines, peels, or other active treatments you use before a professional procedure.
What About PRP?
Platelet rich plasma, or PRP, is sometimes combined with treatments such as microneedling.
AAD notes that PRP may be used to enhance the results of another procedure rather than act as the main scar correction on its own.
This is how I would think about it.
Do not start by asking whether a clinic sells PRP. Start by asking what scar structure needs treatment. Then ask whether PRP adds something useful to that plan.
What Should People With Darker Skin Know?
People with medium and deep skin tones can receive acne scar treatment.
The plan simply needs to respect the skin's tendency to develop pigment change after inflammation.
Post inflammatory hyperpigmentation may become more noticeable after an irritating procedure, especially when treatment causes too much inflammation for that person's skin.
This does not mean laser, microneedling, or peeling is automatically unsafe.
It means the device, depth, energy, preparation, aftercare, and clinician's experience with your skin tone matter.
Questions worth asking:
- How often do you treat acne scars in my skin tone?
- What is my risk of darker or lighter patches afterward?
- How will you reduce that risk?
- Do I need skin preparation before treatment?
- What should I do if pigmentation appears during healing?
Can You Microneedle Acne Scars at Home?
I would not treat a home dermaroller as a substitute for professional microneedling.
A professional controls treatment depth, device technique, hygiene, scar selection, and aftercare.
At home, people can be tempted to press harder, repeat treatment too often, treat inflamed acne, or apply irritating products immediately afterward.
If your goal is improving visible pitted scars, a professional scar assessment can save months of treating the wrong problem.
What Should You Avoid?
Do not pick active acne
Picking, popping, scratching, or squeezing acne increases inflammation and can raise the risk of scarring.
If you tend to touch deep pimples, read our guide to Pimple Patches on Cystic Acne for safer ways to protect a lesion from picking.
Do not copy professional acid treatments at home
A strong chemical treatment can create a chemical burn, pigmentation, infection risk, or a new scar when used incorrectly.
More acid does not mean faster scar repair.
Do not keep increasing irritation
Burning, rawness, painful peeling, and swelling are not signs that a routine is “working harder.”
If your skin becomes damaged from too many active products, simplify the routine and read our Damaged Skin Barrier guide.
Do not choose a treatment because it is trending
A popular machine is still the wrong machine if it does not match your scar.
Diagnosis comes first.
How Long Does Pitted Acne Scar Treatment Take?
There is no single timeline.
Some procedures produce swelling or an early visual change quickly, while collagen remodeling takes longer.
Several treatments also require more than one session.
Your timeline depends on scar type, scar depth, number of scars, treatment choice, healing speed, downtime, and whether several procedures are being staged.
That is why a promise such as “all acne scars gone in one treatment” deserves skepticism.
Can Pitted Acne Scars Completely Disappear?
Complete removal should not be the promise.
AAD explains that acne scars can become less noticeable, but established depressed scars rarely disappear completely on their own.
Professional treatment aims to improve texture, soften edges, lift depressions, release tethering, or make scars less visible.
The better goal is meaningful improvement, not perfect unscarred skin.
How Do You Choose Treatment by Scar Type?
This is the decision framework I would use before discussing brands or devices.
If the scar is very narrow and deep
Ask whether it behaves like an ice pick scar. A dermatologist may discuss a targeted technique such as TCA CROSS or a punch procedure.
If it has clear sides and a broad base
It may be a boxcar scar. Depth matters. A shallow scar and a deep scar may need different treatment.
If the skin looks wavy or pulled down
Ask whether the scar is tethered. Subcision may make more sense when fibrous bands are holding the skin down.
If the texture is shallow and widespread
Collagen remodeling methods such as microneedling, radiofrequency microneedling, selected lasers, or peels may be discussed.
If there is volume loss
A dermatologist may consider a dermal filler for selected depressions.
If you have several scar types
Expect a combination plan rather than one treatment for the entire face.
When Should You See a Dermatologist?
You do not need to wait until your scars are severe.
Consider professional assessment if:
- You have obvious deep pits.
- You have rolling or wavy scars that appear tethered.
- You have several scar types.
- Active acne is still causing new scars.
- Your acne treatment is not controlling deep breakouts.
- Home skincare has reached its limit.
- You are considering laser, TCA CROSS, subcision, filler, or another procedure.
- You have darker skin and are concerned about pigment changes after treatment.
- You are not sure whether you have scars, pigmentation, redness, or a mixture.
- Your scarring is affecting confidence, work, relationships, or daily life.
Scarring acne deserves proper care rather than months of random product testing.
What Should You Ask at an Acne Scar Consultation?
Start with scar type, not the name of a machine.
- What scar types do I have?
- Which scars are ice pick, boxcar, or rolling?
- Are any scars tethered underneath?
- Do I need better acne control before treatment?
- Which procedure is meant to treat which scar?
- Why are you recommending this procedure for my skin tone?
