How to treat acne scarring? A Systematic Summary

by Dr Haroon Ahmad

Introduction

Acne scarring affects millions of people worldwide, often lasting long after breakouts clear up. Unlike temporary red marks that fade over time, acne scars are permanent changes to your skin that require specific treatments.

The biggest challenge? Figuring out what actually works. Between drugstore shelves packed with products, social media influencers promoting the latest trends, and expensive dermatologist procedures, it’s overwhelming to know where to start or what to trust.

How This Systematic Summary Works

We are a team of physicians who have become frustrated with the complexity and level of disinformation within dermatology. We’ve created these Systematic Summaries to provide evidence-based information on various topics.

Here’s how it works:

We gather academic research papers and analyze advice from Reddit, TikTok, and other platforms
We’ll independently analyze each recommendation and provide a grading on the strength of the evidence.
We collate these insights and research into these systematic summaries.

You’ll be able to find our full methodology here.

How It Should Be Used

Know what you want? Search for your specific treatment (Ctrl+F or Cmd+F) to jump straight to the evidence
Starting from scratch? Read through the explanation below about different scar types and explore our treatment guides to understand the right therapy. You can then search the specific treatment (Ctrl+F or Cmd+F) to read the detailed research summaries for that therapy.

What Are Acne Scars?

Acne scars are permanent marks left when pimples heal badly. They’re different from temporary dark spots or redness that fade over months.

How they form: When deep pimples damage your skin, your body tries to fix it with collagen (like internal scar tissue). Sometimes this repair goes wrong:

Too little collagen = sunken scars (most common)
Too much collagen = raised, thick scars

Risk factors:

Picking or squeezing pimples
Deep, inflamed acne (cysts and nodules)
Genetics (some people scar more easily)
Delayed treatment of severe acne

Types of Acne Scars

Post-Inflammatory Hyperpigmentation (PIH):

Dark spots or patches left behind after acne heals
Brown, black, or dark red discoloration
More common in darker skin tones
Affects the top layer of skin (epidermis)

Post-Inflammatory Erythema (PIE):

Red or pink marks left behind after acne heals
Caused by dilated or damaged capillaries
More common in lighter skin tones
Affects deeper layers of skin (dermis)

Indented/Atrophic Scars:

Ice pick: Deep, narrow holes (look like tiny puncture wounds)
Boxcar: Wide, square-shaped dents with sharp edges
Rolling: Broad, wave-like dips in the skin

Raised Scars:

Hypertrophic: Thick, raised bumps that stay within the original wound area
Keloid: Thick scars that grow beyond the original wound (more common in darker skin)

Treatment Guidance

Post-Inflammatory Hyperpigmentation (PIH)

1. Foundational Skincare

Sunscreen

What it does, who it’s for, why it’s recommended: Sunscreen blocks the UV rays that trigger melanin production, which prevents brown spots from forming or getting darker. It is an essential daily step for anyone with acne or post-acne marks.
Product examples: EltaMD UV Clear Broad-Spectrum SPF 46, Beauty of Joseon - Relief Sun : Rice + Probiotics SPF50+
Clinical basis: Daily sunscreen use is described as essential for preventing post-inflammatory hyperpigmentation. Its protective mechanism allows other brightening treatments to work more effectively and lets marks fade naturally without being re-darkened by sun exposure. The EltaMD UV Clear is highlighted for containing niacinamide, an ingredient shown in a clinical trial to significantly decrease hyperpigmentation.

Brightening Serums (Niacinamide, Vitamin C, Tranexamic Acid)

What it does, who it’s for, why it’s recommended: These serums contain active ingredients that fade dark spots and even out skin tone. Niacinamide strengthens the skin barrier, Vitamin C is a powerful antioxidant that brightens, and Tranexamic Acid targets stubborn discoloration. They are for individuals whose primary concern is brown or dark spots.
Product examples: The Ordinary Niacinamide 10% + Zinc 1%, Good Molecules Discoloration Correcting Serum, Goodal Green Tangerine Vita-C Dark Spot Care Serum
Clinical basis: A systematic review concluded that topical Vitamin C is an effective and safe treatment for fading post-inflammatory hyperpigmentation from acne. A clinical trial found that a 2% topical niacinamide formula significantly decreased dark spots after 4 weeks of use. Tranexamic acid is praised by users for being a gentle yet effective option for discoloration.

Alpha Hydroxy Acids (AHAs)

What it does, who it’s for, why it’s recommended: AHAs (like glycolic acid) exfoliate the skin’s surface, speeding up cell turnover to shed pigmented cells and lighten dark spots. They are best for individuals with PIH and minor surface texture issues.
Product examples: The Ordinary Glycolic Acid 7% Toning Solution, Dr. Dennis Gross Alpha Beta® Universal Daily Peel
Clinical basis: A study on 45 patients with atrophic acne scars found that a series of 35% glycolic acid peels performed every two weeks showed a good-to-excellent improvement in scars for over 90% of participants, which includes an effect on associated pigmentation.

2. Targeted Topicals

Azelaic Acid

Mechanism in plain English: It calms inflammation and directly blocks the enzyme your skin uses to produce excess pigment, making it highly effective at fading brown spots.
Who it works best for: Patients dealing with both active acne and the stubborn brown marks it leaves behind. It’s an excellent choice for sensitive skin.
When to use it in the journey: As a primary daily treatment, morning or night, to both prevent and treat discoloration.
Product examples: The Ordinary Azelaic Acid Suspension 10% (OTC), Finacea 15% Gel (Rx)
Clinical basis: Rated as ‘Excellent’ for fading dark marks, based on overwhelmingly positive user reports and its established dual mechanism of action on inflammation and pigment production.

Topical Retinoids (Tretinoin)

Mechanism in plain English: It speeds up skin cell turnover, which helps shed discolored surface cells and stimulates new collagen.
Who it works best for: Patients with post-inflammatory hyperpigmentation who also have textural concerns or active acne.
When to use it in the journey: As a long-term, nightly treatment to be started once the skin barrier is healthy and any active inflammation is under control.
Product examples: Altreno (tretinoin) Lotion 0.05%, generic tretinoin creams and gels
Clinical basis: Tretinoin works by increasing the rate of skin cell turnover, which helps shed discolored surface cells. It is also well-established for controlling the active acne that leads to new marks.

Hydroquinone

Mechanism in plain English: A powerful skin-lightening agent that works by significantly decreasing the production of melanin (pigment) in the skin.
Who it works best for: Individuals with stubborn brown spots that have not responded to other topical treatments.
When to use it in the journey: As a short-term (3-4 month) treatment under strict medical supervision after other options have failed. It is often used to “prime” the skin before a procedural treatment.
Product examples: Prescribed as a generic compound or as part of a blend like Tri-Luma.
Clinical basis: Multiple studies have successfully used a pre-treatment regimen of topical tretinoin and hydroquinone (2-4%) for at least two weeks before TCA CROSS peels, finding it reduced complications like PIH, especially in patients with darker skin.

3. Systemic Support (if applicable)

Hormonal Therapies (Spironolactone)

Mechanism in plain English: This oral medication for women blocks the effects of male hormones (androgens) on the skin’s oil glands, preventing the deep, inflammatory acne that often leads to significant PIH.
Who it works best for: Women with persistent, hormonally-driven acne.
When to use it in the journey: As a long-term preventative measure to stop the cycle of new breakouts that cause stubborn discoloration. It does not treat existing marks but stops new ones from forming.
Product examples: Prescription-only Spironolactone (generic) or Aldactone.
Clinical basis: A 2017 systematic review of 10 studies found that spironolactone consistently improved acne in women. By controlling inflammatory acne, it creates a stable foundation for other topical and procedural treatments to work effectively on existing PIH.

4. Procedural Options

Chemical Peels

Mechanism in plain English: A chemical solution is applied to the skin to remove the top, pigmented layers, promoting the growth of new, evenly-toned skin.
Who it works best for: Patients with PIH and shallow textural scars. Caution is needed for darker skin tones due to a higher risk of complications.
When to use it in the journey: When topical treatments alone are not sufficient. A series of superficial peels can significantly lighten discoloration.
Product examples: This is a professional-only procedure.
Clinical basis: Superficial chemical peels are considered a safe and effective treatment for atrophic acne scars and associated discoloration, with relatively few side effects.

Laser Therapies (Picosecond, BBL/IPL)

Mechanism in plain English: These devices use light energy to target and shatter the excess pigment in dark spots without damaging the surrounding skin.
Who it works best for: Patients with stubborn brown spots that haven’t responded to topicals. Picosecond lasers are particularly good for darker skin tones.
When to use it in the journey: As an escalation from topical treatments for faster, more dramatic results.
Product examples: Professional devices include PicoSure (Picosecond Laser) and Sciton BBL (IPL).
Clinical basis: A trial comparing picosecond laser to an Er:YAG laser in Asian patients found the pico laser had a lower incidence of PIH. BBL/IPL is effective for targeting brown pigment from sun damage and PIH.

Bottom Line: The most effective strategy for PIH is combining daily, high-SPF sunscreen with a topical routine featuring a tyrosinase inhibitor (like Azelaic Acid or Tranexamic Acid) and a retinoid. For persistent marks, procedural options like chemical peels and picosecond lasers offer the best results.

Post-Inflammatory Erythema (PIE)

1. Foundational Skincare

Mineral Sunscreen

What it does, who it’s for, why it’s recommended: Creates a physical barrier to block UV rays, which prevents red marks from turning into permanent brown spots. The key ingredient, zinc oxide, also has a calming, anti-inflammatory effect on red, irritated skin. It’s ideal for those with sensitive, reactive, or inflamed acne-prone skin.
Product examples: SkinCeuticals Physical Fusion UV Defense SPF 50, Tower 28 Beauty SunnyDays SPF 30 Tinted Sunscreen
Clinical basis: User reports specifically highlight mineral sunscreens with zinc oxide as beneficial for post-acne red marks due to their perceived calming properties, in addition to the essential UV protection that prevents PIE from becoming PIH.

Soothing Moisturizers (Centella Asiatica, Snail Mucin)

What it does, who it’s for, why it’s recommended: These ingredients calm inflammation, support skin barrier repair, and provide gentle hydration. They are excellent for reducing the redness associated with PIE and helping skin heal after a breakout. They are best for anyone with red marks or easily irritated skin.
Product examples: La Roche-Posay Cicaplast Baume B5+, COSRX Advanced Snail 96 Mucin Power Essence
Clinical basis: A split-face, randomized controlled trial with 25 participants found a cream with Centella asiatica significantly reduced skin redness post-laser (p<0.05). In a 12-week study on 48 patients, a regimen with snail secretion filtrate significantly reduced redness (erythema).

Redness-Reducing Serums (Niacinamide, Tranexamic Acid)

What it does, who it’s for, why it’s recommended: These serums contain ingredients clinically shown to reduce redness. Niacinamide calms inflammation and strengthens the skin barrier, while Tranexamic Acid interrupts the pathways that cause redness and visible blood vessels. They are for those with persistent red marks.
Product examples: The INKEY List Tranexamic Acid Night Treatment, The Ordinary Niacinamide 10% + Zinc 1%
Clinical basis: A 2019 study showed a serum containing 2% tranexamic acid was effective in reducing redness from acne. User reports recommend niacinamide for managing PIE due to its anti-inflammatory and barrier-supporting properties.

2. Targeted Topicals

Azelaic Acid

Mechanism in plain English: It has powerful anti-inflammatory properties that directly calm the redness and irritation that define PIE. It also helps clear acne, preventing new marks from forming.
Who it works best for: Patients whose primary concern is redness (PIE), especially those with active acne or rosacea.
When to use it in the journey: As a first-line daily treatment to target redness and prevent new marks.
Product examples: Paula’s Choice 10% Azelaic Acid Booster (OTC), Finacea 15% Gel (Rx)
Clinical basis: Rated as ‘Excellent’ in the source data, with strong user consensus confirming its ability to clear post-inflammatory erythema (red marks). Its primary mechanism is reducing inflammation, which directly targets the cause of PIE.

Calcineurin Inhibitors (Tacrolimus)

Mechanism in plain English: This prescription ointment suppresses the immune system’s inflammatory response in the skin, which can help calm the prolonged redness that leads to PIE.
Who it works best for: Patients with significant and persistent post-acne redness.
When to use it in the journey: As an off-label option to try when other topicals have failed to reduce redness, under a doctor’s supervision.
Product examples: Protopic (tacrolimus) Ointment.
Clinical basis: Evidence is weak. A 2023 review noted that tacrolimus ointment reduced acne-related redness, suggesting it might help prevent subsequent scarring, but the evidence was rated as poor. It does not treat existing texture and carries a “black box” warning. (FLAG: Weak evidence)

3. Systemic Support (if applicable)

Oral Antibiotics (Doxycycline)

Mechanism in plain English: This prescription antibiotic has powerful anti-inflammatory effects that calm down the painful, red pimples that lead to PIE, reducing the risk of them leaving a mark.
Who it works best for: Patients with active, inflammatory acne who need to get breakouts under control to prevent new red marks.
When to use it in the journey: As a short-term measure to halt inflammatory acne and provide a clear canvas for other treatments to work on existing PIE.
Product examples: Prescription-only Doxycycline.
Clinical basis: This is positioned as a preventative and preparatory step. By calming the inflammation of active acne, it directly lowers the risk of developing the vascular damage that causes PIE. User reports confirm its use to manage active breakouts before starting scar treatments.

4. Procedural Options

Pulsed Dye Laser (PDL / Vbeam / Excel V)

Mechanism in plain English: This laser targets the red pigment in the tiny, broken blood vessels that cause PIE. The laser energy heats and destroys these vessels, causing the redness to fade.
Who it works best for: Patients with stubborn red or pink marks (PIE) that have not faded with time or topical treatments.
When to use it in the journey: This is the gold-standard procedural treatment for PIE when topical therapies are not enough.
Product examples: This is a professional procedure using devices like Vbeam or Excel V.
Clinical basis: User reports consistently state that vascular lasers like Vbeam and Excel V are the “gold standard” and most effective way to treat stubborn PIE. A systematic review found that vascular lasers are highly effective in managing the redness in macular (flat, red) acne scars.

Bottom Line: The best strategy for PIE is a foundation of gentle skincare with soothing ingredients like Centella Asiatica and strict sun protection. For stubborn redness that persists, vascular lasers like Vbeam are the most effective and rapid treatment available.

Indented/Atrophic Scars (ice pick, boxcar, rolling)

1. Foundational Skincare

Sunscreen

What it does, who it’s for, why it’s recommended: Daily sunscreen use is critical. While it doesn’t improve texture, it prevents any associated discoloration (PIH/PIE) from making scars look more prominent and protects skin that is sensitized by powerful topical treatments or procedures.
Product examples: La Roche-Posay Anthelios UVMune 400 Invisible Fluid SPF50+, Supergoop! Unseen Sunscreen SPF 40
Clinical basis: Protecting the skin from UV is paramount when using retinoids or undergoing procedures. Multiple treatment summaries emphasize that strict sun avoidance is required to prevent hyperpigmentation, which can complicate recovery and worsen the overall appearance of scars.

Gentle Moisturizers

What it does, who it’s for, why it’s recommended: Using a simple, soothing moisturizer helps maintain a healthy skin barrier, which is essential when using potent topical retinoids or recovering from procedures. A damaged barrier can lead to irritation and more acne.
Product examples: La Roche-Posay Cicaplast Baume B5+
Clinical basis: The topical retinoids summary emphasizes that proper use with a moisturizer is critical to manage side effects and avoid irritation-induced breakouts. User reports warn against overly complex routines that damage the skin barrier.

2. Targeted Topicals

Topical Retinoids (Adapalene, Tretinoin, Tazarotene, Trifarotene)

Mechanism in plain English: These powerful Vitamin A derivatives speed up skin cell turnover and, more importantly, stimulate the production of new collagen deep in the skin. This helps to gradually rebuild the skin’s structure and fill in indented scars.
Who it works best for: Patients with shallow-to-moderate atrophic scars. Adapalene is a gentle start, Tretinoin is the standard, and Tazarotene and Trifarotene are the most powerful options for more significant texture.
When to use it in the journey: As the primary, long-term topical treatment for textural improvement. Start with a gentler retinoid and titrate up in strength as tolerated.
Product examples: Differin Gel (0.1% Adapalene), Altreno (tretinoin) Lotion 0.05%, Arazlo (tazarotene) Lotion 0.045%, Aklief (trifarotene) Cream 0.005%
Clinical basis: A split-face randomized trial found topical 0.1% tazarotene gel to be as effective as four sessions of microneedling. A 24-week split-face study showed daily trifarotene cream resulted in a significantly greater reduction in total atrophic scar count than placebo. A 24-week study showed adapalene 0.3% gel alone resulted in a significant improvement in the average grade of atrophic scarring.

Combination: Adapalene + Benzoyl Peroxide

Mechanism in plain English: Provides a two-pronged attack: the adapalene remodels existing shallow scars while the benzoyl peroxide kills acne bacteria to prevent new inflammatory lesions from forming new scars.
Who it works best for: People with active inflammatory acne who also want to treat existing mild atrophic scars.
When to use it in the journey: As a primary treatment for those who need to control active acne and treat scars simultaneously.
Product examples: Epiduo / Epiduo Forte, TactuPump / TactuPump Forte (Canada)
Clinical basis: Rated ‘Excellent’, a 24-week split-face trial found this combination gel resulted in twice as many faces being rated ‘clear/almost clear’ of scars compared to a placebo (32.9% vs 16.4%, p<0.01). Another 24-week trial found the gel significantly reduced atrophic scar counts.

3. Systemic Support (if applicable)

Oral Retinoids (Isotretinoin)

Mechanism in plain English: This powerful oral medication dramatically shrinks oil glands and calms inflammation, effectively shutting down severe acne to prevent new scars from forming.
Who it works best for: Patients with severe, persistent, or scarring acne for whom other treatments have failed.
When to use it in the journey: As an essential first step for those with severe active acne. You must stop the cause of new scars before trying to fix old ones.
Product examples: Accutane, Roaccutane (prescription only)
Clinical basis: Rated ‘Excellent’ for preventing new scars, with a study on a low-dose regimen showing 96.4% of 140 patients achieved complete clearing of scar-prone acne. User reports overwhelmingly state regret over delaying treatment, which led to more preventable scarring.

4. Procedural Options

Subcision

Mechanism in plain English: A special needle is used to cut the fibrous bands under the skin that tether scars down and create a depression. This physically releases the scar, allowing it to rise.
Who it works best for: Patients with rolling scars and other atrophic scars that are “tethered” or anchored down.
When to use it in the journey: As the essential first step for treating tethered scars, often before laser resurfacing. For best results, it should be combined with a filler.
Product examples: This is a professional procedure using Nokor needles or cannulas.
Clinical basis: Rated ‘Excellent’ and considered a gold-standard treatment for rolling scars. A prospective study showed subcision significantly improved the average scar score at 6 months (p<0.0000001), and a comparative study found it more effective than microneedling or fractional CO2 laser for achieving an ‘excellent’ response.

Laser Therapies (Fractional CO2, Er:YAG, Picosecond)

Mechanism in plain English: These devices use focused light energy to create controlled injury deep in the skin, which powerfully stimulates the production of new collagen to fill in and smooth out scars.
Who it works best for: Patients with moderate-to-severe atrophic scars (boxcar, rolling). CO2 is most powerful but has more downtime. Er:YAG is a strong alternative with less risk. Picosecond is best for those prioritizing minimal downtime and safety, especially for darker skin.
When to use it in the journey: As a primary procedural modality after active acne is controlled. Often used after subcision for tethered scars.
Product examples: Professional devices include Fraxel Re:pair (CO2), Sciton ProFractional (Er:YAG), PicoSure (Picosecond).
Clinical basis: A meta-analysis of 6 studies found ultra-pulsed CO2 fractional laser led to significantly better skin smoothness than other methods. A meta-analysis found CO2 lasers superior to Erbium lasers. A trial in Asian patients showed picosecond laser had comparable efficacy to Er:YAG but with significantly less pain and lower PIH risk.

Injectables (Fillers, Saline, PLLA)

Mechanism in plain English: Substances are injected beneath scars to provide immediate lift and/or stimulate the body to produce its own new collagen for long-term improvement.
Who it works best for: HA fillers are for immediate lift in rolling scars. PLLA fillers (Sculptra) are for gradual, long-term collagen building in widespread volume loss. PMMA (Bellafill) is a permanent option for rolling scars. Saline is a very low-cost, low-risk option for mild-moderate scars.
When to use it in the journey: Often combined with subcision to provide a “spacer” and prevent re-tethering. PLLA is a standalone treatment course for long-term volume.
Product examples: Restylane (HA), Sculptra® Aesthetic (PLLA), Bellafill® (PMMA)
Clinical basis: A study showed combining subcision with HA filler was significantly better than subcision alone (p=0.015). A Phase II trial showed PLLA injections led to ‘much to excellent’ improvement in 45.5% to 68.2% of patients. A large randomized trial found PMMA injections corrected scars in 84% of participants. Weekly saline injections were shown in a study to significantly improve atrophic scar severity.

Chemical Peels (TCA CROSS)

Mechanism in plain English: A very high concentration of Trichloroacetic Acid (TCA) is precisely applied to the base of a deep, narrow scar. This causes a controlled chemical burn that stimulates intense collagen production to raise the scar floor.
Who it works best for: Patients with deep ice pick scars and narrow boxcar scars.
When to use it in the journey: As the most targeted and effective treatment for ice pick scars.
Product examples: This is a highly specialized professional-only technique.
Clinical basis: Rated ‘Good’. Two studies using 100% TCA CROSS found that over 70% of patients with ice pick scars achieved excellent improvement (>70% scar reduction). User reports confirm it is highly effective but carries a significant risk of widening scars if done improperly.

Bottom Line: Atrophic scars require procedural intervention, as topicals alone are insufficient for significant texture. Combination therapy (e.g., subcision followed by laser or filler) is the most effective approach. The most evidence-backed topicals, like prescription Tazarotene, can help but are best as an adjunct to, not a replacement for, procedures.

Raised Scars (hypertrophic, keloid)

1. Foundational Skincare

Barrier Ointments (Silicone Gels & Sheets)

What it does, who it’s for, why it’s recommended: Silicone forms a thin, breathable barrier over a raised scar. This locks in moisture, which helps regulate collagen production, leading to a flatter, softer, and less red appearance. It is the first-line at-home treatment for anyone with new or existing raised scars.
Product examples: Kelo-Cote Advanced Formula Scar Gel, ScarAway Silicone Scar Sheets, Dermatix Ultra Scar Gel
Clinical basis: An expert consensus paper recommends applying silicone preparations for more than 6 months as a primary treatment for hypertrophic (raised) scars. A clinical study on postsurgical scars found that a silicone gel led to a 40-50% improvement in scar appearance and symptoms like redness.

2. Targeted Topicals

Heparin Sodium Allantoin Gels

Mechanism in plain English: This compound gel works to soften scar tissue and prevent excessive collagen growth, while also promoting healing and making the scar more pliable.
Who it works best for: Patients with raised, lumpy, or thick (hypertrophic) scars.
When to use it in the journey: As a long-term topical treatment, used similarly to silicone gel, to gradually improve the texture of raised scars.
Product examples: Contractubex Scar Gel, Mederma Advanced Scar Gel
Clinical basis: A 2021 consensus from dermatologists in China recommends the long-term topical application of a heparin sodium allantoin compound as a primary treatment for hypertrophic scars, on par with silicone preparations.

Topical Corticosteroid Patches

Mechanism in plain English: A medicated patch containing a steroid is applied to the scar. The steroid suppresses inflammation and inhibits collagen production, helping to flatten the raised tissue.
Who it works best for: Individuals with specific, isolated hypertrophic or keloid scars under a doctor’s care.
When to use it in the journey: When prescribed by a dermatologist for a specific raised lesion.
Product examples: Cordran Tape (Flurandrenolide) (Rx only).
Clinical basis: The evidence for this is very limited. It is rated as ‘Poor’, based on a single user report that noted flattening but also worsening of skin discoloration. This should only be used with caution under medical guidance. (FLAG: Weak evidence)

3. Systemic Support (if applicable)

This tier is not highly applicable for treating existing raised scars based on the provided data. Systemic therapies like oral antibiotics or isotretinoin would be used preventatively to treat the severe inflammatory acne that can lead to hypertrophic or keloid scarring in predisposed individuals.

4. Procedural Options

Corticosteroid Injections

Mechanism in plain English: A steroid solution is injected directly into the raised scar. This reduces inflammation and inhibits the cells that produce excess collagen, causing the scar to flatten and soften.
Who it works best for: Patients with raised, firm hypertrophic scars or keloids. It is also used to prevent scars by injecting deep, painful acne cysts.
When to use it in the journey: As the first-line, gold-standard professional treatment for raised scars.
Product examples: Triamcinolone Acetonide (Kenalog®) injections.
Clinical basis: Rated ‘Excellent’, this treatment is highly recommended (Level I Evidence) for hypertrophic scars and keloids. It is considered a cornerstone of therapy.

Fluorouracil (5-FU) & Bleomycin Injections

Mechanism in plain English: These are chemotherapy agents injected into the scar that selectively target and slow the growth of the overactive cells responsible for producing excess collagen.
Who it works best for: Patients with hypertrophic or keloid scars that have not responded to first-line corticosteroid injections.
When to use it in the journey: As a second-line or third-line treatment for tough, resistant raised scars, often in combination with corticosteroids.
Product examples: Generic 5-fluorouracil or bleomycin for injection.
Clinical basis: Both intralesional 5-FU and bleomycin are recognized in clinical overviews as effective procedural options for managing hypertrophic scars, particularly those on the trunk or resistant to other therapies.

Cryotherapy

Mechanism in plain English: Extreme cold (liquid nitrogen) is applied to the scar to freeze and destroy the excess scar tissue, causing it to flatten over time.
Who it works best for: Patients with raised hypertrophic or keloid scars, especially on the chest, shoulders, and back.
When to use it in the journey: As a primary or secondary procedural option for flattening raised scars. Can be combined with other therapies for resistant cases.
Product examples: This is a professional, in-clinic procedure.
Clinical basis: Rated ‘Good’, with multiple clinical reviews recommending cryotherapy as a standard procedural treatment for both hypertrophic and keloid scars. A 2022 review identified it as a promising treatment for hypertrophic scars on the trunk.

Laser Therapies (Pulsed Dye Laser)

Mechanism in plain English: This laser targets the blood vessels within the scar, reducing redness and inhibiting the growth signals that contribute to the scar’s raised appearance.
Who it works best for: Patients with red, raised hypertrophic scars or keloids.
When to use it in the journey: As a procedural option to reduce redness and improve the texture of raised scars, often in combination with injections or cryotherapy.
Product examples: Professional procedure using Vbeam or Excel V devices.
Clinical basis: Clinical guidelines from multiple review papers recommend PDL as a procedural treatment for hypertrophic and keloidal scars.

Bottom Line: For raised scars, start with over-the-counter silicone gels or sheets. If that’s not enough, intralesional corticosteroid injections are the gold-standard first-line professional treatment. For stubborn scars, procedures like cryotherapy, 5-FU injections, or vascular lasers are effective next steps.

Individual Summaries

Moisturizers

Snail Mucin

What Is It?

The filtered secretion from snails, used in skincare to hydrate and repair the skin. It is often used to help heal post-acne marks and improve overall skin texture. (OTC)

Effectiveness Rating

Good — Praised by users for its ability to soothe inflammation and speed up healing, which helps reduce the redness (PIE) left behind by acne.

Who It’s Best For

Those with red or purple post-acne marks (post-inflammatory erythema, or PIE) and individuals with sensitive or irritated skin looking for gentle repair and hydration.

Evidence Snapshot

User Reports

Praised by Reddit users for its soothing and healing properties, which they find helps with the red marks left after acne (PIE).

The Science

Snail mucin contains growth factors, hyaluronic acid, and glycoproteins that hydrate the skin and support its natural repair processes. This helps to calm inflammation and speed up cell regeneration, which can fade red marks and improve skin texture.

Limitations

Can cause an allergic reaction in some people, particularly those with dust mite allergies.
Not a treatment for indented (atrophic) scars.
The concentration and quality of snail mucin can vary a lot between products.

Expected Time-to-Results

Expect visible improvement in redness and hydration in 4–8 weeks.

Cost

£15–£25 for popular serums and essences.

Products

Bottom Line

Snail mucin is a very popular and well-tolerated ingredient that can help prevent and treat the red marks (PIE) left by acne by promoting healing and calming the skin. It is a supportive treatment and will not fix deep, textured scars.

Centella Asiatica (Cica)

What Is It?

A medicinal herb extract from the plant Centella asiatica (also called Gotu Kola, Tiger Grass, or Cica) used in skincare to soothe inflammation, heal wounds, and calm sensitive skin. It is excellent for reducing the redness from acne breakouts and subsequent marks (post-inflammatory erythema). OTC

Effectiveness Rating

Good — Strong scientific basis for its wound-healing and anti-inflammatory properties, which directly target the redness and irritation associated with PIE (post-inflammatory erythema) scarring.

Who It’s Best For

People with red, inflamed skin and post-acne marks (PIE). It’s particularly beneficial for those with a damaged or sensitive skin barrier and individuals looking to support the healing process and prevent long-term discoloration.

Evidence Snapshot

Clinical Data

In a split-face, randomized controlled trial with 25 participants, a cream containing 0.05% Centella asiatica extract applied after laser resurfacing significantly reduced skin redness and was judged by dermatologists to improve wound appearance compared to a placebo cream (p<0.05).¹
A separate study on 25 people found that an extract from Centella Asiatica was effective in preventing excessive scarring after surgery by improving the wound healing process.²

Damkerngsuntorn W, Rerknimitr P, Panchaprateep R, Tangkijngamvong N, Kumtornrut C, Kerr SJ, Asawanonda P, Tantisira M, Khemawoot P. The Effects of a Standardized Extract of Centella asiatica on Postlaser Resurfacing Wound Healing on the Face: A Split-Face, Double-Blind, Randomized, Placebo-Controlled Trial. J Altern Complement Med. 2020;26:529–536. doi: 10.1089/acm.2019.0325.
Paocharoen V. The efficacy and side effects of oral Centella asiatica extract for wound healing promotion in diabetic wound patients. J Med Assoc Thai. 2010;93 Suppl 7:S166-70.

User Reports

Reddit users recommend Centella Asiatica (often called ‘cica’) for its ability to calm the inflammation and redness associated with post-acne marks.

The Science

Cica contains active compounds (madecassoside, asiaticoside) that have powerful anti-inflammatory effects and are known to boost the production of collagen. This helps to repair the skin barrier and speed up the healing of damaged skin, which reduces redness and calms irritated skin, allowing damaged skin from acne to heal more effectively.

Limitations

Primarily addresses redness (PIE) and irritation; it will not improve indented or raised scars
Product effectiveness depends on the concentration of the active cica compounds, which vary significantly between products
The primary clinical evidence is for healing after laser procedures, not directly for acne scarring itself
Allergic reactions or skin sensitivity are possible, though rare

Expected Time-to-Results

Noticeable calming effects within 2–4 weeks; reduction in redness can take 8+ weeks.

Cost

£10–£35 for serums, creams, and balms.

Products

Bottom Line

Centella Asiatica is a proven, reliable ingredient for calming the inflammation and redness that can lead to post-acne marks (PIE). Based on strong evidence for its wound-healing and anti-inflammatory properties, it is an excellent supportive treatment for helping skin heal from breakouts and may prevent lingering discoloration, but it will not change the texture of established scars.

Licorice Root Extract

What Is It?

A plant extract used in skincare for its powerful anti-inflammatory and skin-brightening properties. It is used to treat both red and brown discoloration left behind by acne. (OTC)

Effectiveness Rating

Good — It effectively targets two types of post-acne marks: redness (PIE) through its anti-inflammatory action and brown spots (PIH) through its pigment-inhibiting properties.

Who It’s Best For

Patients with a mix of red (PIE) and brown (post-inflammatory hyperpigmentation, or PIH) post-acne marks who are looking for a gentle way to even out their skin tone.

Evidence Snapshot

User Reports

Reddit users recommend licorice root for its ability to calm inflammation, helping to reduce the redness of new acne marks.

The Science

Licorice root contains glabridin, which stops the enzyme that produces melanin (pigment), helping to fade brown spots. It also contains licochalcone A, a potent anti-inflammatory agent that soothes skin and reduces redness.

Limitations

Not as powerful for fading dark spots as prescription ingredients like hydroquinone.
Will not treat textured scarring like pits or bumps.
The amount of active compounds can vary greatly between different products.

Expected Time-to-Results

Visible fading of discoloration can take 8–12 weeks of consistent use.

Cost

£10–£40, most commonly found in toners and serums.

Products

ACWELL Licorice pH Balancing Cleansing Toner
Eucerin Anti-Pigment Dual Serum (contains Thiamidol, a related patented ingredient)

Bottom Line

Licorice root extract is a gentle, multi-tasking ingredient that helps fade both the red and brown marks that acne leaves behind. It is a great option for sensitive skin, but patience is required and it will not help with textural changes.

Sunscreen

Sunscreen (General)

What Is It?

Sunscreen is a topical product that protects the skin from the sun’s ultraviolet (UV) rays. It is essential for preventing red acne marks from darkening and becoming more permanent forms of discoloration scarring. (OTC)

Effectiveness Rating

Excellent — Crucial for preventing the discoloration part of acne scarring (post-inflammatory hyperpigmentation) by blocking UV rays.

Who It’s Best For

Anyone with active acne or recent red/brown marks (post-inflammatory erythema or hyperpigmentation) to prevent them from getting darker and more stubborn.

User Reports

User reports collated from Reddit describe daily sunscreen use as “essential” and “paramount” for managing red acne marks (PIE) and stopping them from turning into brown marks (PIH).

The Science

UV radiation from the sun triggers melanin production in the skin, which can cause the red, inflamed skin of an acne mark to heal with a dark brown spot. Sunscreen works by blocking or absorbing these UV rays, preventing this darkening process and allowing the mark to fade more quickly and evenly.

Limitations

Some formulations can feel greasy, heavy, or clog pores, potentially worsening acne for some individuals.
Must be applied consistently every day, and reapplied after sweating or swimming, for best results.
Finding a formula that works for your skin type (e.g., doesn’t cause breakouts or irritation) can involve trial and error.

Expected Time-to-Results

Acts immediately to prevent darkening; helps existing marks fade more efficiently over 4–12 weeks.

Cost

£$15–$40 for a quality facial sunscreen.

Products

Bottom Line

Daily sunscreen use is a non-negotiable step in any routine focused on acne scarring. It is one of the most effective preventative measures to stop red marks from becoming long-lasting brown spots.

Mineral Sunscreen

What Is It?

Also known as physical sunscreen, this type uses mineral filters like zinc oxide and titanium dioxide to create a physical barrier on the skin that blocks UV rays. It is often recommended for sensitive or acne-prone skin. (OTC)

Effectiveness Rating

Excellent — Physically blocks the UV rays that darken acne marks, with user reports suggesting added calming benefits for inflamed skin.

Who It’s Best For

Individuals with sensitive, reactive, or inflamed acne-prone skin, as the ingredients are less likely to cause irritation and may help calm redness.

User Reports

Reddit users specifically highlight mineral sunscreens with zinc oxide as being beneficial for post-acne red marks due to their perceived calming properties.

The Science

Mineral sunscreens sit on top of the skin and physically reflect UV radiation away, preventing it from stimulating the pigment cells that darken acne scars. The key ingredient, zinc oxide, is also known to have anti-inflammatory and skin-soothing properties, which can help calm the redness associated with acne marks.

Limitations

Can often leave a noticeable white or grayish cast on the skin, especially on deeper skin tones.
Formulations can feel thicker or heavier than chemical sunscreen equivalents.

Expected Time-to-Results

Immediately prevents UV-induced darkening; calming effects on redness may be noticed within days of use.

Cost

£$20–$45, as formulations can be more expensive.

Products

Bottom Line

An excellent choice for preventing scar discoloration, especially for those with sensitive skin. The added anti-inflammatory benefit of zinc oxide makes it a strong contender for managing both active acne and the red marks it leaves behind.

EltaMD UV Clear Broad-Spectrum SPF 46

What Is It?

A popular hybrid (containing both mineral and chemical filters) sunscreen specifically formulated for skin types prone to acne, rosacea, and hyperpigmentation. (OTC)

Effectiveness Rating

Excellent — Specifically formulated for discoloration-prone skin and contains niacinamide to actively help fade marks, in addition to providing sun protection.

Who It’s Best For

Individuals with acne-prone and sensitive skin looking for a lightweight, cosmetically elegant sunscreen that also includes active ingredients to treat discoloration and calm inflammation.

User Reports

EltaMD UV Clear is a specifically recommended product by Reddit users for managing post-inflammatory marks due to its gentle, effective, and non-comedogenic formula.

The Science

This sunscreen provides broad-spectrum UV protection to prevent scars from darkening. It also contains 5% niacinamide (Vitamin B3), which is scientifically proven to reduce inflammation, improve skin barrier function, and inhibit the transfer of pigment, actively helping to fade discoloration.

Limitations

Higher price point compared to many drugstore sunscreens.
Contains octinoxate, a chemical filter that some people prefer to avoid.
The formula has been updated over the years, and some long-term users have reported sensitivities to newer versions.

Expected Time-to-Results

Immediately protects from UV; visible improvement in skin tone and redness from niacinamide can be seen in 4–8 weeks.

Cost

£$35–$45.

Products

EltaMD UV Clear Broad-Spectrum SPF 46

Bottom Line

This is a top-tier product for preventing and treating acne scar discoloration. Its combination of robust sun protection and a clinically effective concentration of niacinamide makes it a dual-action product highly recommended by both dermatologists and users.

La Roche-Posay Anthelios UVMune 400 Invisible Fluid SPF50+

What Is It?

A lightweight chemical sunscreen from a French pharmacy brand, famous for its cosmetically elegant texture and advanced, stable UV filter technology. (OTC)

Effectiveness Rating

Excellent — Offers very high, cutting-edge UV protection in a lightweight formula that is well-tolerated by acne-prone skin, effectively preventing scar darkening.

Who It’s Best For

Those who dislike the feeling of traditional sunscreens and want the highest level of UV protection in a formula that feels weightless and invisible on the skin.

User Reports

La Roche-Posay Anthelios products are frequently recommended by Reddit users for their comfortable wear and high efficacy, making daily compliance easier.

The Science

This sunscreen uses a new, exclusive UV filter (Mexoryl 400) that protects against the most damaging, ultra-long UVA rays, which are known to contribute significantly to pigmentation issues. By providing superior protection across the entire UV spectrum, it offers enhanced defense against the darkening of acne scars.

Limitations

As a chemical sunscreen, it may cause stinging or irritation in those with very sensitive skin or compromised skin barriers.
The most advanced versions (with UVMune 400) can be harder to find in the US compared to Europe/UK.
Can be shiny on oilier skin types.

Expected Time-to-Results

Provides immediate and high-level protection against the darkening of acne marks.

Cost

£$25–$35.

Products

Bottom Line

An outstanding choice for preventing scar discoloration, especially for those who prioritize a comfortable, invisible finish. Its advanced filtering technology provides robust protection, making it a reliable daily option to keep acne marks from turning into permanent spots.

Vitamin C

What Is It?

A powerful antioxidant serum used to brighten skin, fade discoloration from acne (red marks/Post-Inflammatory Erythema and brown spots/Post-Inflammatory Hyperpigmentation), and support collagen synthesis. Available over-the-counter (OTC).

Effectiveness Rating

Mixed to Good — User reports are highly polarized. While many find it effective for fading discoloration, particularly when used consistently on newer marks, many others report it does nothing for atrophic (pitted) scar texture. Clinical evidence supports its effectiveness for post-inflammatory hyperpigmentation.

Who It’s Best For

Patients with post-inflammatory hyperpigmentation (dark spots) or erythema (red spots) left after acne has healed, and those looking to brighten overall skin tone. It can also support a regimen aimed at building collagen (e.g., alongside a retinoid). It is not effective for changing the texture of indented or raised scars.

Evidence Snapshot

Clinical Data

A systematic review of multiple studies concluded that topical Vitamin C is an effective and safe treatment for fading post-inflammatory hyperpigmentation (dark spots) from acne.¹

Zaid AN, Al Ramahi R. Depigmentation and Anti-aging Treatment by Vitamin C: A Review. J Dermatol Cosmetol. 2019;3(4):68-75.

User Reports

Experiences are divided. Some users call specific products (Numbuzin No. 5, Dr. Idriss, Goodal, Cosrx) “game changers” for fading scars and dark spots, especially when used consistently or combined with tretinoin.
A Reddit user found that Melano CC, a popular Japanese Vitamin C serum, was effective at minimizing fresh surgical and burn scars, but had little effect on their old dark spots.
One user added a daily Vitamin C serum to their tretinoin regimen to enhance results for shallow scars and skin tone.
Conversely, many users claim Vitamin C is “completely ineffective” for improving the texture of pitted acne scars.
A contradictory report noted a 9-month routine including Vitamin C was insufficient to fade persistent red marks.
Some users report irritation, which can be counterproductive for red, inflamed skin. Starting with a lower concentration is advised.

The Science

Vitamin C is a cofactor for enzymes that build new, stable collagen and helps fade dark spots by blocking the enzyme your skin uses to produce melanin (pigment). As a powerful antioxidant, it neutralizes free radicals that cause inflammation and damage, protects the skin, and supports the natural healing process, which can help reduce redness from recent breakouts.

Limitations

Can cause irritation, stinging, or breakouts in some people, especially at higher concentrations
Many formulations are unstable and lose effectiveness quickly when exposed to light and air (oxidize)
User reports are mixed, suggesting it’s more effective on fresh marks than old ones
It is not effective for improving the texture of indented (atrophic) scars

Expected Time-to-Results

≥8 weeks for visible brightening and fading of marks.

Cost

£10–£80+, price varies widely by formulation and brand.

Products

Bottom Line

Vitamin C is a good option for tackling the discoloration (red and brown spots) left behind by acne and providing antioxidant protection. While it supports collagen production, it is not a primary treatment for remodeling indented scars on its own. User results vary significantly, so consistency and finding a stable formula that doesn’t irritate your skin are key to success.

Tranexamic Acid

Tranexamic Acid Serum

What Is It?

A serum ingredient that helps fade skin discoloration, particularly stubborn brown spots (PIH) and red marks (PIE) left after acne. Available over-the-counter (OTC).

Effectiveness Rating

Good — Addresses discoloration from scarring, with a growing body of clinical evidence and positive user reports for stubborn red and brown marks.

Who It’s Best For

People with persistent red or brown spots after acne, particularly those who haven’t had success with or can’t tolerate other brightening agents like vitamin C or retinoids.

Evidence Snapshot

Clinical Data

In a 2019 study, a serum containing 2% tranexamic acid was shown to be effective in reducing redness (post-inflammatory erythema) from acne.¹

Zhong S, Sun N, Liu J, et al. Topical tranexamic acid improves parameter of facial post-inflammatory erythema: A prospective, split-face, randomized, controlled trial. J Cosmet Dermatol. 2020;19(7):1748-1753. doi:10.1111/jocd.13204

User Reports

A few Reddit users report that tranexamic acid is a helpful ingredient for reducing the redness of post-inflammatory erythema.