- What improvement is realistic?
- How much downtime should I expect?
- What are the pigment and scarring risks?
- Will I need several treatment stages?
- Which skincare products should I stop before treatment?
- What should I use while the skin heals?
If a clinic recommends several procedures, you should understand what job each procedure is meant to perform.
Conclusion: Choose the Treatment That Matches the Scar
The most useful lesson about pitted acne scars treatment is that the shape of the scar matters more than the popularity of the procedure.
An ice pick scar, a boxcar scar, and a tethered rolling scar are different structural problems. A brown mark is different again.
Your next step is simple: control active acne, stop picking, use gentle daily skin care, and book a dermatologist assessment if the pits still bother you. Ask the dermatologist to identify each scar type before discussing treatment packages.
That one question can help you avoid spending money on a procedure that was never designed for your main scar type.
References and Sources
- American Academy of Dermatology. Acne scars: Consultation and treatment.
Covers individualized scar assessment, acne control before scar treatment, microneedling, radiofrequency, fillers, laser treatment, peels, dermabrasion, scar surgery, and combination care.
https://www.aad.org/public/diseases/acne/derm-treat/scars/treatment - American Academy of Dermatology. Acne scars: Signs and symptoms.
Explains depressed acne scars and the differences between ice pick, boxcar, and rolling scars.
https://www.aad.org/public/diseases/acne/derm-treat/scars/symptoms - DermNet. Acne Scarring.
Clinical overview of atrophic scars, scar classification, pigmentation, and treatment approaches.
https://dermnetnz.org/topics/acne-scarring - DermNet. TCA CROSS.
Explains chemical reconstruction of skin scars and its use for selected atrophic acne scars.
https://dermnetnz.org/topics/tca-cross - Mayo Clinic. Acne scars: What's the best treatment?
Reviews home care, fillers, laser resurfacing, needling, surgery, peels, and other treatment options based on scar and skin type.
https://www.mayoclinic.org/diseases-conditions/acne/expert-answers/acne-scars/faq-20058101
Internal Links and Helpful NextFitLife Guides
- Healthy Skin 101: Simple Daily Habits
- Post Inflammatory Erythema Acne Guide
- Back Acne Treatment Guide
- Damaged Skin Barrier: Signs and Recovery
- Pimple Patches on Cystic Acne
- Non Comedogenic Skincare Meaning
About the Author
Adel Galal is the Founder and Lead Writer at NextFitLife. He researches health, fitness, skin care, nutrition, wellness, and healthy aging topics and turns published guidance into clear, practical information for everyday readers.
I am not a dermatologist or a doctor, and this content does not replace professional medical advice. What I share comes from real life experience, extensive research, and consultation with healthcare providers. Always consult qualified medical professionals for diagnosis and treatment of any health condition.
Learn more about the author, editorial approach, and NextFitLife mission on the About Us page.
Frequently Asked Questions
What is the best treatment for deep pitted acne scars?
There is no single best treatment. Deep ice pick scars may need a targeted method such as TCA CROSS or a punch procedure, while tethered rolling scars may respond better to subcision. Scar type should be identified before treatment is chosen.
Can retinol remove pitted acne scars?
Retinoids may make mild acne scarring less noticeable and can help control active acne, but they cannot mechanically release a tethered scar or remove a deep scar tract.
Is microneedling good for pitted acne scars?
Microneedling can help selected depressed acne scars by encouraging collagen and elastin production. Deep ice pick scars and strongly tethered rolling scars may need another procedure as well.
Can pitted acne scars heal naturally?
They may become less noticeable with time, but established depressed scars rarely disappear completely on their own. Professional treatment can improve their appearance.
Is laser better than microneedling for acne scars?
Neither is best for everyone. The better choice depends on scar type, depth, skin tone, downtime, risk of pigmentation, device settings, and treatment goals.
Does subcision permanently remove rolling scars?
Subcision releases fibrous attachments beneath selected rolling scars. Improvement can last, but no procedure guarantees complete or permanent scar removal, and other treatment may be needed for remaining texture or volume loss.
Can acne scar treatment make scars worse?
Yes, complications are possible. Depending on the procedure, risks can include irritation, pigment change, infection, burns, prolonged redness, or additional scarring. Proper patient selection and professional technique reduce risk.
Does TCA CROSS work for ice pick scars?
TCA CROSS is commonly used for selected atrophic scars, including ice pick scars. It should be performed by a trained professional because high concentration acid can injure normal skin.
Can skincare fill deep acne scars?
No cream can physically lift every deep depression. Skincare can help active acne, mild texture, pigmentation, sun protection, and skin health, but deeper structural scars often need procedures.
Should active acne be treated before scars?
Usually, yes. Controlling active acne helps reduce the chance of forming new scars while older scars are being treated.
Health & wellness writer with 30+ years of experience in nutrition, fitness, and healthy aging. Founder of NextFitLife.com — evidence-based health guidance.