The Science

Tranexamic acid works by calming the skin and interrupting two pathways: the one that produces excess melanin (brown pigment) and the one that causes redness and visible blood vessels. This dual action makes it effective for both brown and red marks.

Limitations

Can be slow to show results compared to some other ingredients.
Often works best when formulated with other brightening ingredients like niacinamide or vitamin C.
Will not help with textural scars.

Expected Time-to-Results

Visible improvement may take 8–12 weeks of consistent use.

Cost

£15–£40 OTC.

Products

Bottom Line

Tranexamic acid is a promising and effective ingredient for tackling stubborn red and brown marks left by acne. While user reports are still emerging, the science is strong, making it a great choice to add to a routine, especially for discoloration that hasn’t responded to other treatments.

Niacinamide

Niacinamide Serum

What Is It?

A form of vitamin B3, this multi-tasking serum ingredient helps with redness, supports the skin barrier, and controls oil. It is commonly recommended for the red marks (PIE) that linger after acne. Available over-the-counter (OTC).

Effectiveness Rating

Good — Directly addresses the inflammation and barrier damage that cause red marks (PIE), though it is less potent for deep brown spots than other agents.

Who It’s Best For

Individuals with active acne and red post-acne marks (PIE). Its ability to calm inflammation and strengthen the skin makes it a great preventative and supportive treatment. Also beneficial for oily skin types.

Evidence Snapshot

Clinical Data

A clinical trial found that a 2% topical niacinamide formula significantly decreased hyperpigmentation (dark spots) and increased skin lightness after 4 weeks of use.¹

Hakozaki T, Minwalla L, Zhuang J, et al. The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer. Br J Dermatol. 2002;147(1):20-31. doi:10.1046/j.1365-2133.2002.04834.x

User Reports

Reddit users recommend niacinamide for managing red marks (PIE). They note its anti-inflammatory properties and ability to support the skin barrier help to calm overall redness.

The Science

Niacinamide works by strengthening the skin’s protective barrier, which reduces water loss and helps it better defend against irritation. It also has proven anti-inflammatory effects, directly calming the redness that characterises PIE.

Limitations

High concentrations (over 10%) can cause irritation, redness, or breakouts for some users.
Less effective on deep, established brown spots (PIH) compared to ingredients like tranexamic acid or vitamin C.
It will not improve the texture of indented or raised scars.

Expected Time-to-Results

Expect visible changes in skin tone and redness in 4–8 weeks.

Cost

£5–£30 OTC. It is widely available and one of the most affordable active ingredients.

Products

Bottom Line

Niacinamide is an excellent supportive ingredient for both preventing and treating red post-acne marks. It calms inflammation, strengthens the skin, and helps control oil that can lead to breakouts. It’s a reliable, affordable starting point but may need to be paired with other ingredients for stubborn brown spots.

Serums & Oils

Sulwhasoo Concentrated Ginseng Renewing Serum

What Is It?

A luxury anti-aging serum containing ginseng extract, which one user reported helped improve their scar appearance and redness. Available over-the-counter (OTC).

Effectiveness Rating

Mixed — Based on a single positive user report for scarring, but lacks any clinical evidence for this specific purpose.

Who It’s Best For

Based on the single user report, this could be an option for those with sensitive skin looking for a very gentle product to potentially reduce redness and the prominence of scars.

Evidence Snapshot

User Reports

One Reddit user with sensitive skin reported that this serum reduced redness and diminished their prominent acne scars.

The Science

Ginseng is rich in antioxidants and has known anti-inflammatory properties. This can help calm the skin and support the healing process, which may in turn reduce the redness associated with fresh scars.

Limitations

Extremely expensive.
The evidence for acne scarring is based on a single user’s anecdotal report.
Unlikely to have any effect on the texture of indented scars.

Expected Time-to-Results

Unknown for scarring; likely requires >8 weeks for general skin benefits.

Cost

£90–£150+ OTC.

Products

Sulwhasoo Concentrated Ginseng Renewing Serum

Bottom Line

While one user had a good experience, this serum is a very expensive gamble with no scientific backing for treating acne scars. Its anti-inflammatory properties might help with redness, but other, more proven ingredients are available for a fraction of the cost.

Marula Oil

What Is It?

A lightweight plant oil rich in antioxidants and fatty acids, used to moisturize and protect the skin. Available over-the-counter (OTC).

Effectiveness Rating

Poor — No direct evidence for treating scars. Its benefit is supportive (moisturizing), and the single user report notes it was used with a stronger active ingredient (glycolic acid).

Who It’s Best For

People using potentially drying acne or scar treatments (like acids or retinoids) who want to add moisture to support the skin’s healing environment.

Evidence Snapshot

User Reports

One Reddit user reported that combining Marula Oil with Drunk Elephant’s glycolic acid serum was highly effective for improving their sensitive, acne-scarred skin.

The Science

Marula oil is primarily an emollient, meaning it moisturizes the skin and helps lock in hydration. A well-moisturized skin barrier functions better and can heal more effectively. The oil does not contain ingredients that directly remodel scar tissue or fade pigmentation.

Limitations

It does not directly treat acne scars.
The reported benefit was only when used alongside a powerful exfoliating acid.
As an oil, it may be comedogenic (pore-clogging) for some acne-prone individuals.

Expected Time-to-Results

Immediate moisturizing benefits; no defined timeline for scar improvement.

Cost

£8–£60 OTC.

Products

Bottom Line

Marula oil does not treat acne scars. It is a moisturizing oil that can help support your skin barrier when you are using other, more powerful scar-treating ingredients, but it is not a scar treatment on its own.

Rosehip Oil

What Is It?

A plant oil known for its high content of vitamins and fatty acids. It is a popular natural remedy for helping with general skin healing and the appearance of scars. Available over-the-counter (OTC).

Effectiveness Rating

Mixed — Some clinical data on surgical scars and positive user reports suggest it can help, but evidence for acne scars is not strong and it is unlikely to impact deep, pitted scars.

Who It’s Best For

Individuals with post-acne discoloration (red or brown spots) or very fine surface texture issues who prefer a gentle, natural approach to skincare.

Evidence Snapshot

Clinical Data

A study on post-surgical scars found that patients who used rosehip oil twice daily for 12 weeks had significantly less redness (erythema), discoloration, and atrophy than those who didn’t. ¹

Valerón-Almazán P, Gómez-Duque B, Carretero-Guzmán M, et al. Evolution of Post-Surgical Scars Treated with Pure Rosehip Seed Oil. J Cosmet Dermatol Sci App. 2015;5(2):161-167.

User Reports

One Reddit user suggested that combining rosehip oil with Vitamin E may help with acne scarring.

The Science

Rosehip oil naturally contains beneficial fatty acids and a small amount of retinoic acid (a form of Vitamin A). These components can support skin regeneration, promote cell turnover, and reduce inflammation, which helps to fade discoloration and subtly improve skin appearance over time.

Limitations

Can be too heavy or cause breakouts for very oily or acne-prone skin.
Any effect on indented (atrophic) scars is likely to be minimal to none.
Results are typically slow and subtle.

Expected Time-to-Results

May see subtle improvements in discoloration and texture in ≥12 weeks.

Cost

£8–£25 OTC.

Products

Bottom Line

Rosehip oil is a gentle, natural option that may help fade discoloration and improve the overall appearance of scars, particularly redness. It is a good supportive product but is not a powerful treatment for significant textural scarring.

Tea Tree Oil

What Is It?

An essential oil with strong antimicrobial properties, most commonly used as a spot treatment for active acne pimples. Available over-the-counter (OTC).

Effectiveness Rating

Very Poor — This is a treatment for the bacteria that cause active acne, not for existing scars. Using it on healing skin can cause significant irritation and worsen scarring.

Who It’s Best For

This product is not recommended for treating acne scars. It should only be used (in a diluted form) to spot-treat active, inflammatory pimples.

Evidence Snapshot

User Reports

One Reddit user recommended tea tree oil for scarring. However, they also mentioned they had stopped picking their skin, which is the more likely reason their skin improved.

The Science

Tea tree oil’s main function is killing acne-causing bacteria and reducing inflammation in active pimples. It has no known mechanism to remodel collagen, break down scar tissue, or fade pigmentation to treat existing scars.

Limitations

Must always be diluted before use; pure tea tree oil can cause chemical burns, irritation, and allergic reactions.
There is no evidence it treats any form of acne scarring (discoloration or texture).
It can be very drying and irritating, which can interfere with proper healing and potentially make scarring worse.

Expected Time-to-Results

Not applicable for scarring.

Cost

£5–£15 OTC.

Products

The Body Shop Tea Tree Oil (pre-diluted)
Various brands of 100% pure tea tree oil (must be diluted in a carrier oil before use).

Bottom Line

Do not use tea tree oil to treat acne scars. Its purpose is to help clear active breakouts. Applying it to healing skin or existing scars is ineffective and risks causing irritation that could make matters worse.

Chemical Exfoliants

Alpha Hydroxy Acids (AHAs)

What Is It?

Water-soluble acids (like glycolic, lactic, and mandelic acid) that exfoliate the skin’s surface. They are commonly used to treat the dark spots (post-inflammatory hyperpigmentation) and mild textural issues left behind by acne. Available Over-the-Counter (OTC).

Effectiveness Rating

Good — particularly effective for fading the discolored marks (PIH) and smoothing minor surface texture from acne scarring, based on strong user reports and established dermatological use.

Who It’s Best For

Individuals with post-inflammatory hyperpigmentation (red or brown spots) and minor textural irregularities. Gentler AHAs like mandelic acid are a good choice for those with sensitive skin.

Evidence Snapshot

Clinical Data

In a study on 45 patients with atrophic acne scars, a series of 35% glycolic acid peels performed every two weeks for 24 weeks showed a good-to-excellent improvement in scars for over 90% of participants.¹

Sharad J. Glycolic acid peel therapy – a current review. Clin Cosmet Investig Dermatol. 2013;6:281-288. Published 2013 Nov 26. doi:10.2147/CCID.S34029

User Reports

Reddit users praise glycolic and lactic acid for fading post-acne marks and improving scar texture.
Mandelic acid is frequently recommended as a gentler AHA for improving both textured and pigmented scars.
Users report success with high-concentration weekly masks (e.g., 25% AHA) and note that combining AHAs with tretinoin can significantly improve physical scars.

The Science

AHAs work by dissolving the bonds that hold dead skin cells to the surface, which speeds up cell turnover. This process helps lighten dark spots and, over time, can stimulate collagen production to subtly improve the appearance of shallow, indented scars.

Limitations

Can cause irritation, redness, and sun sensitivity (daily sunscreen use is essential).
If overused, they can compromise the skin barrier, potentially leading to more breakouts.
May not be strong enough for deep, pitted (atrophic) scars.

Expected Time-to-Results

Expect visible improvement in discoloration and texture in 8–12 weeks.

Cost

£8–£50 for OTC products. Professional in-clinic peels will cost significantly more.

Products

Bottom Line

AHAs are a reliable and accessible treatment for tackling the discoloration and minor textural changes left by acne. They are most effective for post-inflammatory hyperpigmentation (dark spots) and can help prevent future marks by keeping skin renewed.

Beta Hydroxy Acids (BHAs)

What Is It?

An oil-soluble acid, most commonly salicylic acid, that exfoliates inside the pores as well as on the skin’s surface. It is primarily used to treat active acne to prevent new scars from forming. Available Over-the-Counter (OTC).

Effectiveness Rating

Poor — for existing scars. Its main benefit is preventing future scars by treating active acne, not resolving established textural scars or significant hyperpigmentation.

Who It’s Best For

Individuals with active, oily, and acne-prone skin who want to prevent new breakouts and the scars they can leave behind.

Evidence Snapshot

User Reports

Reddit users consistently state that salicylic acid’s primary benefit is treating active acne to prevent future scars, rather than improving existing ones.
A high-strength peel containing BHA (The Ordinary AHA 30% + BHA 2%) was reported by one user as insufficient for resolving dark post-acne marks.
Toners and scrubs with salicylic acid are suggested for managing acne and scars on the back and body.

The Science

Because BHAs are oil-soluble, they can penetrate deep into pores to dissolve the mix of oil and dead skin that causes pimples. By treating acne at the source, they reduce the inflammation that often leads to post-acne marks and scars.

Limitations

Can be drying and irritating, especially for those with dry or sensitive skin.
Not considered an effective treatment for existing textural scarring (e.g., pitted or indented scars).
Some toner formulations can be irritating or ineffective for some users.

Expected Time-to-Results

For acne prevention, results can be seen in 4–6 weeks. No significant results should be expected for existing scars.

Cost

£10–£30 for OTC products.

Products

Bottom Line

BHA is a hero ingredient for preventing new acne scars by keeping pores clear and controlling breakouts. However, it is not the right choice for treating significant dark marks or textural scars that are already present.

Polyhydroxy Acids (PHAs)

What Is It?

A very gentle type of chemical exfoliant with a larger molecular size than AHAs. PHAs are used for mild exfoliation and hydration, making them a good option for sensitive skin looking to improve minor discoloration. Available Over-the-Counter (OTC).

Effectiveness Rating

Mixed — provides very gentle exfoliation that can help with mild hyperpigmentation over time, but lacks the strength for significant textural scarring. It is best viewed as a supportive, rather than primary, scar treatment.

Who It’s Best For

Individuals with sensitive, reactive, or dry skin who cannot tolerate stronger acids like AHAs and are targeting only very minor, superficial discoloration from past acne.

Evidence Snapshot

User Reports

Reddit users mention using PHAs in combination with AHAs and BHAs in serums or masks to help address texture and scarring.
A weekly mask containing both AHA and PHA was reported as an effective strategy, suggesting PHAs work well as part of a team rather than as a standalone scar treatment.

The Science

PHAs have a large molecular structure, meaning they can’t penetrate the skin as deeply as other acids, which results in less irritation. They gently slough off the very top layer of dead skin cells to improve tone and also act as humectants, drawing moisture into the skin.

Limitations

Results are much slower and more subtle compared to AHAs.
There is very little evidence specifically for its effectiveness on significant acne scarring.
It is often found in formulations with other, more powerful acids, making it difficult to judge its individual impact.

Expected Time-to-Results

Expect subtle improvements in skin tone after 12+ weeks of consistent use.

Cost

£15–£40 for OTC products.

Products

Bottom Line

PHAs are an excellent choice for very sensitive skin seeking gentle exfoliation, but they are unlikely to make a major difference to established acne scars on their own. They can be a great supporting ingredient to help maintain skin tone without causing irritation.

Spot Treatments

Benzoyl Peroxide Gel

What Is It?

An antiseptic treatment that kills acne-causing bacteria on the skin. While primarily used for active acne, it’s clinically proven to help prevent new atrophic (indented) scars from forming. (OTC, Rx)

Effectiveness Rating

Excellent — for preventing new atrophic (indented) scars, based on strong clinical trial evidence.

Who It’s Best For

Individuals with active inflammatory acne who are concerned about developing new atrophic (indented) scars.

Evidence Snapshot

Clinical Data

In a 24-week maintenance therapy trial with 111 participants, using benzoyl peroxide 2.5% gel significantly reduced the number of atrophic scars and stopped them from getting worse, unlike the group that received no treatment (p<0.0001).¹

Tanizaki H, Hayashi N, Abe M. Evaluation of the efficacy of maintenance therapy for acne vulgaris using adapalene 0.1%/benzoyl peroxide 2.5% gel and benzoyl peroxide 2.5% gel for 24 weeks and assessment of atrophic acne scars using three-dimensional image analysis. J Dermatol. 2023 Dec;50(12):1513-1522. doi: 10.1111/1346-8138.16942. Epub 2023 Sep 4. PMID: 37665181.

The Science

Benzoyl peroxide releases oxygen to kill acne-causing bacteria and reduce the inflammation that can damage collagen and lead to scarring. By treating active acne lesions quickly, it helps prevent new atrophic scars from developing.

Limitations

Can cause dryness, redness, and peeling, especially when first starting.
Known to bleach fabrics, including clothing, towels, and pillowcases.
Primarily prevents new atrophic scars; it does not treat existing ones.

Expected Time-to-Results

Noticeable reduction in new scar formation may take ≥24 weeks of consistent use.

Cost

$5–$25 OTC; often covered by insurance with a prescription.

Products

Bottom Line

Benzoyl peroxide is a highly effective and accessible treatment for preventing the formation of new atrophic (indented) scars by controlling the inflammatory acne that causes them. While it will not improve existing scars, strong clinical evidence supports its use as a preventative maintenance therapy.

Silicone Products

Silicone Gels, Creams, and Sheets

What Is It?

Medical-grade silicone applied to the skin as a gel, cream, or sheet to improve the appearance of scars. They are widely used to manage raised (hypertrophic) scars and are available over-the-counter. (OTC)

Effectiveness Rating

Good — particularly for raised (hypertrophic) acne scars and the red marks left by new spots, based on clinical guidelines and user reports. Its effect on indented scars is less proven.

Who It’s Best For

Individuals with new or healing acne spots, especially those prone to developing red, raised, or thickened scars.

User Reports

One Reddit user reported a silicone stick made a “noticeable difference” on new scars within a month.
Another user shared that their physician specifically recommended a silicone cream over sheets for their acne scars.
Users generally find that silicone products work much better and faster on new scars than on older ones.

The Science

Silicone forms a thin, breathable, and waterproof layer over the scar. This locks in moisture, which helps to soften the scar tissue and regulate collagen production, leading to a flatter, smoother, and less red appearance.

Limitations

Less effective for older, white, or indented (atrophic) acne scars.
Requires consistent, daily application for several months.
Some formulations can feel greasy or may not wear well under makeup.
Can occasionally cause skin irritation or clogged pores in acne-prone skin.

Expected Time-to-Results

Expect visible improvement in 4–8 weeks for new scars, with optimal results after 6+ months of continuous use.

Cost

£$15–$50 for a tube of gel or a pack of sheets, available over-the-counter.

Products

Gels/Creams: Kelo-Cote Advanced Formula Scar Gel, Dermatix Ultra Scar Gel, Strataderm Scar Therapy Gel.
Sheets: ScarAway Silicone Scar Sheets.
Sticks: Kelo-Cote Scar Gel Stick.

Bottom Line

Silicone products are a safe and clinically recommended first-line option for both preventing and treating raised acne scars. They are most effective when used on new or healing scars to reduce redness and flatten texture.

Topical Retinoids

Tretinoin

What Is It?

A powerful, prescription-only form of Vitamin A (retinoid) that treats active acne, signs of aging, and textural issues. It is one of the most well-known topicals for improving skin texture related to acne scarring. (Availability: Rx)

Effectiveness Rating

Mixed — strong user reports for improving overall skin texture and discoloration, but clinical and user evidence suggests it is not very effective for deep, indented scars on its own.

Who It’s Best For

Patients with shallow textural irregularities, post-inflammatory hyperpigmentation (dark spots), and those looking to prevent new scars by controlling active acne.

Evidence Snapshot

User Reports

Tretinoin is overwhelmingly recommended by Reddit users for improving scar texture and preventing new scars, with many finding it significantly more effective than over-the-counter products.
A strong consensus among users is that it offers only minimal improvement for deep, pitted, or established atrophic scars.
3 users reported that incorrect use (e.g., without enough moisturizer, or with a heavy occlusive on top) caused severe irritation and breakouts that led to more scarring.
Some users who “pushed through the purge” for up to a year found it persistently worsened their acne and scarring.

The Science

Tretinoin works by increasing the rate of skin cell turnover, which helps shed discolored surface cells and smooths the skin’s surface. It also stimulates the production of new collagen in the deeper layers of the skin, which can, over time, help to plump up and reduce the depth of shallow scars.

Limitations

High risk of irritation, dryness, peeling, and increased sun sensitivity, especially during the initial weeks of use (the “retinization” period).
An initial “purging” phase, where acne may worsen before it improves, is common.
Considered ineffective for deep or “tethered” scars like ice pick and boxcar scars.

Expected Time-to-Results

Expect initial changes in ≥3–6 months, with more significant improvement in texture after 1+ years of consistent use.

Cost

~$20–$100+ per tube without insurance in the US; often covered by prescription plans. Generic versions are available.

Products

Gentler option: Altreno (tretinoin) Lotion 0.05%
Standard options: Retin-A, Retin-A Micro, generic tretinoin creams and gels (0.025%, 0.05%, 0.1%).

Bottom Line

Tretinoin is a gold-standard, long-term treatment for improving overall skin texture and preventing the formation of new acne scars. However, it is not a solution for deep, indented scarring, and proper use with moisturizer and sunscreen is critical to manage side effects and avoid irritation-induced breakouts.

Adapalene

What Is It?

A third-generation topical retinoid used to treat acne. It is known for being gentler than tretinoin and is available over-the-counter in some countries, making it a popular starting point for addressing mild scars and preventing new ones. (Availability: OTC, Rx)

Effectiveness Rating

Good — well-tolerated and clinically shown to be effective for mild atrophic scars, while also preventing new breakouts. User reports strongly support it as an accessible, effective first-line option.

Who It’s Best For

Individuals with mild atrophic acne scars and active acne, especially those who are new to retinoids or have more sensitive skin.

Evidence Snapshot

Clinical Data

In a 24-week study with 20 patients, adapalene 0.3% gel used alone resulted in a significant improvement in the average grade of atrophic scarring (p=0.02) and reduced the average scar count from 18.7 to 11.8. ¹

Loss MJ, et al. An open-label study of adapalene 0.3% gel in the treatment of atrophic acne scars. Dermatol Ther (Heidelb). 2018;8(3):471-476. doi:10.1007/s13555-018-0252-x

User Reports

Reddit users highly recommend adapalene as a cost-effective and well-tolerated retinoid for treating active acne, post-inflammatory marks, and minor textural scars.
One user noted that nightly use of adapalene cream created a temporary “plumping” effect, making scars appear less noticeable in the morning.

The Science

Adapalene works by regulating skin cell turnover, which prevents pores from becoming clogged and helps to gently exfoliate the skin’s surface. It also has significant anti-inflammatory properties, which calms the inflammation that leads to scar formation and helps the skin to remodel existing mild scars.

Limitations

It is milder than other prescription retinoids, so it may not be potent enough for moderate to severe scarring.
Can still cause initial dryness, redness, and purging, though this is typically less severe than with tretinoin or tazarotene.

Expected Time-to-Results

Expect visible improvement in ≥8–12 weeks.

Cost

Approximately $15–$30 for over-the-counter versions. Usually covered by insurance with a prescription.

Products

Differin Gel (0.1% Adapalene)
La Roche-Posay Effaclar Adapalene Gel 0.1%
Prescription-strength Adapalene 0.3% is also available.

Bottom Line

Adapalene is an excellent and accessible choice for preventing new acne scars while treating mild existing textural issues. Its favorable balance of effectiveness and tolerability makes it an ideal starting retinoid for many people.

Tazarotene

What Is It?

A potent, prescription-only retinoid used to treat acne, psoriasis, and, more recently, atrophic acne scars. It is considered one of the most powerful topical options for textural improvement. (Availability: Rx)

Effectiveness Rating

Excellent — strong clinical evidence shows its efficacy for atrophic scars is comparable to microneedling, and user reports frequently describe it as a “game changer” for indented scars.

Who It’s Best For

Patients with moderate to severe atrophic (indented) acne scars who have already tried and tolerated other retinoids.

Evidence Snapshot

Clinical Data

In a split-face randomized trial, topical 0.1% tazarotene gel applied daily was found to be as effective as four sessions of microneedling for improving atrophic acne scars (p=0.42).¹

Afra T, Razmi T, Narang T, Dogra S, Kumar A. Topical Tazarotene Gel, 0.1%, as a Novel Treatment Approach for Atrophic Postacne Scars: A Randomized Active-Controlled Clinical Trial. JAMA Facial Plast Surg. 2019;21(2):125-132. doi:10.1001/jamafacial.2018.1404

User Reports

Tazarotene is frequently described by Reddit users as the most potent topical retinoid for atrophic and pitted scars.
A user reported it was effective on both recent boxcar scars and very old chickenpox scars.
Users noted that modern lotion formulations like Arazlo are gentler and more tolerable than older gel versions.
In Canada, pharmacists can reportedly prescribe Arazlo directly, making access easier.

The Science

Tazarotene is highly selective for specific retinoic acid receptors in the skin, leading to a very powerful effect on skin cell turnover and collagen production. This helps to significantly remodel the skin’s structure, building it back up in areas where tissue was lost from scarring.

Limitations

Can be very irritating, with a high risk of redness, significant peeling, and dryness. It is generally not suitable for beginners or those with very sensitive skin.
User reports state it is largely ineffective for the deepest types of scars, like ice pick scars.

Expected Time-to-Results

Expect visible improvement in ≥12 weeks.

Cost

Prescription only. Brand names can be expensive (>$100), but cost varies depending on insurance coverage.

Products

Gentler option: Arazlo (tazarotene) Lotion 0.045%
Standard options: Tazorac (cream/gel), Fabior (foam), generic tazarotene.

Bottom Line

Tazarotene is one of the most effective and evidence-backed topical treatments for improving atrophic acne scars, with a power that can rival some in-office procedures. However, its strength demands careful use and a strong skin barrier to manage the high potential for irritation.

Trifarotene

What Is It?

The newest (fourth-generation) prescription retinoid that selectively targets a key receptor in the skin. It was designed to be highly effective for acne and scarring with potentially better tolerability than older retinoids. (Availability: Rx)

Effectiveness Rating

Excellent — supported by a high-quality clinical trial showing a significant and rapid reduction in atrophic acne scar counts compared to a placebo.

Who It’s Best For

Individuals with active acne and atrophic scars who are looking for the most modern, targeted retinoid available, which may offer a better balance between high efficacy and tolerability.

Evidence Snapshot

Clinical Data

In a 24-week split-face study of 121 patients, a daily trifarotene cream resulted in a significantly greater reduction in total atrophic scar count compared to a placebo vehicle (−5.9 vs −2.7; p < 0.0001). A significant difference was seen as early as week 2.¹

Schleicher S, Moore A, Rafal E, et al. Trifarotene Reduces Risk for Atrophic Acne Scars: Results from A Phase 4 Controlled Study. Dermatol Ther (Heidelb). 2023;13(11):2647-2659. doi:10.1007/s13555-023-01042-7

The Science

Trifarotene works by selectively targeting the retinoic acid receptor-gamma (RAR-γ), the most common retinoid receptor in the skin. This precise action allows it to powerfully regulate skin cell turnover and inflammation to treat acne and remodel scar tissue, potentially causing fewer side effects than less selective retinoids.

Limitations

As a newer drug, it is expensive and may not be on all insurance formularies.
There is less long-term, real-world user data available compared to retinoids that have been on the market for decades.

Expected Time-to-Results

Clinical data suggests improvements can be seen as early as 2 weeks, with significant results by 24 weeks.

Cost

Prescription only. Can be expensive without good insurance coverage. Manufacturer savings programs may be available.

Products

Aklief (trifarotene) Cream 0.005%

Bottom Line

Aklief is a highly promising, powerful, and evidence-backed new option for both preventing and treating atrophic acne scars. Its targeted mechanism makes it an exciting development in topical scar treatment.

Retinol

What Is It?

An over-the-counter form of Vitamin A that is much gentler than prescription retinoids. It is a very popular ingredient in anti-aging and general skincare products. (Availability: OTC)

Effectiveness Rating

Poor — widely considered by users to be ineffective for treating indented acne scars. It is the mildest retinoid and primarily helps with minor skin tone and texture issues, not true scar revision.

Who It’s Best For

Individuals with very sensitive skin or those completely new to Vitamin A products, looking for general anti-aging benefits or very minor improvement in skin tone. It is not a primary treatment for acne scars.

Evidence Snapshot

User Reports

Reddit users consistently report that over-the-counter retinols are a “waste of money” for treating indented scars and are completely ineffective compared to prescription options like tretinoin.
Users warn that using high-strength (e.g., 1%) retinol, especially at a young age or combined with other exfoliants, can damage the skin barrier and worsen acne and texture.
It is critical to first focus on healing the skin barrier before starting retinol to avoid irritation.

The Science

Retinol must first be converted by enzymes in the skin into retinoic acid before it can work, a process which makes it much less potent than prescription-strength products. It gently encourages cell turnover and provides a very mild collagen-stimulating effect over a long period.

Limitations

Much slower and significantly less effective than prescription retinoids for any type of scar.
High-strength formulations can still cause irritation, peeling, and skin barrier damage if overused or combined with too many other active ingredients.

Expected Time-to-Results

Requires very long-term, consistent use (≥6 months) to see even minimal changes in skin tone or fine lines. Unlikely to impact scars.

Cost

Widely available and affordable, typically ranging from £10–£50.

Products

Bottom Line

While retinol is a fine ingredient for maintaining general skin health and preventing some signs of aging, it is not an effective treatment for atrophic acne scars. Those seeking meaningful scar improvement should look to more potent, prescription-strength retinoids.

Combination Therapies

Adapalene + Benzoyl Peroxide

What Is It?

A prescription gel that combines a retinoid (adapalene) with a powerful antimicrobial agent (benzoyl peroxide). It’s designed to attack acne from multiple angles and is clinically proven to help with scarring. (Availability: Rx)

Effectiveness Rating

Excellent — strong clinical trials show this combination is highly effective at both reducing existing atrophic scars and preventing new ones from forming by controlling active acne.

Who It’s Best For

People with active inflammatory acne who are also concerned with treating and preventing the atrophic scars that can result from it.

Evidence Snapshot

Clinical Data

In a 24-week split-face trial (n=67), the combination gel resulted in twice as many faces being rated ‘clear/almost clear’ of scars compared to a placebo (32.9% vs 16.4%, p<0.01).¹
A 24-week maintenance trial (n=111) found the gel significantly reduced atrophic scar counts from the start (p=0.0004) and prevented the worsening that was seen in untreated controls.²

Dréno B, Bissonnette R, Gagné-Henley A, et al. Prevention and Reduction of Atrophic Acne Scars with Adapalene 0.3%/Benzoyl Peroxide 2.5% Gel in Subjects with Moderate or Severe Facial Acne: Results of a 6-Month Randomized, Vehicle-Controlled Trial Using Intra-Individual Comparison. Am J Clin Dermatol. 2018;19(2):275-286. doi:10.1007/s40257-017-0335-2
Tanizaki H, Hayashi N, Abe M. Evaluation of the efficacy of maintenance therapy for acne vulgaris using adapalene 0.1%/benzoyl peroxide 2.5% gel and benzoyl peroxide 2.5% gel for 24 weeks and assessment of atrophic acne scars using three-dimensional image analysis. J Dermatol. 2023;50(12):1559-1568. doi:10.1111/1346-8138.16942

The Science

This combination provides a two-pronged attack. The adapalene regulates skin cell turnover and reduces inflammation, while the benzoyl peroxide kills acne-causing bacteria. By aggressively treating active breakouts, it prevents new scars, while the retinoid component helps to remodel existing shallow scars.

Limitations

The combination of two powerful active ingredients can be very drying and irritating.
Benzoyl peroxide is known to bleach fabrics, towels, and pillowcases.

Expected Time-to-Results

Clinical trials show significant results are achievable within 24 weeks.

Cost

Prescription only. Brand names can be expensive, but generics may be available and covered by insurance.

Products

Epiduo / Epiduo Forte
TactuPump / TactuPump Forte (Canada)

Bottom Line

This is a highly effective, evidence-backed treatment for people who need to control active acne while simultaneously treating and preventing atrophic scarring. It is a true dual-action product.

Tretinoin + Hydroquinone

What Is It?

A dermatologist-prescribed combination therapy used to “prime” or prepare the skin before an in-office scar procedure, like a deep chemical peel. It helps improve healing and prevent complications. (Availability: Rx)

Effectiveness Rating

Good — not a scar treatment on its own, but clinical data supports its use as a preparatory step to improve results and reduce the risk of dark spots from procedures, especially in darker skin.

Who It’s Best For

Patients, particularly those with medium to dark skin tones (Fitzpatrick types III-VI), who are preparing for a procedural scar treatment like TCA CROSS or laser resurfacing.

Evidence Snapshot

Clinical Data

Multiple studies have successfully used a pre-treatment regimen of topical tretinoin (0.025%) and hydroquinone (2-4%) for at least two weeks before TCA CROSS peels. This was shown to reduce complications and promote better healing, especially in patients with darker skin.¹⁻³

Bhardwaj D, Khunger N. An assessment of the efficacy and safety of 100% trichloroacetic acid in the management of ice pick acne scars. J Cutan Aesthet Surg. 2010;3(2):93-96. doi:10.4103/0974-2077.69019
Khunger N, Bhardwaj D, Khunger M. Evaluation of 100% trichloroacetic acid (TCA) for the treatment of ice pick acne scars. J Cutan Aesthet Surg. 2011;4(2):117-120. doi:10.4103/0974-2077.85022
Dalpizzol M, Weber MB, Mattiazzi AP, Manzoni AP. Comparative Study of the Use of Trichloroacetic Acid and Phenolic Acid in the Treatment of Atrophic-Type Acne Scars. Dermatol Surg. 2016 Mar;42(3):377-83. doi: 10.1097/DSS.0000000000000606. PMID: 26849087.

The Science

This is a pre-emptive strategy. Tretinoin speeds up cell turnover and gets the skin’s healing mechanisms ready to go. Hydroquinone is a tyrosinase inhibitor, meaning it suppresses the skin’s ability to produce melanin (pigment), thereby preventing dark spots (post-inflammatory hyperpigmentation) from forming as a side effect of the procedure.

Limitations

This is not a standalone treatment for atrophic scars; it is only used to prepare for a separate procedure.
Hydroquinone use must be supervised by a doctor due to the risk of side effects like skin irritation and, with long-term misuse, a permanent skin darkening called ochronosis.

Expected Time-to-Results

The regimen is typically used for 2–4 weeks immediately before a scheduled procedure.

Cost

Prescription only. The ingredients are often available as affordable generics.

Products

This therapy is typically prescribed as two separate generic creams (e.g., a tretinoin 0.025% cream and a hydroquinone 4% cream) or mixed by a compounding pharmacy.

Bottom Line

This is an important and effective preparatory step for many people undergoing procedural scar treatment. It helps ensure a safer procedure with a better final outcome, but it does not treat the scars by itself.

Retinoic Acid + Glycolic Acid

What Is It?

A combination of a prescription retinoid (retinoic acid/tretinoin) and an alpha-hydroxy acid (glycolic acid). This duo works to exfoliate the skin on two levels to improve texture and tone. (Availability: Rx/OTC)

Effectiveness Rating

Poor

Who It’s Best For

Individuals with shallow, textural acne scars and surface discoloration who have resilient skin that can tolerate two potent active ingredients.

Evidence Snapshot

The Science

This combination offers a “one-two punch” for skin resurfacing. Glycolic acid works on the surface, dissolving the “glue” that holds dead skin cells together for a brighter, smoother appearance. At the same time, retinoic acid works deeper in the skin to accelerate cell turnover and build new collagen.

Limitations

The risk of irritation, redness, dryness, and peeling is very high when combining two powerful exfoliants. This approach is not suitable for sensitive skin.
The supporting evidence is very limited, coming from a single study that was rated ‘Poor’ in the input data.

Cost

Cost will vary as this is typically achieved by using two separate products: one prescription retinoid and one over-the-counter glycolic acid product.

Products

This can be done by alternating a prescription tretinoin cream with an OTC glycolic acid product like The Ordinary Glycolic Acid 7% Toning Solution. This should only be done with caution.

Bottom Line

While this combination has a logical scientific basis for improving skin texture, the evidence for its effect on acne scars is weak and the potential for significant irritation is high. This approach should be taken with extreme caution, ideally under the guidance of a dermatologist.

Topical Antibiotics

Nadifloxacin

What Is It?

Nadifloxacin is a prescription-only topical antibiotic gel or cream used to treat mild to moderate inflammatory acne. It works by killing the bacteria that contribute to acne breakouts, which can help prevent new scars from forming. (Availability: Rx)

Effectiveness Rating

Poor — evidence for a direct anti-scarring effect is currently limited to a single, preliminary laboratory study on animal cells.

Who It’s Best For

Patients with active inflammatory acne who want to prevent the formation of new acne scars. Its main benefit comes from treating the acne itself, not existing scars.

Evidence Snapshot

Clinical Data

In a laboratory study using hamster skin cells, nadifloxacin was found to suppress the production of an enzyme (pro-MMP-2) that is involved in tissue breakdown during scarring. Another common antibiotic, clindamycin, did not show this effect.¹

Sato T, Shirane T, Noguchi N, Sasatsu M, Ito A. Novel anti‐acne actions of nadifloxacin and clindamycin that inhibit the production of sebum, prostaglandin E2 and promatrix metalloproteinase‐2 in hamster sebocytes. J Dermatol. 2012;39(9):848-55. doi: 10.1111/j.1346-8138.2012.01525.x.

The Science

Nadifloxacin kills acne-causing bacteria on the skin, reducing the inflammation and painful pimples that can lead to scarring. The lab study suggests it may also have a secondary benefit by directly inhibiting an enzyme involved in the skin’s scarring response, but this has not been proven in humans.

Limitations

The evidence for a direct impact on the scarring process is very weak and based on a single non-human lab study.
Like all antibiotics, there is a risk of developing bacterial resistance, especially with long-term use.
It is not widely available in all countries (e.g., less common in the US and UK).
It only helps prevent new scars by treating active acne; it does not treat existing textural scars.

Expected Time-to-Results

Expect visible improvement in active acne within 4–8 weeks.

Cost

This is a prescription medication, so cost varies based on insurance coverage and location.

Products

Nadoxin Cream/Gel
Nadibact Gel
Acuatim Cream

Bottom Line

Nadifloxacin is effective at treating active inflammatory acne, which is a key step in preventing new scars. While there’s a hint of a direct anti-scarring mechanism from early lab research, this is unproven in people. Its primary role in a scarring context is preventative.

Topical Corticosteroids

Topical Corticosteroid Patches

What Is It?

These are small, medicated adhesive patches containing a steroid, prescribed by a doctor to reduce inflammation and flatten raised scars. (Rx)

Effectiveness Rating

Poor — based on a single, mixed user report that noted flattening of a raised scar but also worsening of skin discoloration.

Who It’s Best For

Individuals with specific types of raised acne scars, such as hypertrophic or keloid scars, who are under the care of a dermatologist.

Evidence Snapshot

User Reports

1 Reddit user reported that dermatologist-prescribed patches reduced the size of raised, persistent post-acne bumps but also caused increased hyperpigmentation in the area.

The Science

Topical corticosteroids suppress the local immune response and inhibit collagen synthesis. This action can help break down the excess collagen that forms raised scars, leading to a flatter and softer appearance over time.

Limitations

Can cause significant side effects like skin thinning (atrophy), stretch marks, and changes in pigmentation (either lightening or darkening).
Not effective for indented (atrophic) acne scars.
Requires a prescription and careful monitoring by a healthcare professional.
Use on the face is generally limited due to the higher risk of side effects on thinner skin.

Expected Time-to-Results

Improvement may be noticeable within 4-8 weeks of consistent use.

Cost

Cost varies significantly depending on the specific product and insurance coverage.

Products

These are prescription-only items. An example is Cordran Tape (Flurandrenolide), which must be prescribed by a doctor.

Bottom Line

While steroid patches have a medical basis for treating raised scars, the available evidence for acne scarring is extremely limited and points to a significant risk of worsening discoloration. This treatment should only be considered for specific hypertrophic or keloid scars under the strict guidance of a dermatologist and is not a general solution for acne scarring.

Calcineurin Inhibitors

Tacrolimus

What Is It?

Tacrolimus is a prescription-only (Rx) ointment that calms skin inflammation, commonly used for conditions like eczema. It is sometimes used off-label to reduce the persistent redness after acne, which may help prevent indented scars from forming.

Effectiveness Rating

Poor — The evidence for preventing scarring is very limited and indirect, based only on its ability to reduce post-acne redness.

Who It’s Best For

Patients with significant and persistent red marks (post-inflammatory erythema) after their acne clears, who want to try and prevent new atrophic scars from developing.

Evidence Snapshot

Clinical Data

A 2023 review noted that tacrolimus 0.1% ointment applied for 5–7 weeks reduced acne-related redness (macular erythema), suggesting it might help prevent subsequent atrophic scarring. The evidence was rated as poor. ¹

Chingshubam B, Sarkar R. Topical management of acne scars: The uncharted terrain. J Cosmet Dermatol. 2023;22(4):1191-1196. doi: 10.1111/jocd.15584.

The Science

Tacrolimus works by suppressing the immune system’s inflammatory response in the skin. By calming the prolonged inflammation and redness that occurs after an acne lesion, it may reduce the risk of collagen damage that leads to indented (atrophic) scars.

Limitations

It does not treat existing acne scars.
Use is ‘off-label’ for acne-related conditions, meaning it’s not an officially approved use.
A burning or stinging sensation is common upon initial application.
It carries an FDA “black box” warning regarding a potential but unproven risk of skin cancer and lymphoma with long-term, continuous use.

Expected Time-to-Results

Reduced redness may be seen in 5–7 weeks.

Cost

This is a prescription-only medication. A generic tube can cost $30–$100+ in the US without insurance. It is often covered by insurance for approved uses (like eczema), but coverage for off-label use for acne scarring may vary.

Products

Tacrolimus is available as a generic ointment or under the brand name Protopic.

Bottom Line

Tacrolimus is an anti-inflammatory ointment that may have a minor preventative role for atrophic scarring by reducing the precursor redness and inflammation. However, the evidence is very weak, it does not treat existing scars, and it requires a prescription and careful consideration of its side effects. It is not a primary or proven treatment for acne scarring.

Depigmenting Agents

Niacinamide (Topical)

What Is It?

A form of vitamin B3 that helps improve the appearance of uneven skin tone and redness left by acne. It is widely available in over-the-counter (OTC) serums, toners, and moisturizers.

Effectiveness Rating

Mixed — Good for the red and brown discoloration (PIE/PIH) left by acne, but user reports consistently state it does not improve indented (atrophic) scar texture.

Who It’s Best For

Patients primarily concerned with red or brown marks left after acne has healed, not those with textural scarring like pits or indents.

Evidence Snapshot

User Reports

Reddit users consistently report niacinamide is effective for fading post-inflammatory hyperpigmentation (PIH) and erythema (PIE), which are the dark or red marks often referred to as ‘scars’.
Users frequently recommend combining it with Vitamin C or tranexamic acid for better results on discoloration.
There is a strong consensus among users that it is not effective for improving the texture of indented (atrophic) scars.

The Science

Niacinamide works by reducing the transfer of pigment (melanin) between skin cells, which helps to lighten dark spots. Its anti-inflammatory properties also help calm redness from past or current breakouts, preventing marks from becoming as dark in the first place.

Limitations

Ineffective for changing the texture of indented (atrophic) scars.
High concentrations (above 10%) can cause irritation, redness, or breakouts for some people.
Can be slow to show results compared to prescription-strength ingredients.

Expected Time-to-Results

Expect visible improvement in 4–8 weeks.

Cost

£8–£25 for OTC products.

Products

Bottom Line

Niacinamide is a great starting point for tackling the red and brown marks often mistaken for scars. While it won’t fix any changes in skin texture like pits or indents, it is effective for evening out skin tone and can help prevent new discoloration from forming.

Azelaic Acid

Azelaic Acid (Topical)

What Is It?

A naturally derived acid that fights acne, reduces inflammation, and helps fade discoloration from acne marks. It’s available in lower strengths over-the-counter (OTC) and higher strengths via prescription (Rx).

Effectiveness Rating

Excellent — User reports are overwhelmingly positive for fading red and dark acne marks (PIE/PIH), and its ability to treat active acne helps prevent new scars from forming.

Who It’s Best For

Patients dealing with both active acne and the persistent red or brown marks it leaves behind. It is also an excellent, well-tolerated option for those with sensitive skin who cannot handle retinoids.

Evidence Snapshot

User Reports

Users consistently report that prescription-strength (15-20%) azelaic acid is highly effective and acts faster than over-the-counter 10% versions for fading acne marks.
It is frequently praised as a multifunctional ingredient that successfully treats active breakouts while also reducing the subsequent red marks (PIE).
Many users recommend it as a gentler, effective alternative for those whose skin is too sensitive for retinoids like tretinoin.
One user noted it was effective for body acne and scarring after other common actives like retinol and salicylic acid had failed.

The Science

Azelaic acid calms inflammation, which directly reduces the redness of acne and post-acne marks. It also inhibits tyrosinase, an enzyme needed for melanin production, which helps to fade dark spots (PIH). It also helps normalise skin cell turnover to keep pores clear.

Limitations

Prescription strength is most effective but requires a consultation with a healthcare provider.
Can cause mild, temporary itching or stinging upon application, especially at first.
Its primary benefit is for discoloration; it has a limited effect on deep, indented scars.

Expected Time-to-Results

Visible improvement in 6–12 weeks, with prescription versions often working faster.

Cost

£10–£30 for OTC products; often covered by NHS prescription (Rx).

Products

OTC: The Ordinary Azelaic Acid Suspension 10%, Paula’s Choice 10% Azelaic Acid Booster
Rx: Finacea 15% Gel, Skinoren 20% Cream

Bottom Line

Azelaic acid is a powerful, multi-tasking ingredient that is highly effective at both clearing active acne and fading the stubborn red and brown marks it leaves behind. It is a top-tier choice for preventing and treating the discoloration component of acne scarring.

Tranexamic Acid

Tranexamic Acid (Topical)

What Is It?

A topical ingredient that specifically targets stubborn brown spots and uneven skin tone caused by sun damage or acne. It is available over-the-counter (OTC), often in serums.

Effectiveness Rating

Good — User reports suggest it is a gentle and effective option for fading newer, discolored acne scars (PIH), especially when used in combination with other brightening agents.

Who It’s Best For

Patients with brown or dark spots (post-inflammatory hyperpigmentation) from past acne breakouts. It’s a good choice for those with sensitive skin or for adding a boost to an existing routine.

Evidence Snapshot

User Reports

Users describe tranexamic acid as a gentle yet effective option for fading newer acne scars and post-inflammatory hyperpigmentation.
It is frequently recommended in serums that also contain niacinamide or azelaic acid for enhanced results.
Specific Asian Beauty products, like those from Hada Labo and Anua, are often highlighted as effective user favourites.

The Science

Tranexamic acid works by blocking the pathways that lead to excess melanin (pigment) production after inflammation (like an acne spot). This helps to fade existing dark marks and prevent new ones from becoming as prominent.

Limitations

Primarily targets brown hyperpigmentation (PIH) and is less effective on red marks (PIE) or textural scars.
It is a newer ingredient in skincare, so the body of evidence is not as large as for ingredients like retinoids or azelaic acid.
Often works best when paired with other brightening ingredients like niacinamide or vitamin C.

Expected Time-to-Results

Expect visible improvement in 8–12 weeks.

Cost

£15–£45 for OTC products.

Products

Bottom Line

Tranexamic acid is a promising and gentle ingredient for tackling the stubborn brown marks left by acne. While it won’t help with indented scars, it is a valuable tool for a routine focused on evening out skin tone and can effectively fade post-acne hyperpigmentation.

Scar-Specific Formulations

Heparin Sodium Allantoin

What Is It?

A compound gel, often combined with onion extract, used to treat raised, thick scars (hypertrophic and keloid). Its availability varies by country, but it’s often sold as a non-prescription treatment. (OTC/Rx)

Effectiveness Rating

Good — clinical guidelines recommend it for improving raised hypertrophic scars, but it is not intended for indented atrophic scars.

Who It’s Best For

Patients with raised, lumpy, or thick scars (hypertrophic scars), often after surgery or injury. Its use for acne scars is specific to this raised scar type, not common pits or indents.

Evidence Snapshot

Clinical Data

A 2021 consensus from dermatologists in China recommends the long-term topical application of a heparin sodium allantoin compound as a treatment for hypertrophic scars, on par with silicone preparations. ¹

Yang SA, Lu Z, Lin T, Zhou G, Yao M, Liu Y, Yang RY, Liu Z, Li YH, Li DN, Chen X, Yan SX, Gao L, Sun Q, Cai HR, Liang Y, Xiao RX, Jia X, Chen J, Cai J, Tu CX. Consensus on Treatment of Acne Scars in China (2021). Int J Dermatol Venereol. 2022 Sep;5(3):121-31. doi: 10.1097/JD9.0000000000000229.

The Science

Heparin has anti-inflammatory and anti-proliferative effects that help soften scar tissue and prevent excessive collagen growth. Allantoin promotes wound healing and increases the skin’s moisture content, making the scar more pliable.

Limitations

Primarily effective for hypertrophic (raised) scars, not atrophic (indented) acne scars.
Requires consistent, long-term use for over 6 months.

Expected Time-to-Results

Expect visible improvement in 6–12 months.

Cost

£20–£40 for brands like Contractubex or Mederma.

Products

Bottom Line

This is a clinically recommended option for raised, thick hypertrophic scars. It will not help with the indented or pitted scars that are common after acne.

Silicone Gel

What Is It?

A topical gel or sheet that creates a protective, breathable barrier over a scar to hydrate the tissue and regulate collagen production, helping to flatten and soften it. (OTC)

Effectiveness Rating

Poor — while a gold standard for surgical and keloid scars, user reports find it ineffective for common atrophic (indented) acne scars.

Who It’s Best For

Primarily patients with raised (hypertrophic or keloid) scars, especially after surgery or injury. It is not typically recommended for indented acne scars.

Evidence Snapshot

User Reports

Multiple Reddit users anecdotally report that silicone gel was ineffective for their acne scars.

The Science

Silicone hydrates the scar by trapping moisture, which helps to normalize collagen production and can flatten and soften raised scars. It also protects the scar from bacteria and environmental factors.

Limitations

Strong evidence supports its use for hypertrophic and keloid scars, but there is a significant evidence gap and negative user reports for its use on atrophic (indented) acne scars.
Must be worn consistently for many hours a day.

Expected Time-to-Results

≥12 weeks for hypertrophic scars; unlikely to show results for atrophic acne scars.

Cost

£15–£35 for a tube or pack of sheets.

Products

Bottom Line

An excellent choice for raised scars from surgery or injury, but based on user reports and its mechanism, it is unlikely to improve the texture of indented acne scars.

Differin Resurfacing Scar Gel

What Is It?

An over-the-counter gel that combines a surface-exfoliating peptide, bakuchiol, and tranexamic acid to improve the appearance of texture and discoloration from scars. (OTC)

Effectiveness Rating

Poor — user reports indicate it provides minimal to no improvement for the texture of atrophic (indented) acne scars.

Who It’s Best For

Individuals looking for a gentle, all-in-one product for very mild, superficial textural issues and post-acne discoloration. It is not suitable for significant indented scars.

Evidence Snapshot

User Reports

One Reddit user reported only minimal improvement for atrophic (boxcar) scars after 6 months of consistent use.

The Science

It aims to hydrate, exfoliate, and brighten. A peptide and bakuchiol work to smooth surface texture, while tranexamic acid targets discoloration. Note: this is different from Differin Gel (adapalene), which is a retinoid for treating active acne.

Limitations

Contains no powerful, evidence-backed collagen-stimulating ingredients.
User reports suggest it is not potent enough to remodel established atrophic scars.

Expected Time-to-Results

The company suggests 8 weeks, but user reports indicate results may be minimal even after 6 months.

Cost

$20–$25 for a 1oz tube.

Products

Differin Resurfacing Scar Gel

Bottom Line

Despite its name, this product appears to be ineffective for significantly improving the texture of indented atrophic acne scars. It may offer a slight improvement for the discoloration left behind by acne.

Acids & Exfoliants

Azelaic Acid

What Is It?

A dicarboxylic acid that gently exfoliates, reduces inflammation, and blocks the production of abnormal pigment, making it a go-to for post-acne redness and brown spots. (OTC & Rx)

Effectiveness Rating

Excellent — strong user consensus confirms its ability to clear post-inflammatory erythema (red marks) and hyperpigmentation (brown marks).

Who It’s Best For

Patients whose primary scarring concern is discoloration—either red marks (PIE) or brown marks (PIH). It is also great for those with active acne and rosacea.

Evidence Snapshot

User Reports

Widely recommended by Reddit users as a top-tier treatment for post-inflammatory erythema (PIE) because it specifically targets redness.
Prescription-strength versions (Finacea 15-20%) are reported to be highly effective.
Over-the-counter options from brands like The Ordinary and Paula’s Choice are also considered helpful.
One user report noted a 9-month routine including Azelaic Acid was not enough to fade persistent red marks, highlighting that results can vary.

The Science

Azelaic acid works by calming inflammation, which reduces redness and prevents the formation of post-acne marks. It is also a tyrosinase inhibitor, meaning it slows down the enzyme responsible for producing melanin, thereby fading dark spots.

Limitations

It does not treat textural scars (indents or pits).
Higher concentrations can cause itching or mild irritation initially.
Some formulations can have a gritty or unpleasant texture.

Expected Time-to-Results

Expect visible improvement in 8–12 weeks.

Cost

£10–£15 for OTC versions; often covered by prescription (e.g., NHS, insurance).

Products

The Ordinary Azelaic Acid 10% Suspension (OTC)
Paula’s Choice 10% Azelaic Acid Booster (OTC)
Finacea 15% Gel/Foam (Rx)

Bottom Line

A first-line, evidence-backed choice for tackling the red and brown discoloration left behind by acne. It will not improve indented scars but can help prevent new marks from forming by controlling active acne.

Salicylic Acid (BHA)

What Is It?

A beta-hydroxy acid (BHA) that exfoliates inside the pore lining to clear out oil and dead skin cells, primarily used to treat and prevent active acne. (OTC)

Effectiveness Rating

Good — excellent for preventing the acne that causes scars and helpful for the surface discoloration associated with them.

Who It’s Best For

People with active, oily, and acne-prone skin who want to prevent new scars from forming and help fade surface-level discoloration.

Evidence Snapshot

User Reports

A Reddit user reported that skin cycling with a 2% BHA liquid (Paula’s Choice) helped to control breakouts and reduce post-acne redness.

The Science

As an oil-soluble acid, it penetrates deep into pores to dissolve clogs, which treats and prevents acne lesions. Its exfoliating properties also help to speed up cell turnover on the skin’s surface, which can gradually lighten discoloration.

Limitations

Can be drying and irritating, especially when first introduced or overused.
It does not remodel collagen, so it won’t fix indented scars.

Expected Time-to-Results

4–8 weeks for clearer skin and prevention of new marks.

Cost

£10–£30 for popular formulations.

Products

Bottom Line

A powerful tool for preventing new acne scars by keeping skin clear. While not a direct treatment for indented scars, its exfoliating action can help lessen the associated discoloration.

Glycolic Acid (AHA)

What Is It?

An alpha-hydroxy acid (AHA) derived from sugar cane that exfoliates the surface of the skin, helping to smooth texture and fade dark spots. (OTC)

Effectiveness Rating

Mixed — user reports are conflicting; it may help with shallow texture but seems ineffective for redness (PIE).

Who It’s Best For

Individuals with concerns about mild textural irregularities, surface roughness, and brown spots (PIH).

Evidence Snapshot

User Reports

One Reddit user reported that a regimen including glycolic acid and tretinoin was effective for improving textural scars.
A contradictory report from the same user noted the regimen had no impact on associated red marks (PIE).

The Science

As the smallest AHA, glycolic acid effectively dissolves the ‘glue’ holding dead cells on the skin’s surface. This accelerated cell turnover can smooth skin texture and fade hyperpigmentation over time.

Limitations

Can cause significant irritation, sun sensitivity, and a damaged moisture barrier if overused.
User reports suggest it doesn’t help with redness (PIE).
Unlikely to impact deep, atrophic scars.

Expected Time-to-Results

8–12 weeks for smoother texture and more even tone.

Cost

£8–£25 for popular serums and toners.

Products

Bottom Line

May offer some benefit for very superficial textural issues and brown spots, but it comes with a risk of irritation and won’t address redness or deep, indented scars.

Pigment Inhibitors & Antioxidants

Hydroquinone

What Is It?

A powerful skin-lightening agent that is considered the gold standard for treating hyperpigmentation, such as dark spots from acne (PIH). (Rx in many countries, including UK/EU)

Effectiveness Rating

Excellent — highly effective for fading stubborn brown post-acne marks (PIH), though it requires patience and medical supervision.

Who It’s Best For

Individuals with persistent brown or dark spots (post-inflammatory hyperpigmentation) that have not responded to other treatments.

Evidence Snapshot

User Reports

Reddit users confirm that fading post-acne marks is a multi-month process even with potent routines that include hydroquinone and tretinoin.

The Science

Hydroquinone works by significantly decreasing the production of melanin in the skin. It does this by inhibiting tyrosinase, the key enzyme needed to create pigment.

Limitations

Should only be used for short periods (e.g., 3-4 months) under medical supervision to avoid side effects like ochronosis (a permanent blue-black discoloration).
It does not treat redness (PIE) or textural scars.
Prescription is required in many regions.

Expected Time-to-Results

Visible lightening in 8–12 weeks, with full results taking several months.

Cost

Typically requires a private prescription or dermatologist visit; cost varies.

Products

Usually prescribed as a generic compound or as part of a blend like the Tri-Luma formula (which also contains a retinoid and a steroid).

Bottom Line

A highly potent and effective treatment for stubborn brown marks left by acne, but it must be used with caution and under a doctor’s guidance. It does not help with indented or red scars.

Copper Peptides

What Is It?

A serum containing peptides (small chains of amino acids) bound to copper, believed to support wound healing and collagen production. (OTC)

Effectiveness Rating

Mixed — some user reports suggest it can enhance a routine for shallow scars, but lacks strong, independent clinical data for significant scar revision.

Who It’s Best For

Individuals already using a core treatment like a retinoid who want to add a supportive product to potentially boost collagen synthesis and improve overall skin health.

Evidence Snapshot

User Reports

One Reddit user reported that adding a copper peptide serum to their tretinoin regimen was beneficial for improving shallow scars and skin tone.

The Science

Copper is essential for the function of enzymes that build collagen and elastin. Copper peptides deliver copper to the skin, theoretically promoting wound healing, reducing inflammation, and stimulating the production of structural proteins to firm the skin.

Limitations

The evidence for significant scar improvement in humans is still emerging and less robust than for ingredients like retinoids.
Some formulations can be expensive.
Can potentially conflict with other ingredients like Vitamin C.

Expected Time-to-Results

≥12 weeks to see potential changes in skin texture and firmness.

Cost

£15–£100+, price varies dramatically.

Products

Bottom Line

A promising but not yet proven ingredient for acne scarring. It may offer a supportive role in a wider routine for shallow scars but is unlikely to be a primary treatment for significant textural issues.

Epidermal Growth Factor (EGF) / Growth Factor Serums

What Is It?

Serums containing lab-created proteins (growth factors) that act as chemical messengers to signal skin cells to repair and rejuvenate themselves. (OTC)

Effectiveness Rating

Mixed — recommended anecdotally for atrophic scars with some user success, but clinical evidence is still developing and products are very expensive.

Who It’s Best For

Those with atrophic (indented) scars looking for an advanced topical to potentially enhance results from in-office procedures or a retinoid-based regimen.

Evidence Snapshot

User Reports

One Reddit user recommended EGF serum for improving atrophic scars, noting their scars looked “less harsh” and citing a PubMed study as support.
Users report using growth factor serums (e.g., Skinmedica) and stable Korean EGF ointments as adjunctive topicals to boost results from procedures.

The Science

Growth factors bind to receptors on the skin’s surface, signaling cells to behave like younger, healthier cells. This can stimulate the production of collagen and elastin, helping to repair damaged tissue and improve skin thickness.

Limitations

High cost is a major barrier.
The science is promising but still emerging, with questions about molecule size and penetration into the skin.
Effectiveness can vary greatly between products.

Expected Time-to-Results

≥12 weeks for potential improvements in skin texture.

Cost

£50–£200+, generally a very expensive category.

Products

Bottom Line

An advanced, expensive option that may help soften the appearance of atrophic scars based on user reports. It’s best seen as a supportive treatment rather than a standalone solution for significant scarring.

VT Reedle Shot

What Is It?

A serum containing microscopic, needle-like particles (hydrolyzed sea sponge spicules) designed to create micro-channels in the skin. (OTC)

Effectiveness Rating

Poor — it is believed to function as a penetration enhancer for other products, not as a treatment to induce collagen and remodel scar tissue.

Who It’s Best For

Individuals who want to potentially boost the absorption and effectiveness of their other skincare serums.

Evidence Snapshot

User Reports

The “reedles” are identified as hydrolyzed sea sponge spicules (silica). Reddit users believe their primary function is to enhance the penetration of other ingredients, not to induce collagen for scar remodeling in the same way as professional microneedling.

The Science

The sharp spicules create tiny, temporary pathways in the stratum corneum (the skin’s outermost layer). This allows subsequently applied skincare ingredients to penetrate deeper than they would on their own. It does not go deep enough to stimulate the dermal collagen remodeling required to fix atrophic scars.

Limitations

Can cause a tingling or stinging sensation.
The main function is penetration enhancement, not scar treatment itself.
It is not a substitute for clinical microneedling.

Expected Time-to-Results

Unlikely to show results for scarring itself; any benefits depend on the products applied afterward.

Cost

£25–£40 per bottle.

Products

VT Cosmetics Reedle Shot 100

Bottom Line

This product is a delivery system, not a treatment for scars. It might make your other products work better, but it will not fix indented scars on its own.

Bakuchiol

What Is It?

A plant-based extract that is often marketed as a natural, gentler alternative to retinol for its anti-aging and skin-smoothing benefits. (OTC)

Effectiveness Rating

Mixed — suggested as a gentle option for minor scars, but lacks the potency and robust evidence of retinoids for significant scar revision.

Who It’s Best For

Individuals with very sensitive skin who cannot tolerate retinoids but still want a product to help with fine lines and very minor textural issues.

Evidence Snapshot

User Reports

Recommended by Reddit users as a non-irritating topical alternative to retinol for addressing minor acne scars.

The Science

Bakuchiol has been shown to interact with some of the same receptors as retinoids, leading to increased cell turnover and collagen stimulation. However, its effects are generally considered to be milder than those of prescription retinoids.

Limitations

Significantly less potent and less studied for acne and scarring than retinoids like tretinoin.
Unlikely to have a major impact on anything other than very superficial scars.

Expected Time-to-Results

≥12 weeks to see potential subtle improvements.

Cost

£10–£50+.

Products

Bybi Beauty Bakuchiol Booster

Bottom Line

A good option for those who absolutely cannot tolerate retinoids and are targeting very minor scars or textural concerns. It is not a powerful solution for atrophic acne scarring.

Bio-Oil

What Is It?

A popular body oil containing a blend of mineral oil, plant extracts, and vitamins, marketed for improving the appearance of scars and stretch marks. (OTC)

Effectiveness Rating

Very Poor — user reports indicate it has no noticeable effect on acne scars, even with long-term, consistent use.

Who It’s Best For

Best used as a general body moisturizer for dry skin. It is not recommended for treating facial acne scars.

Evidence Snapshot

User Reports

A Reddit user reported that long-term daily use of Bio-Oil for nearly two years showed no noticeable improvement in their acne scars.

The Science

The oil acts as an occlusive, locking in moisture which can help keep skin pliable. However, it contains no active ingredients proven to remodel scar tissue or stimulate significant collagen production in the dermis.

Limitations

Strong negative anecdotal evidence for acne scars.
Its oily, fragranced formula can potentially clog pores and worsen acne for some individuals.

Expected Time-to-Results

Unlikely to show results for acne scars.

Cost

£10–£20 for a standard bottle.

Products

Bio-Oil Skincare Oil

Bottom Line

Despite its marketing, Bio-Oil is not an effective treatment for facial acne scars and may even cause breakouts in acne-prone individuals.

Manuka Honey

What Is It?

A type of honey native to New Zealand known for its strong antibacterial and anti-inflammatory properties, often used for wound care and calming acne. (OTC/Supplement)

Effectiveness Rating

Poor — while beneficial for calming inflamed, active acne bumps, it is not effective for treating established atrophic scars.

Who It’s Best For

People with active, inflamed acne lesions who want a natural spot treatment to reduce redness and fight bacteria.

Evidence Snapshot

User Reports

Its anti-inflammatory properties are noted by users to help reduce inflamed acne bumps.
Contradictory reports state that it is not effective for treating established atrophic scars.

The Science

Manuka honey’s high concentration of Methylglyoxal (MGO) gives it potent antibacterial properties. Its anti-inflammatory and hydrating nature helps create an ideal environment for wound healing, which can be beneficial for active pimples.

Limitations

Its benefits are primarily for active, inflamed lesions, not for remodeling the collagen of existing scars.
Can be sticky and impractical for widespread use.

Expected Time-to-Results

1–3 days for calming active pimples; not applicable for established scars.

Cost

£15–£40 for a jar of medical-grade honey.

Products

Look for medical-grade honey with a UMF (Unique Manuka Factor) or MGO rating.
Manuka Health MGO 400+ Manuka Honey

Bottom Line

A useful natural remedy for calming down active, angry pimples to potentially prevent a scar from getting worse, but it will not fix a scar that has already formed.

Cinnamon (DIY)

What Is It?

A common kitchen spice sometimes used in homemade face masks with the belief that it can treat acne or scars. (DIY)

Effectiveness Rating

Very Poor — not an effective treatment for scarring and carries a high risk of causing severe skin irritation, chemical burns, and contact dermatitis.

Who It’s Best For

This intervention is not recommended for anyone. The risks of skin damage far outweigh any potential, unproven benefits.

Evidence Snapshot

User Reports

Users warn that the potency and composition of DIY ingredients like cinnamon can vary significantly, potentially leading to unexpected and severe skin damage.

The Science

Cinnamon contains cinnamaldehyde, a compound that can be a potent skin irritant and allergen. While it has some antimicrobial properties in a lab setting, applying it directly to the face can cause inflammation, redness, and burns, which can worsen skin condition and lead to more hyperpigmentation.

Limitations

High risk of causing contact dermatitis, chemical burns, and irritation.
Potency is completely uncontrolled.
Can worsen the very conditions (inflammation, hyperpigmentation) it is intended to treat.
No scientific evidence supports its use for acne scars.

Expected Time-to-Results

Not applicable; skin damage can occur immediately.

Cost

Minimal, but the potential cost of repairing the damage is high.

Products

Not applicable. The use of kitchen-grade cinnamon for skincare is strongly discouraged.

Bottom Line

Avoid using DIY cinnamon treatments on your skin. They are ineffective for acne scars and pose a serious risk of causing significant skin damage, which can lead to more scarring and discoloration.

Oral Antibiotics

Doxycycline

What Is It?

Doxycycline is a prescription oral antibiotic used to treat the bacteria and inflammation associated with moderate to severe acne. For scarring, it’s used to control active breakouts to prevent new scars from forming and to prepare the skin for procedural scar treatments. (Rx)

Effectiveness Rating

Mixed — It does not treat existing scars, but can be essential for preventing new ones by controlling active, inflammatory acne before it has a chance to scar.

Who It’s Best For

Patients with active inflammatory acne who need to get breakouts under control before they can begin treatments for existing scars, or to prevent future scarring.

Evidence Snapshot

User Reports

2 Reddit users reported using oral antibiotics (one specifically mentioning doxycycline) to manage active breakouts before starting scar treatments like lasers and subcision.
1 user reported that doxycycline was ineffective for their cystic acne.

The Science

Doxycycline reduces the population of acne-causing bacteria (C. acnes) on the skin and has powerful anti-inflammatory effects. By calming the inflammation of active pimples, it lowers the risk of them leaving behind permanent scars or discoloration.

Limitations

Does not treat existing atrophic or hypertrophic scars.
Long-term use can lead to antibiotic resistance, making it less effective over time.
Common side effects include increased sensitivity to the sun (photosensitivity) and stomach upset.
It is not a long-term solution; acne often returns after the medication is stopped.
Can disrupt the balance of good bacteria in the gut.

Expected Time-to-Results

Expect to see a reduction in active acne within 4–12 weeks.

Cost

This is a prescription-only medication. In the US, it is an inexpensive generic, with cost dependent on insurance. In the UK, it is covered by the standard NHS prescription charge.

Products

Doxycycline is a generic medication available by prescription only from a doctor or dermatologist.

Bottom Line

Doxycycline is not a treatment for existing acne scars but a preventative and preparatory measure. By getting active, inflammatory acne under control, it plays a key role in stopping new scars from forming and is often a necessary first step before professional scar treatments like lasers or subcision can be safely performed.

Oral Retinoids

Isotretinoin (e.g., Accutane, Roaccutane)

What Is It?

Isotretinoin is a powerful oral prescription medication, derived from vitamin A, used to treat severe, persistent, or scarring acne. It is considered the most effective treatment for stopping the underlying cause of severe acne to prevent new scars from forming. (Rx)

Effectiveness Rating

Excellent — for preventing new acne scars by treating severe acne. Mixed — for improving the appearance of existing atrophic scars.

Who It’s Best For

Patients with severe inflammatory or nodular acne, acne that is resistant to other treatments, or moderate acne that is already causing physical scars or significant psychological distress.

Evidence Snapshot

Clinical Data

A low-dose regimen of 20mg/day of isotretinoin was highly effective for moderate to severe scar-prone acne, with 96.4% of 140 patients achieving complete clearing. The relapse rate was low over a 5-year follow-up. ¹
Clinical guidelines recommend starting systemic therapies like isotretinoin early for patients with severe acne or a high risk of scarring to prevent the formation of permanent scars. ²
Recent high-quality evidence challenges the old guideline of waiting 6 months after finishing isotretinoin to begin procedural scar treatments (like lasers), suggesting concurrent treatment can be safe and effective. ³

Rasi A, Behrangi E, Rohaninasab M, Mehr Nahad Z. Efficacy of fixed daily 20 mg of isotretinoin in moderate to severe scar prone acne. Adv Biomed Res. 2014;3(1):103. doi: 10.4103/2277-9175.129693.
Schnopp C, Mempel M. Acne vulgaris in children and adolescents. Minerva pediatrica. 2011;63(4):383-92.
Gallo ES, Katz U, Artzi O. Fractional Radiofrequency and Oral Isotretinoin—A Prospective Randomized Controlled Split‐Face Trial Comparing Concurrent Versus Delayed Fractional Radiofrequency Treatment for Acne Scars. Lasers Surg Med. 2024 Jun 18;56(6):e23811. doi: 10.1002/lsm.23811. PMID: 38890778.

User Reports

The overwhelming community consensus is that isotretinoin is the primary treatment for severe acne to stop it from causing more scars.
Many users report deep regret for delaying treatment, which they feel led to preventable permanent scarring.
User experiences on its effect on existing scars are divided: some report improvement (especially in new or rolling scars), while many others state it did not help existing atrophic scars and any perceived improvement was temporary due to skin dryness and tightness.
A small number of users reported a definitive worsening of scar appearance while on the drug.
Users caution about the initial “purging” phase, where acne can temporarily worsen, fearing it could create new scars.

The Science

Isotretinoin targets all major causes of acne: it dramatically shrinks the skin’s oil glands, reduces oil production, kills acne-causing bacteria, and calms inflammation. By halting the formation of severe inflammatory acne lesions, it prevents the skin damage that leads to new scars.

Limitations

Requires a prescription and strict medical supervision, including regular blood tests.
High risk of severe birth defects; mandatory pregnancy prevention programs are in place for female patients.
Common side effects include extremely dry skin and lips, dry eyes, and joint pain. Less common but serious side effects can include mood changes.
An initial “purge” or worsening of acne is common in the first month.

Expected Time-to-Results

A full course of treatment typically lasts 4-9 months. The preventative benefit for scarring begins as soon as the active acne starts to clear.

Cost

Prescription only. Often covered by insurance or national health services (like the NHS), but can be expensive without coverage. Costs are increased by mandatory monthly dermatologist visits and blood tests.

Products

Isotretinoin is the generic name. Common brand names include Accutane, Roaccutane, Absorica, and Claravis. It is only available via prescription.

Bottom Line

Isotretinoin is the gold standard for preventing new acne scars by effectively treating severe, active acne. While it is not a reliable treatment for existing atrophic scars, it is often the essential first step to clear the acne before other scar revision treatments can be started.

Isotretinoin + Salicylic Acid Peel

What Is It?

This is a combination therapy that involves taking low-dose oral isotretinoin while also receiving a series of in-office 20% salicylic acid peels from a professional. (Rx, Professional)

Effectiveness Rating

Good — A clinical study showed this combination cleared acne and made scars less conspicuous more effectively than isotretinoin alone.

Who It’s Best For

Patients with moderate to severe active acne who also want to begin addressing the appearance of atrophic (indented) scars at the same time.

Evidence Snapshot

Clinical Data

In a 16-week study, combining 20 mg/day of oral isotretinoin with salicylic acid peels every two weeks led to a significantly greater reduction in acne (92.5% vs 73.4% lesion reduction, p<0.05) and less noticeable atrophic scars compared to taking isotretinoin by itself.¹

Kar B, Tripathy S, Panda M. Comparative Study of Oral Isotretinoin Versus Oral Isotretinoin + 20% Salicylic Acid Peel in the Treatment of Active Acne. J Cutan Aesthet Surg. 2013;6(4):204–8. doi:10.4103/0974-2077.123403.

The Science

Isotretinoin works internally to shut down acne, while the salicylic acid peel works on the surface. The peel exfoliates dead skin cells, unclogs pores, and provides anti-inflammatory benefits, which can help improve skin texture and scar appearance.

Limitations

Requires regular visits to a dermatologist or licensed aesthetician for the peels.
The combination can increase skin dryness, redness, and sensitivity.
Evidence is based on a single, relatively small study.

Expected Time-to-Results

Expect visible improvement within 4 months.

Cost

This approach combines the cost of a private isotretinoin prescription with a series of professional peels, which can range from $100-$300 (£75-£200) per session.

Products

Isotretinoin is prescription-only. 20% Salicylic Acid Peels are for professional use and must be administered in a clinic.

Bottom Line

Combining low-dose isotretinoin with professional salicylic acid peels appears to be a highly effective way to tackle both active acne and early scarring simultaneously, offering better results than isotretinoin alone.

Isotretinoin with Energy-Based Devices

What Is It?

This is a modern treatment approach where patients undergo scar treatments like laser therapy or fractional radiofrequency while they are still taking oral isotretinoin. (Rx, Professional)

Effectiveness Rating

Excellent — Strong new evidence shows this concurrent approach is safe and effective for treating acne scars earlier, overturning previous guidelines that recommended a long waiting period.

Who It’s Best For

Patients taking isotretinoin who are eager to start treating their atrophic acne scars as soon as possible, without waiting 6+ months after their course is finished.

Evidence Snapshot

Clinical Data

A recent systematic review and multiple clinical trials found no instances of keloid scarring or other severe side effects when energy-based devices were used on patients actively taking isotretinoin.¹
One randomized study found that combining low-dose isotretinoin with a picosecond laser was significantly more effective for improving acne scars than isotretinoin monotherapy.²

Xu Y, Wang H, Guo L, Hamblin MR, Wen X. Combinations of Energy-based Devices plus isotretinoin for management of acne and acne scars: A systematic review. J Cosmet Dermatol. 2024 Oct 1;23(10):[pii]: 10.1111/jocd.16407. PMID: 38845186.
Xue H, Ye D, Huang S-L, He S, Li Y, Liu J, Hu D, Zhu Y, Hu G, Dong Y, Shen H, Zeng W-h, Wang Z-x. Efficacy and safety of low‐dose oral isotretinoin monotherapy versus combined therapy with picosecond laser for the treatment of acne scars in Asian population. Lasers Surg Med. 2023;55:23646. doi: 10.1002/lsm.23646. PMID: 36856028.

The Science

Isotretinoin gets the active acne under control, which provides a stable environment for scar revision. The energy-based device (e.g., laser) then delivers focused energy into the skin to stimulate a wound-healing response and build new collagen, which helps to plump and smooth out indented scars.

Limitations

This is a newer protocol, so not all dermatologists may be comfortable or experienced with it yet.
These treatments are expensive and not typically covered by insurance.
Multiple treatment sessions are required for best results.

Expected Time-to-Results

Initial results may be visible after the first few sessions, but final results take 3–6 months after the last treatment as collagen continues to remodel.

Cost

Highly variable. A course of 3-5 laser or radiofrequency sessions can cost from $1,500-$5,000+ (£1,200-£4,000+).

Products

Isotretinoin is prescription-only. Energy-based devices include professional systems like Fraxel (fractional laser), CO2RE (CO2 laser), and Morpheus8 (radiofrequency microneedling).

Bottom Line

Strong new evidence supports treating acne scars with lasers or other energy devices at the same time as taking isotretinoin. This approach is safe and can significantly speed up the journey to both clear skin and a smoother texture.

Isotretinoin + Contractubex

What Is It?

This therapy combines taking oral isotretinoin with the daily application of a topical scar gel, Contractubex, which is available over the counter in many countries. (Rx, OTC)

Effectiveness Rating

Poor — The clinical evidence provided for this combination is unreliable due to a mismatched study reference in the source data, making it difficult to verify the claim.

Who It’s Best For

This might be considered by patients on isotretinoin who want to try an accessible, non-invasive topical product for their atrophic scars, but they should have low expectations.

The Science

Isotretinoin works systemically to control acne. Contractubex contains onion extract (cepalin), heparin, and allantoin. These ingredients are claimed to reduce inflammation, soften hardened scar tissue, and promote organized healing.

Limitations

The supporting evidence from the provided data is highly questionable.
The effectiveness of most OTC topical scar gels for atrophic (indented) scars is widely debated and often considered minimal.

Cost

Cost of the isotretinoin prescription plus the cost of the gel. Contractubex gel typically costs around $15–$25 (£10–£20) per tube.

Products

Contractubex Gel

Bottom Line

There is a very weak suggestion that adding Contractubex gel to an isotretinoin regimen could help atrophic scars, but the evidence is not solid. It’s a low-risk, but likely low-reward, addition to treatment.

Isotretinoin + Tranilast

What Is It?

This is an experimental combination therapy, currently being researched, that pairs oral isotretinoin with a topical gel containing tranilast for scar prevention and treatment. (Rx, Investigational)

Effectiveness Rating

Poor — This is not a proven therapy. Its effectiveness is currently unknown as it is still in the clinical trial phase.

Who It’s Best For

This combination is not available for public use. It is only for individuals enrolled in a specific clinical study.

Evidence Snapshot

Clinical Data

A prospective, double-blind, split-face clinical trial was designed to investigate if adding an 8% tranilast gel to isotretinoin treatment improves the final appearance of acne scars.¹

Weinstein A, Koren A, Sprecher E, Zur E, Mehrabi J, Artzi O. The combined effect of tranilast 8% liposomal gel on the final cosmesis of acne scarring in patients concomitantly treated by isotretinoin: prospective, double‐blind, split‐face study. Clin Exp Dermatol. 2019;44(6):752-758. doi: 10.1111/ced.14032.

The Science

Tranilast is a drug that is known to inhibit the release of certain factors from cells that are involved in inflammation and collagen production. The theory is that applying it to the skin could help regulate scar formation, leading to a better cosmetic outcome.

Limitations

It is an investigational treatment and is not available to the public.
The safety, side effects, and effectiveness for acne scars have not yet been established.

Expected Time-to-Results

Unknown.

Cost

Not applicable.

Products

Not available for purchase.

Bottom Line

This is a potential future treatment for acne scarring that is currently being studied. It is not a therapy that patients can access or use today.

Protein & Amino Acid Supplements

Oral Collagen

What Is It?

Oral collagen is a protein supplement, usually sold as a powder or capsule, that provides the building blocks for your skin, hair, nails, and joints. For scarring, the hope is that it can help the body rebuild the damaged skin structure. (Availability: supplement)

Effectiveness Rating

Poor — User reports are highly skeptical about its ability to visibly improve indented acne scars, and the scientific theory is debated.

Who It’s Best For

This supplement is for individuals looking for general improvements in skin hydration and elasticity, but it is not considered a primary or effective treatment for atrophic (indented) acne scars on its own.

Evidence Snapshot

User Reports

Reddit users express significant skepticism about oral collagen’s effectiveness for scarring, noting a lack of strong evidence that it specifically targets and rebuilds indented scars.
The consensus among users is that it is likely insufficient for treating scars without other procedures like chemical peels or lasers.

The Science

The theory is that ingesting collagen provides your body with the specific amino acids needed to produce its own collagen, helping to repair damaged skin. However, collagen is broken down into individual amino acids during digestion, and there is no guarantee these building blocks will be sent to the skin to fix scars.

Limitations

The biggest limitation is the lack of strong clinical evidence showing it can rebuild indented scars.
The body cannot target where the collagen building blocks go; they are used wherever needed.
Many products are derived from animal sources (bovine, marine), which may not be suitable for everyone.
Results are highly variable between individuals.

Expected Time-to-Results

Do not expect visible improvement in indented scars; general skin hydration may improve in ≥8 weeks.

Cost

£15–£40 for a month’s supply.

Products

Bottom Line

While potentially beneficial for overall skin health and hydration, oral collagen is not a reliable or proven treatment for improving the appearance of indented acne scars. It should not be used as a primary treatment and is best seen as a supportive supplement at most.

Gelatin

What Is It?

Gelatin is a protein derived from cooked collagen, often from animal sources. It’s used as a supplement (e.g., in gummies or powders) with the goal of providing amino acids to support skin structure and plumpness. (Availability: supplement, food product)

Effectiveness Rating

Mixed — There are no clinical studies for scarring, but some user reports suggest it can improve overall skin softness and plumpness, which might subtly reduce the appearance of shallow scars.

Who It’s Best For

Individuals with very minor, shallow texture issues or those looking for a general improvement in skin texture and softness, who understand it’s not a targeted scar treatment.

Evidence Snapshot

User Reports

Some users report that supplements like homemade grass-fed gelatin gummies help improve skin plumpness and softness from within, which they feel may help reduce the visibility of scars.

The Science

Like collagen, gelatin provides amino acids such as glycine and proline, which are essential for the body to build its own collagen. By increasing the availability of these building blocks, the supplement may support the body’s natural skin maintenance and repair processes.

Limitations

No clinical evidence exists to support its use for acne scars.
Its effects are systemic and not targeted to scar tissue.
Most gelatin is from animal sources (pork or beef), making it unsuitable for vegetarians or vegans.
Benefits are based on anecdotal user reports, not scientific studies.

Expected Time-to-Results

Expect potential changes in overall skin texture in ≥8–12 weeks.

Cost

£5–£15 for a standard-sized container of powder.

Bottom Line

Gelatin is an inexpensive supplement that might offer a minor benefit to overall skin plumpness, but it is not a proven treatment for acne scars. It is unlikely to have any significant impact on indented or severe scarring.

Lysine

What Is It?

L-Lysine is an essential amino acid, meaning the body cannot produce it and must get it from food or supplements. It plays a key role in the formation of collagen, a crucial protein for skin structure and wound healing. (Availability: supplement)

Effectiveness Rating

Poor — Evidence is extremely limited and anecdotal, based on a single user report suggesting it as part of a combination therapy for body acne scars.

Who It’s Best For

This might be considered by individuals with body acne and scars who are already using a primary topical treatment and want to add a supplement known to be involved in collagen production.

Evidence Snapshot

User Reports

One commenter anecdotally reported that using an oral lysine supplement in combination with topical adapalene was effective for their residual acne and scars on the chest and shoulders.

The Science

Lysine is a critical component in the cross-linking process of collagen fibers, which gives skin its strength and structure. In theory, ensuring adequate lysine levels could support more effective skin repair and remodeling.

Limitations

The evidence for its use in acne scarring is virtually non-existent, relying on a single anecdotal mention.
Its effect is supportive and systemic, not a direct or targeted treatment for scars.
High doses can potentially cause side effects like stomach cramps or diarrhea.

Expected Time-to-Results

It is unclear if this supplement provides any direct benefit for scars; do not expect noticeable results.

Cost

£5–£15 for a bottle of 60-120 capsules.

Products

Bottom Line

There is no credible evidence to suggest that taking a lysine supplement will improve acne scars. While it is essential for overall health and collagen production, it should not be considered a treatment for scarring.

Oral Hyaluronic Acid

What Is It?

Hyaluronic Acid (HA) is a substance naturally found in the body that holds onto water to keep tissues lubricated and moist. As a supplement, it’s taken to increase skin hydration from the inside out, which can help plump the skin. (Availability: supplement)

Effectiveness Rating

Mixed — While some studies show it improves skin hydration and elasticity, its effect on acne scars is indirect and based on user reports of increased skin “plumpness,” which may soften the look of shallow scars.

Who It’s Best For

Best for individuals with dehydrated skin and very shallow, textural acne scars, as the plumping effect from hydration may make these indentations appear less noticeable.

Evidence Snapshot

User Reports

Users on Reddit report that oral hyaluronic acid capsules can improve skin plumpness and softness from within, which may help to reduce the visibility of scars.

The Science

Oral HA is absorbed and distributed throughout the body, including the skin. It increases the skin’s moisture content by binding to water, leading to a plumper, more hydrated appearance, which can temporarily fill out and soften the look of fine lines and shallow indentations.

Limitations

There are no clinical studies specifically evaluating oral HA for the treatment of acne scars.
The effect is cosmetic and temporary; it plumps the skin rather than rebuilding the lost collagen in the scar.
The benefit for deeper, ice pick, or boxcar scars is likely to be minimal to none.
Bioavailability (how much is absorbed and used by the body) can vary.

Expected Time-to-Results

Expect visible improvement in skin hydration and plumpness in ≥6–8 weeks.

Cost

£15–£35 for a month’s supply.

Products

Solgar Collagen Hyaluronic Acid Complex

Bottom Line

Oral hyaluronic acid can improve overall skin hydration and plumpness, which may subtly and temporarily reduce the appearance of very shallow acne scars. However, it does not treat the scar itself and is not an effective solution for moderate to severe indented scarring.

Hormonal Therapies

Spironolactone

What Is It?

An oral prescription medication that helps control hormonal acne in women by blocking the effects of male hormones (androgens) on the skin. It is primarily used to prevent the deep, inflammatory acne that often leads to scarring. Availability: Rx.

Effectiveness Rating

Good — it is highly effective at preventing new, inflammatory acne breakouts that cause scarring, but it does not directly treat existing scars.

Who It’s Best For

Women with persistent, moderate-to-severe hormonal acne, often located on the lower face, jawline, and back. It is ideal for those looking to stop the cycle of new breakouts to prevent future scarring.

Evidence Snapshot

Clinical Data

A 2017 systematic review of 10 studies found that spironolactone consistently improved acne, with 33-85% of women seeing a complete or marked improvement in their breakouts. The review noted that while the overall quality of evidence was low, the results were consistently positive in showing a benefit. ¹

Layton AM, Eady EA, Whitehouse H, Del Rosso JQ, Fedorowicz Z, van Zuuren EJ. Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review. Am J Clin Dermatol. 2017 Apr;18(2):169-191. doi: 10.1007/s40257-016-0245-x. PMID: 28155090; PMCID: PMC5360829.

User Reports

One Reddit user reported that a 2-3 year combination of spironolactone (100mg/day) and tretinoin (0.05%) significantly improved their cystic acne and related textural scarring.
Another user found a 50mg daily dose stopped new hormonal back acne within 3 months, but had no effect on existing hyperpigmentation (discoloration).
Some users suggest it as an alternative to Accutane for those who want to avoid a severe initial breakout that could worsen scarring.

The Science

Spironolactone blocks androgen receptors in the body, including those in the skin’s oil glands. This reduces oil (sebum) production and inflammation, which stops the formation of the deep, painful pimples most likely to leave scars.

Limitations

Does not directly improve existing acne scars; its benefit is preventative.
Side effects can include increased urination, dizziness, breast tenderness, and menstrual spotting.
Cannot be used during pregnancy.
May require periodic blood tests to monitor potassium levels.
Results are not immediate and require consistent, long-term use.

Expected Time-to-Results

Expect a noticeable reduction in new acne breakouts within 3–6 months.

Cost

Typically covered by insurance or available as a low-cost generic prescription ($10–$30 per month in the US; covered by NHS prescription in the UK).

Products

Spironolactone is an oral medication available by prescription, commonly sold under the brand name Aldactone or as a generic.

Bottom Line

Spironolactone is a powerful preventative therapy for new acne scarring in women with hormonal acne. By stopping new breakouts, it creates a stable foundation for the skin to heal and for other scar treatments (like tretinoin or in-office procedures) to work more effectively on existing scars over the long term.

Phototherapy

ALA-PDT + 5-Fluorouracil + Triamcinolone Acetonide

What Is It?

This is an intensive, in-clinic combination therapy for raised acne scars. It involves applying a light-sensitizing solution (ALA), activating it with light (PDT), and then injecting a steroid and a chemotherapy agent to break down the scar tissue. (Rx)

Effectiveness Rating

Good — Based on a small but promising clinical study showing it can significantly flatten and improve tough, raised hypertrophic scars.

Who It’s Best For

Patients with stubborn, raised, and thick (hypertrophic) acne scars that have not responded to other treatments.

Evidence Snapshot

Clinical Data

In a small study of 13 patients with hypertrophic acne scars, this three-part treatment led to a statistically significant improvement in scar appearance, height, and texture (p<0.05).¹

Wei J, Du L-k, Cao Z, Li M, Zhang C, Zhang C, Meng L. 5-Aminolevulinic Acid Photodynamic Therapy Combined with Intralesional Triamcinolone and 5-Fluorouracil to Treat Acne Hypertrophic Scar. Clin Cosmet Investig Dermatol. 2023;16:1337-1344. doi: 10.2147/CCID.S427427.

The Science

The therapy works in stages: PDT helps destroy the rapidly growing cells in the scar, while the injected steroid (triamcinolone) reduces inflammation and the chemotherapy agent (5-fluorouracil) stops the cells from over-producing the collagen that forms the scar.

Limitations

Requires multiple, intensive in-clinic sessions.
Injections can be painful.
The evidence comes from a single, very small study.
Expect temporary redness, swelling, and significant sun sensitivity after treatment.

Expected Time-to-Results

Expect visible improvement after a full course of treatment over several months.

Cost

High. Likely several hundred to thousands of dollars for a full course of treatment; not typically covered by insurance.

Products

This is a clinical procedure and not a product you can purchase.

Bottom Line

This is a powerful, multi-pronged clinical approach that shows early promise for effectively tackling some of the most difficult-to-treat raised acne scars. Its effectiveness is backed by early clinical data, but more research is needed.

Photodynamic Therapy (PDT)

What Is It?

A two-step medical procedure where a light-sensitizing cream is applied to the skin and then activated by a specific wavelength of light to treat various skin conditions. Its use for acne scarring is an emerging application. (Rx)

Effectiveness Rating

Mixed — Labelled as a “promising” treatment for raised scars on the body, but clinical evidence is currently very limited and based on a small retrospective report.

Who It’s Best For

Patients with hypertrophic (raised) acne scars, particularly on the chest and back, who are exploring emerging clinical treatments.

Evidence Snapshot

Clinical Data

A review paper identified PDT as an emerging and promising treatment for hypertrophic scars on the trunk (chest and back).²
In a retrospective analysis of off-label use, 5 out of 8 patients (62.5%) with hypertrophic scars saw a marked improvement after treatment with a specific type of PDT (MAL-PDT).¹

Calzavara-Pinton P, Rossi M, Aronson E, Sala R, The DC-vaccine study group at the Japan Society of Inn Therapy. A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 1: Inflammatory and aesthetic indications. Photochem Photobiol Sci. 2012;11:1797-806. doi: 10.1039/c2pp25124h.
Woo Y, Kim HS. Truncal Acne: An Overview. J Clin Med. 2022;11(13):3660. doi: 10.3390/jcm11133660. PMID: 35806952; PMCID: PMC9267677.

The Science

The light-sensitizing cream is absorbed by the overactive, rapidly dividing cells that make up scar tissue. When the light is applied, it creates a reaction that selectively destroys these cells, helping to break down the scar and encourage healthier tissue to grow.

Limitations

Must strictly avoid sunlight for 24–48 hours post-treatment to prevent severe burns.
Can cause significant redness, peeling, pain, and swelling.
Evidence specifically for acne scarring is still sparse.
Multiple sessions are required.

Expected Time-to-Results

Noticeable changes may require 2–4 sessions over several months.

Cost

High. A single session can cost several hundred dollars or more.

Products

This is a clinical procedure. The light-sensitizing agents used by dermatologists include brands like Levulan® and Metvixia®.

Bottom Line

PDT is an interesting future possibility for treating raised acne scars, but it is not yet a proven or standard treatment. While some early data is positive, more robust evidence is needed to confirm its effectiveness and place in therapy.

1440-nm Non-Ablative Fractional Laser (NAFL)

What Is It?

A non-invasive laser that creates microscopic columns of heat deep in the skin to stimulate new collagen growth, improving skin texture and acne scars without damaging the skin’s surface. (Rx)

Effectiveness Rating

Good — Supported by clinical data showing it effectively improves facial acne scars with a good safety profile, even in those with sensitive skin.

Who It’s Best For

Patients with facial acne scars, especially atrophic (indented) scars. It is a particularly good option for those who also have sensitive skin or rosacea.

Evidence Snapshot

Clinical Data

A study showed that this laser therapy was effective and well-tolerated for improving facial acne scars in patients who also had rosacea, with no serious side effects reported.¹

Wang B, Deng Y, Yan S, Xie H, Li J, Jian D. Efficacy of non-ablative fractional 1440-nm laser therapy for treatment of facial acne scars in patients with rosacea: a prospective, interventional study. Lasers Med Sci. 2020;35(7):1831-1838. doi: 10.1007/s10103-020-03107-x

The Science

The laser energy heats the deeper skin layers in a grid-like pattern, leaving the surrounding tissue intact. This controlled injury triggers the body’s natural healing process, stimulating the production of new collagen to help fill in and smooth scars from the inside out.

Limitations

Multiple sessions (typically 3–5) are needed for optimal results.
Can cause temporary redness and mild swelling, like a sunburn.
Results are more gradual compared to more aggressive ablative lasers.

Expected Time-to-Results

Gradual improvement over 3–6 months following a course of treatments.

Cost

Expensive. Typically ranges from $500–$1,000+ per session.

Products

This is a clinical procedure performed with devices like the Fraxel® laser.

Bottom Line

This is a solid, evidence-backed laser option for tackling facial acne scars with minimal downtime. Its proven safety profile, especially for patients with co-existing rosacea or sensitive skin, makes it a valuable and reliable choice in a clinical setting.

675-nm Laser

What Is It?

A newer type of non-invasive laser performed in a clinic. It uses a specific wavelength of red light to target components in the skin, aiming to remodel collagen and improve acne scar appearance with minimal downtime. (Rx)

Effectiveness Rating

Mixed — A single small study found it to be effective with very few side effects, but the evidence base is too narrow to be considered proven.

Who It’s Best For

Patients with various types of acne scars who are interested in trying a novel laser treatment with a potentially high safety profile.

Evidence Snapshot

Clinical Data

In an observational study of 24 patients, this laser led to a good clinical response and a reduction in acne scars. Side effects were minimal, with only 3 patients (12.5%) experiencing minor temporary redness.¹

Cannarozzo G, Silvestri M, Tamburi F, Sicilia C, Del Duca E, Scali E, Bennardo L, Nisticò S. A new 675-nm laser device in the treatment of acne scars: an observational study. Lasers Med Sci. 2020;35(6):1389-1394. doi: 10.1007/s10103-020-03063-6. PMID: 32533470.

The Science

The 675-nm wavelength is absorbed by structures within the skin, creating controlled heat. This thermal effect kick-starts a wound-healing response that encourages the formation of new, more organized collagen, which helps to smooth and repair scarred skin over time.

Limitations

Evidence is very limited, based on a single small observational study.
May cause temporary, minor redness after treatment.
Requires a series of treatments for best results.

Expected Time-to-Results

Visible improvement would be expected after a full series of treatments over 3–6 months.

Cost

Likely expensive, costing several hundred dollars per session.

Products

This is a clinical procedure and not available for at-home use.

Bottom Line

This is a new and novel laser with very early, promising data for treating acne scars with minimal side effects. While it appears safe, it cannot be considered a standard or proven treatment until more extensive clinical studies are performed.

CO2 Laser Therapies

Fractional CO2 Laser

What Is It?

An ablative laser that uses focused light beams to vaporize microscopic columns of skin, stimulating collagen production to resurface the skin. It is a powerful, in-clinic procedure commonly used for significant atrophic scars like boxcar, rolling, and some ice pick scars. (Availability: Procedure)

Effectiveness Rating

Excellent — Considered a first-line, gold-standard treatment with extensive clinical evidence, including multiple meta-analyses, supporting its high efficacy for atrophic acne scarring.

Who It’s Best For

Patients with moderate-to-severe atrophic acne scars, particularly rolling, boxcar, and V-shaped scars. It is more effective than TCA CROSS for ice pick scars. Caution is advised for darker skin tones (Fitzpatrick IV-VI) due to a higher risk of pigmentation changes.

Evidence Snapshot

Clinical Data

A meta-analysis of 6 studies (n=467) found that ultra-pulsed CO2 fractional laser led to significantly better skin smoothness and total lesion scores compared to other methods like microneedling or radiofrequency (p≤0.05).¹³

Lin L, Liao G, Chen J, Chen X. A systematic review and meta-analysis on the effects of the ultra-pulse CO2 fractional laser in the treatment of depressed acne scars. Annals of palliative medicine. 2021;10.21037/apm-22-70.

Multiple studies and a meta-analysis confirm that fractional CO2 laser is more effective than microdermabrasion and Erbium (Er:YAG) lasers for improving atrophic acne scars.⁹ ¹²

Husein-ElAhmed H, Steinhoff M. Comparative appraisal with meta‐analysis of erbium vs. CO2 lasers for atrophic acne scars. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2021;19(9):719-726. doi: 10.1111/ddg.14546.
Faghihi G, Nouraei S, Asilian A, et al. Efficacy of Punch Elevation Combined with Fractional Carbon Dioxide Laser Resurfacing in Facial Atrophic Acne Scarring: A Randomized Split-face Clinical Study. Indian J Dermatol. 2015 Sep-Oct;60(5):473-8. doi: 10.4103/0019-5154.159616. PMID: 26538695; PMCID: PMC4601415.

A randomized trial found CO2 laser’s pinpoint technique was significantly more effective for ice pick scars than TCA CROSS (p < 0.05).³

Ahmed R, Mohammed G, Ismail NI, Elakhras A. Randomized clinical trial of CO2 LASER pinpoint irradiation technique versus chemical reconstruction of skin scars (CROSS) in treating ice pick acne scars. J Cosmet Laser Ther. 2014;16(1):1-7. doi: 10.3109/14764172.2013.854633. PMID: 24131091

A study comparing treatments for different scar subtypes found fractional CO2 laser was more effective than an adipose-derived gel injection for V-shaped scars (p=0.039), but less effective for M-shaped scars (p<0.001).²⁴

Zhao T, Li M, Wang J, et al. Comparison of the Effects of Adipose Extracellular Matrix/Stromal Vascular Fraction Gel Injection and CO. J Cosmet Dermatol. 2025 Mar 1;24(3):10.1111/jocd.70131.

User Reports

Experiences are highly polarized; some users report “amazing” transformations with ~45-75% improvement, while a significant number call it a “scam” with minimal (10-20%) or no improvement, even after multiple costly sessions.
Users report that initial improvements are often due to temporary swelling, which fades to reveal less impressive results.
For some, the treatment improved overall texture and pigmentation but was insufficient for deeper ice pick or boxcar scars.
1 user reported only a 15% scar improvement after a treatment costing over $3,000.
A common concern among users, particularly those with Asian skin, is the risk of post-inflammatory hyperpigmentation (PIH).

The Science

The laser creates microscopic columns of thermal injury deep into the skin. This controlled damage removes scarred tissue and powerfully stimulates the body’s healing response, leading to the formation of new, organized collagen and elastin that smoothes and raises the depressed scars.

Limitations

Significant downtime is required (typically 1-2 weeks of redness, swelling, peeling).
High risk of temporary or persistent post-inflammatory hyperpigmentation (PIH), especially in darker skin types.
Can be painful; typically requires topical anesthetic.
Very expensive, and multiple sessions are usually required.
Results are highly dependent on practitioner skill and laser settings.
One study found it was ineffective for scars on the body.

Expected Time-to-Results

Initial healing takes 1–2 weeks, but full collagen remodeling and visible scar improvement can take 3–6 months to appear.

Cost

Highly variable, ranging from ~$1,100 to over $3,000 per session in the US. Not covered by insurance.

Products

This is a professional procedure. Common device brand names include Fraxel Re:pair, DeepFX/ActiveFX, CO2RE, and Sciton ProFractional.

Bottom Line

Fractional CO2 laser is a powerful, evidence-backed procedure for tackling moderate-to-severe atrophic acne scars. While it offers the potential for dramatic improvement, it comes with significant cost, downtime, and a notable risk of side effects like hyperpigmentation, especially for darker skin. User experiences are mixed, highlighting that results are not guaranteed and depend heavily on the practitioner.

CO2 Laser + PRP (Platelet-Rich Plasma)

What Is It?

This treatment combines a fractional CO2 laser session with the application of Platelet-Rich Plasma (PRP). The PRP, derived from the patient’s own blood, is applied to the skin immediately after lasering to enhance healing and results. (Availability: Procedure)

Effectiveness Rating

Excellent — Multiple meta-analyses and clinical studies robustly support that adding PRP to CO2 laser treatment significantly enhances clinical improvement and reduces downtime compared to laser alone.

Who It’s Best For

Patients undergoing fractional CO2 laser for atrophic acne scars who want to potentially boost results and speed up the recovery process.

Evidence Snapshot

Clinical Data

A meta-analysis of multiple studies concluded that combining PRP with fractional CO2 laser results in significantly greater clinical improvement for atrophic acne scars compared to using the laser by itself (Odds Ratio = 2.56 to 2.99).¹, ²

¹ Chang HC, Sung CW, Lin MH. Efficacy of Autologous Platelet-Rich Plasma Combined With Ablative Fractional Carbon Dioxide Laser for Acne Scars: A Systematic Review and Meta-Analysis. Aesthetic Surg J. 2019 Jul;39(7):NP279-NP287. doi: 10.1093/asj/sjz048. ² Aljefri Y, Ghaddaf A, Alahmadi RA, Alkhamisi TA, Alkhunani TA, Samarkandy S, Alamri AM. Ablative fractional carbon dioxide laser combined with autologous platelet‐rich plasma in the treatment of atrophic acne scars: A systematic review and meta‐analysis. Dermatologic Therapy. 2022;10.1111/dth.15888.

Adding PRP has been shown to significantly reduce the duration of post-procedure crusting and overall recovery time.⁴

Chang HC, Sung CW, Lin MH. Efficacy of Autologous Platelet-Rich Plasma Combined With Ablative Fractional Carbon Dioxide Laser for Acne Scars: A Systematic Review and Meta-Analysis. Aesthetic Surg J. 2019 Jul;39(7):NP279-NP287. doi: 10.1093/asj/sjz048.

User Reports

One user reported “remarkable improvement” in deep scars after 2-3 sessions of a multi-modal plan that included TCA-CROSS followed by PRP and CO2 fractional laser.

The Science

The CO2 laser creates micro-channels in the skin, which not only stimulates collagen but also allows the PRP to penetrate deeply. The growth factors concentrated in the PRP then accelerate the skin’s natural healing processes, modulate inflammation, and further boost collagen and elastin production.

Limitations

Increases the overall cost of the procedure.
Involves a blood draw.
While most studies show a significant benefit, one smaller trial found the added improvement was not statistically significant.
Carries the same risks as CO2 laser alone (PIH, downtime), although downtime may be reduced.

Expected Time-to-Results

Recovery may be faster than CO2 laser alone, but final scar improvement still takes 3–6 months to fully appear.

Cost

Adds several hundred dollars to the cost of a standard CO2 laser session (e.g., ~$1,300 per Fraxel with PRP session reported by a user).

Products

This is a professional procedure combining a CO2 laser device with a centrifuge system to prepare the PRP.

Bottom Line

Adding PRP to a fractional CO2 laser treatment is a clinically proven way to enhance results and shorten recovery time for atrophic acne scars. For those already investing in CO2 laser, the additional cost may be worthwhile for potentially better and faster outcomes.

CO2 Laser + Subcision

What Is It?

This is a combination procedure where subcision (a technique using a needle to break up fibrous scar tissue tethers) is performed along with fractional CO2 laser resurfacing. This dual approach tackles both the tethered-down nature of some scars and the surface texture. (Availability: Procedure)

Effectiveness Rating

Excellent — Strong clinical evidence shows that combining subcision with CO2 laser provides significantly better improvement for atrophic acne scars, especially rolling scars, than laser treatment alone.

Who It’s Best For

Patients with atrophic acne scars, particularly rolling scars and other types of scars that are “tethered” or bound down to the underlying tissue.

Evidence Snapshot

Clinical Data

Multiple studies found that combining subcision with fractional CO2 laser led to significantly greater improvement in atrophic acne scars compared to using the laser alone (p < 0.001 in both studies).¹, ²
A study showed that performing subcision and laser simultaneously is just as effective as performing them sequentially (2 weeks apart), with no significant difference in outcomes (p=0.706).³

Nilforoushzadeh M, Faghihi G, Jaffary F, Haftbaradaran E, Hoseini S, Mazaheri N. Fractional Carbon Dioxide Laser and its Combination with Subcision in Improving Atrophic Acne Scars. Adv Biomed Res. 2017;6(1):20. doi: 10.4103/2277-9175.201332.
Abdelwahab AA, Omar GAE-B, Hamdino M. A combined subcision approach with either fractional CO2 laser (10,600 nm) or cross-linked hyaluronic acid versus subcision alone in atrophic post-acne scar treatment. Lasers Med Sci. 2022;37(12):3677-3688. doi: 10.1007/s10103-022-03677-y. PMID: 36564573; PMCID: PMC9789008.
Tran BQ, Tran TNA, Doan EVL, Nguyen TTP, Nguyen HT. Simultaneous versus sequential fractional CO2. J Cosmet Dermatol. 2024 Oct 1;23(10):16395. doi: 10.1111/jocd.16395. PMID: 38770894.

The Science

Subcision works mechanically by using a needle to break the fibrous bands that pull the scar surface down, allowing the depressed scar to lift up. The CO2 laser then resurfaces the top layer of skin and stimulates new collagen to fill in the now-released scar from below.

Limitations

The combination is associated with more side effects than laser alone, particularly bruising and a higher risk of post-inflammatory hyperpigmentation.
Increases the complexity, potential discomfort, and cost of the procedure.
Effectiveness is highly dependent on the skill of the practitioner performing the subcision.

Expected Time-to-Results

Visible lifting from subcision can be immediate (though obscured by swelling), but the full benefit from laser resurfacing and collagen remodeling takes 3–6 months.

Cost

Adds to the base cost of a CO2 laser session. Varies by provider.

Products

This is a professional procedure combining a CO2 laser device with subcision tools (e.g., Nokor needle, cannula).

Bottom Line

For patients with rolling or tethered atrophic scars, combining subcision with CO2 laser is a highly effective, evidence-based strategy that produces superior results to laser alone. The increased risk of temporary bruising and PIH should be weighed against the potential for greater improvement.

Other CO2 Laser Combinations

What Is It?

Fractional CO2 laser is often combined with other topical agents or procedures to enhance its effectiveness for acne scars. These adjuncts are typically applied during or immediately after the laser session. (Availability: Procedure)

Effectiveness Rating

Good — Strong evidence supports combinations with growth factors (bFGF, EGF) and hyaluronic acid. Evidence for salicylic acid and punch elevation is also positive. Evidence is weaker or contradictory for combinations with stem cell media, microneedling, and needling.

Who It’s Best For

Patients undergoing CO2 laser who wish to maximize their results. The choice of adjunct may depend on specific goals (e.g., punch elevation for deep boxcar scars, growth factors for enhanced healing).

Evidence Snapshot

Clinical Data

With bFGF/EGF: Adding bovine basic fibroblast growth factor (bFGF) or epidermal growth factor (EGF) to CO2 laser treatment resulted in a significantly higher response rate and superior scar improvement compared to laser alone (p<0.05).¹, ²

Yuan C, Li J, Wang H, Gao L, Zheng Y, Ailan L. Therapeutic Efficacy of Bovine Basic Fibroblast Growth Factor Combined with Ultrapulsed Fractional CO2 Laser in Acne Scars: Randomized Controlled Trial. Clin Cosmet Investig Dermatol. 2023;16:1619-1632. doi: 10.2147/CCID.S428017
Ratanapokasatit Y, Sirithanabadeekul P. The Efficacy and Safety of Epidermal Growth Factor Combined with Fractional Carbon Dioxide Laser for Acne Scar Treatment: A Split-Face Trial. J Clin Aesthet Dermatol. 2022;15(7):35942017.

With Hyaluronic Acid: A meta-analysis concluded that combining fractional CO2 laser with a hyaluronic acid dressing is an effective and safe approach for atrophic acne scars.³

Zhang J, Xu F, Lin H, Ma Y, Hu Y, Meng Q, Lin P, Zhang Y. Efficacy of fractional CO₂ laser therapy combined with hyaluronic acid dressing for treating facial atrophic acne scars: a systematic review and meta-analysis of randomized controlled trials. Lasers Med Sci. 2023;10.1007/s10103-023-03879-y.

With Salicylic Acid: Combining a 30% salicylic acid peel with CO2 laser was superior to laser alone for treating atrophic scars (p=0.003).⁴

Zhang YJ, Chen YM, Shao X, Liu L, Pu Y, Zhang LZ, Chen J, Chen J. Combination treatment with 30% salicylic acid and fractional CO2 laser for acne scars: A 20‐week prospective, randomized, split‐face study. Dermatologic Therapy. 2022;35(7):e15693. doi: 10.1111/dth.15693.

With Punch Elevation: For atrophic scars, combining punch elevation with CO2 laser was significantly more effective than laser alone (p=0.02).⁵

Faghihi G, Nouraei S, Asilian A, Keyvan S, Abtahi-Naeini B, Rakhshanpour M, Nilforoushzadeh M, Hosseini S. Efficacy of Punch Elevation Combined with Fractional Carbon Dioxide Laser Resurfacing in Facial Atrophic Acne Scarring: A Randomized Split-face Clinical Study. Indian J Dermatol. 2015 Sep-Oct;60(5):473-8. doi: 10.4103/0019-5154.159616. PMID: 26538695; PMCID: PMC4601415.

With Stem Cells/Exosomes: Adding human adipose-derived exosomes significantly enhanced scar reduction (p<0.01). However, other studies found that adding stem cell-conditioned media provided no significant benefit compared to laser alone.⁶, ⁷

Kwon H, Yang SH, Lee J, Park BC, Park K, Jung J, Bae Y, Park G-H. Combination Treatment with Human Adipose Tissue Stem Cell-derived Exosomes and Fractional CO2 Laser for Acne Scars: A 12-week Prospective, Double-blind, Randomized, Split-face Study. Acta Dermato-Venereologica. 2020;100(18):1–8. doi: 10.2340/00015555-3666.
Park C, Park J-H, Kim C, Lee J. Objective analysis of volume restoration in atrophic acne scars and skin pores: a split study using human stem cell-conditioned media. J Dermatol Treat. 2021;32(1):78-83. doi: 10.1080/09546634.2019.1628915. PMID: 31172821

With Timolol Maleate: Adding topical timolol maleate after the procedure enhances skin barrier restoration but does not provide a statistically significant improvement in the scars themselves.⁸

Hawwas ARM, Mohamed H, Sayedahmed O, Elsaie M. Topical timolol maleate 0.5% after fractional carbon dioxide laser versus fractional carbon dioxide laser alone in treatment of acne scars: split face comparative study. Sci Rep. 2023;13(1):8447. doi: 10.1038/s41598-023-36398-5.

The Science

These combinations work by leveraging the micro-channels created by the laser to deliver active ingredients deep into the skin. Growth factors (EGF, bFGF) and stem cell products provide signals to accelerate and enhance healing, while agents like salicylic acid provide additional exfoliation and anti-inflammatory effects.

Limitations

Significantly increases the complexity and cost of treatment.
The evidence base for some combinations is still emerging.
Carries the same risks as CO2 laser alone, plus any potential risks from the added substance or procedure.

Expected Time-to-Results

While healing may be enhanced, final scar improvement will still take 3–6 months to fully manifest.

Cost

Varies significantly depending on the adjunctive treatment, adding hundreds of dollars per session.

Products

These are professional procedures combining CO2 laser with other medical devices (e.g., punch biopsy tools) or prescription/professional-grade topicals (e.g., bFGF, EGF, PRP).

Bottom Line

For patients already investing in CO2 laser, certain combinations—particularly with growth factors, hyaluronic acid, or procedural techniques like punch elevation—are strongly supported by evidence to boost results. Other combinations have less consistent evidence and should be discussed carefully with a provider.

Er:YAG Laser (Ablative/Fractional)

What Is It?

An ablative laser that removes thin outer layers of skin to promote new cell growth and collagen remodeling. It is considered less aggressive than the CO2 laser, with a shorter recovery time, and is used for atrophic acne scars. (Availability: Procedure)

Effectiveness Rating

Good — A well-established and effective treatment for atrophic scars, though some high-quality evidence suggests it may be slightly less effective than CO2 laser for severe scarring.

Who It’s Best For

Patients with atrophic acne scars, particularly those with lighter skin tones seeking an effective ablative treatment with less downtime and a lower risk of pigmentation changes compared to CO2 laser.

Evidence Snapshot

Clinical Data

A study in Asian patients found the fractional Er:YAG laser had comparable efficacy to a picosecond laser for atrophic scars, though patient satisfaction was higher with the Er:YAG laser.¹

Dai R, Cao Y, Su Y, Cai S. Comparison of 1064-nm Nd:YAG picosecond laser using fractional micro-lens array vs ablative fractional 2940-nm Er:YAG laser for the treatment of atrophic acne scar in Asians: a 20-week prospective, randomized, split-face, controlled pilot study. Front Med. 2023;10:1248831. doi: 10.3389/fmed.2023.1248831.

A split-face trial found no significant difference in efficacy between the 1927nm Thulium laser and the fractional Er:YAG laser for atrophic scars.²

Lu K, Cai S-z. Efficacy and safety comparison between 1927 nm thulium laser and 2940 nm Er:YAG laser in the treatment of facial atrophic acne scarring: a prospective, simultaneous spilt-face clinical trial. Lasers Med Sci. 2021 Nov 26;36(12):3259-3267. doi: 10.1007/s10103-021-03465-0. PMID: 34826022; PMCID: PMC8971160.

While effective, a meta-analysis excluding studies with a high risk of bias found that CO2 lasers were superior to Erbium lasers for atrophic scar improvement.³

Husein-ElAhmed H, Steinhoff M. Comparative appraisal with meta‐analysis of erbium vs. CO2 lasers for atrophic acne scars. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2021;19(9):719-726. doi: 10.1111/ddg.14546.

Combination with topical silicone gel after treatment was shown to be well-tolerated and enhance efficacy in a trial of 19 patients.⁴

Khamthara J, Kumtornrut C, Pongpairoj K, Asawanonda P. Silicone gel enhances the efficacy of Er:YAG laser treatment for atrophic acne scars: A randomized, split-face, evaluator-blinded, placebo-controlled, comparative trial. J Cosmet Laser Ther. 2018;20(2):110-116. doi: 10.1080/14764172.2017.1376095

User Reports

One user reported a cost of ~$4,800 for an aggressive Erbium laser resurfacing in Virginia, USA.
Another user was warned by their dermatologist that treating scars on the jawline with this laser is considered high-risk due to the proximity of facial nerves and arteries.

The Science

The Er:YAG laser emits a wavelength of light that is highly absorbed by water in the skin. This allows for very precise, layer-by-layer vaporization of skin tissue, removing the scarred surface and stimulating collagen production with less excess heat damage to surrounding tissue compared to a CO2 laser.

Limitations

Higher risk of post-inflammatory hyperpigmentation (PIH) in darker skin types, though lower than CO2 laser.
Less effective than CO2 laser for very deep, severe scarring.
Requires downtime for healing (typically 5-10 days).
Still a costly procedure requiring multiple sessions.

Expected Time-to-Results

Visible improvement after initial healing (1–2 weeks), with optimal results appearing at 3–6 months.

Cost

Can range from $2,000 to over $5,000 per session depending on the aggressiveness and location. Not covered by insurance.

Products

This is a professional procedure. Device brands include Sciton (ProFractional, Contour TRL), Fotona, and Alma Lasers.

Bottom Line

Er:YAG laser is a solid, effective option for atrophic acne scars, offering a good balance of efficacy and a better safety profile (less downtime, lower PIH risk) than CO2 laser. It’s a particularly strong choice for patients with mild to moderate scarring or those concerned about the longer recovery of CO2.

Er:Glass Laser (Non-Ablative, e.g., Fraxel)

What Is It?

A non-ablative fractional laser that heats columns of tissue deep in the skin without breaking the surface. It’s best known by the brand name Fraxel and is used to stimulate collagen for atrophic scars with minimal downtime. (Availability: Procedure)

Effectiveness Rating

Mixed — While some clinical studies show efficacy, user reports are highly polarized. Many users report minimal to no improvement for atrophic scars, calling it a “scam,” while others see it as a key part of a successful combination therapy.

Who It’s Best For

Patients with mild atrophic scarring, fine lines, or textural issues who prioritize minimal downtime over dramatic results. It may be a safer option for darker skin tones than ablative lasers.

Evidence Snapshot

Clinical Data

A randomized trial (n=22) found a fractionated picosecond laser was superior to a 1540nm Er:Glass laser for atrophic scars, showing better improvement in skin flatness (p=0.041).¹

Shi Y, Jiang W, Li W, Zhang W, Zou Y. Comparison of fractionated frequency-doubled 1,064/532 nm picosecond Nd:YAG lasers and non-ablative fractional 1,540 nm Er: glass in the treatment of facial atrophic scars: a randomized, split-face, double-blind trial. Ann Transl Med. 2021 May 1;9(10):715. doi: 10.21037/atm-21-1715. PMID: 34164496; PMCID: PMC8184496.

Side effects are generally minimal and temporary (redness, mild pain), but one study noted that procedural pain was significantly higher in patients with darker skin.²

Politi Y, Levi A, Lapidoth M. Integrated Cooling-Vacuum-Assisted Non-Fractional 1540 nm Erbium:Glass Laser is Effective in Treating Acne Scars. J Drugs Dermatol. 2016;15(11):1359-1363.

User Reports

A large number of users perceive Fraxel as a “scam,” reporting zero improvement for atrophic scars despite high costs.
Many users note that any initial improvement seems to be temporary swelling that disappears, leaving them disappointed.
Some users found it helpful as part of a combination treatment, with one reporting a 75% scar improvement.
One user reported minimal benefit for scars after two Fraxel sessions, noting the main effect was temporary improvement in pores and fine lines.

The Science

The laser creates microscopic zones of thermal injury in the dermis while leaving the outer skin layer (epidermis) intact. This heat-based injury triggers a wound-healing response, prompting the production of new collagen to improve scar texture from within.

Limitations

Efficacy for significant atrophic scarring is questionable based on user reports.
Results are often subtle and require multiple expensive sessions.
Full results are slow to appear.
Some users report the need for yearly maintenance treatments to prevent scars from reappearing.
Can be painful, especially for darker skin types.

Expected Time-to-Results

Full results are slow to manifest, often taking 6 months to 2 years as neocollagenesis is a prolonged process.

Cost

~$1,300 per session, with additional costs for post-procedure products. Promotional packages may be available.

Products

This is a professional procedure. The most well-known brand is Fraxel (specifically Fraxel Re:store DUAL, which uses 1550nm and 1927nm wavelengths).

Bottom Line

Er:Glass lasers like Fraxel are a popular but controversial choice for acne scarring. While clinically validated for skin resurfacing, a large volume of user reports suggests it often fails to deliver significant, lasting improvement for atrophic scars, especially given the high cost. It may be better suited for very mild texture issues or as part of a broader combination therapy.

Halo Laser (Hybrid Fractional)

What Is It?

The first hybrid fractional laser, which delivers both ablative (Erbium:YAG) and non-ablative (Diode) wavelengths to the skin in a single pass. It aims to provide ablative-level results with non-ablative level downtime. (Availability: Procedure)

Effectiveness Rating

Mixed — User reports are varied. Some see noticeable improvement in texture and ice pick scars, especially when combined with BBL, while others find it ineffective for atrophic scars or even experienced worsening of their condition.

Who It’s Best For

Patients with a combination of concerns, such as mild atrophic scars, textural irregularities, enlarged pores, and hyperpigmentation, who are looking for a “one-stop-shop” treatment with moderate downtime.

User Reports

One user reported visible reduction in ice pick scars and improved texture within one week of a single Halo + BBL treatment.
Another user found it effective for hyperpigmentation but saw minimal improvement in atrophic scars.
A user reported pronounced swelling of individual ice pick scars post-treatment, making them resemble mosquito bites.
One user experienced a negative outcome where the treatment, performed by a non-specialist, proved ineffective and potentially worsened scars, resulting in a $3,000 loss.
Users report psychological benefits, such as smoother makeup application and relief from worrying about their appearance, even if results on scars are modest.

The Science

The Halo laser simultaneously targets different skin depths. The ablative Erbium wavelength resurfaces the epidermis to improve texture, while the non-ablative Diode wavelength penetrates deeper into the dermis to heat tissue and stimulate long-term collagen production.

Limitations

High cost.
Results are highly dependent on the skill and experience of the practitioner; poor outcomes were reported with non-specialists.
May not be effective enough for moderate to severe atrophic scarring.
Can cause unusual side effects like pronounced, localized swelling of scars.

Expected Time-to-Results

Initial textural and pigment improvements can be seen in 1-2 weeks, but scar improvement continues for 3-6 months.

Cost

Reported at around $3,000 for a single treatment. Combination with BBL will increase the price.

Products

This is a professional procedure using the Sciton Halo device.

Bottom Line

Halo offers a compelling “best of both worlds” approach for patients with multiple mild-to-moderate skin concerns, including some types of acne scars. However, user experiences are inconsistent for scar revision, and the high cost and critical importance of practitioner selection make it a significant investment with uncertain returns for scarring alone.

Picosecond Laser

What Is It?

A non-ablative laser that delivers ultra-short pulses of energy (in picoseconds, or trillionths of a second) to the skin. This creates a photo-acoustic effect that shatters pigment and creates micro-injuries in the dermis to stimulate collagen, all without significant heat damage. (Availability: Procedure)

Effectiveness Rating

Good — Strong clinical data shows it is an effective treatment for atrophic acne scars, comparable in efficacy to ablative Er:YAG but with a superior safety profile (less pain and downtime).

Who It’s Best For

Patients with atrophic acne scars, including V-type and U-type, who are looking for an effective treatment with minimal downtime and a lower risk of side effects. It’s a particularly good option for Asian and darker skin types due to its lower risk of PIH.

Evidence Snapshot

Clinical Data

A randomized trial (n=22) found that a fractional picosecond laser was superior to a 1540nm Er:Glass laser for atrophic scars, showing a more pronounced improvement in skin flatness (p=0.041).¹

Shi Y, Jiang W, Li W, Zhang W, Zou Y. Comparison of fractionated frequency-doubled 1,064/532 nm picosecond Nd:YAG lasers and non-ablative fractional 1,540 nm Er: glass in the treatment of facial atrophic scars: a randomized, split-face, double-blind trial. Ann Transl Med. 2021 May 1;9(10):715. doi: 10.21037/atm-21-1715. PMID: 34164496; PMCID: PMC8184496.

In Asian patients, a 1064nm Nd:YAG picosecond laser showed comparable efficacy for scar improvement as the more aggressive ablative fractional Er:YAG laser (p>0.05), but had significantly less pain, crusting, swelling, and a lower incidence of PIH (p<0.05 for all).²

Dai R, Cao Y, Su Y, Cai S. Comparison of 1064-nm Nd:YAG picosecond laser using fractional micro-lens array vs ablative fractional 2940-nm Er:YAG laser for the treatment of atrophic acne scar in Asians: a 20-week prospective, randomized, split-face, controlled pilot study. Front Med. 2023;10:1248831. doi: 10.3389/fmed.2023.1248831.

A study using a 755nm picosecond laser with a specialized lens showed a 27.2% improvement in scar volume with low associated pain scores.³

Brauer JA, Kazlouskaya V, Alabdulrazzaq H, et al. Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring. JAMA Dermatol. 2015;151(3):278–284. doi:10.1001/jamadermatol.2014.3045

User Reports

One user noted cost was a barrier, with a typical price around $500/session in a major US city, but a 3-session package was available for $1,100.

The Science

Picosecond lasers work primarily through a mechanism called Laser-Induced Optical Breakdown (LIOB). The extremely fast energy pulse creates tiny, bubble-like vacuoles within the skin without breaking the surface. This mechanical disruption triggers the production of new collagen, elastin, and other dermal components, leading to remodeling and improvement of scars.

Limitations

Multiple sessions are required for optimal results.
Can be expensive.
While effective, patient satisfaction may be slightly lower than with more aggressive ablative lasers.
One small study suggested that increasing the number of laser passes (pulse coverage) did not further improve results.

Expected Time-to-Results

Some improvement may be seen after a few weeks, but full results from collagen remodeling will take 3-6 months.

Cost

Reported around $500 per session, with package deals often available (e.g., 3 sessions for $1,100).

Products

This is a professional procedure. Device brands include PicoSure (755nm), PicoWay (1064/532nm), and Enlighten.

Bottom Line

Picosecond lasers are a strong, modern, and evidence-based option for atrophic acne scars, offering a great combination of efficacy and safety. They are an excellent choice for patients who want noticeable results without the extensive downtime and higher risk of ablative procedures, especially for those with skin of color.

Pulsed Dye Laser (PDL) / Vbeam / Excel V

What Is It?

A non-ablative laser that targets hemoglobin (the red protein in blood cells). It is primarily used to treat vascular issues like redness, making it the gold standard for post-inflammatory erythema (PIE), the red marks left after acne, and can also help some raised scars. (Availability: Procedure)

Effectiveness Rating

Excellent — for the redness (PIE) component of acne scarring, based on strong clinical evidence and consistent user reports. It is not effective for textural atrophic scars.

Who It’s Best For

Patients whose primary concern is the persistent red or pink marks (PIE) left behind after acne has healed. It is also a recommended treatment for raised (hypertrophic and keloidal) scars.

Evidence Snapshot

Clinical Data

A systematic review found that lasers, including PDL, are highly effective in managing the redness and discoloration in macular (flat, red) acne scars.¹

Sarvipour N, Akbari Z, Shafie’ei M, Jamali M, Ahmadzade M, Ahramiyanpour N. Lasers for the treatment of erythema, dyspigmentation, and decreased elasticity in macular acne scars: a systematic review. Lasers Med Sci. 2022 Dec;37(12):3621-3630. doi: 10.1007/s10103-022-03621-0. PMID: 35918567.

Clinical guidelines recommend PDL as a procedural treatment for hypertrophic and keloidal scars.², ³

Fabbrocini G, Annunziata M, D’Arco V, et al. Acne Scars: Pathogenesis, Classification and Treatment. Dermatology Research and Practice. 2010;2010:893080. doi:10.1155/2010/893080.
Ogawa R. Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular DermisC. Int J Mol Sci. 2017;18(3):606. doi: 10.3390/ijms18030606.

User Reports

Users consistently report that vascular lasers like Vbeam and Excel V are the “gold standard” and the most effective way to treat stubborn PIE that doesn’t respond to topicals.
One user reported Vbeam was very effective for post-treatment redness but had no effect on atrophic scar texture.

The Science

The laser energy is selectively absorbed by the hemoglobin in superficial blood vessels. This heats and destroys the targeted vessels, reducing the visible redness of PIE. It may also stimulate new collagen formation, which can help improve the texture of some raised scars.

Limitations

Ineffective for treating the texture of atrophic (indented) scars.
May cause temporary bruising (purpura) at the treatment site, which can last for 1-2 weeks.
Multiple sessions are typically required.

Expected Time-to-Results

Improvement in redness can be seen within a few weeks of each session.

Cost

Highly variable, ranging from $100 for a small spot treatment to over $350 for a full-face session.

Products

This is a professional procedure. The most common device brands are Vbeam (Candela) and Excel V (Cutera).

Bottom Line

For the red marks (PIE) left by acne, vascular lasers like PDL are the most effective and rapid treatment available. They are the top choice for tackling the discoloration aspect of acne scarring but will not improve indented or atrophic scars.

Pulsed Dye Laser (PDL) + Combination Therapy

What Is It?

This involves combining a Pulsed Dye Laser session with other treatments, such as a chemical peel (salicylic acid) or an injection (pingyangmycin), to target multiple aspects of scarring simultaneously. (Availability: Procedure)

Effectiveness Rating

Good — Clinical studies show that combining PDL with other modalities can significantly improve outcomes and patient satisfaction for specific types of scarring compared to laser alone.

Who It’s Best For

Patients with specific scar types: combination with salicylic acid for active acne and scars, or with pingyangmycin for raised (hypertrophic) scars.

Evidence Snapshot

Clinical Data

With Salicylic Acid: Patient satisfaction was significantly higher when a salicylic acid peel was combined with PDL for treating acne and scars, compared to just using the laser (p = 0.015).¹

Lekakh O, Mahoney AM, Novice K, Kamalpour J, Sadeghian A, Mondo DM, Kalnicky C, Guo R, Peterson A, Tung R. Treatment of Acne Vulgaris With Salicylic Acid Chemical Peel and Pulsed Dye Laser: A Split Face, Rater-Blinded, Randomized Controlled Trial. J Lasers Med Sci. 2015;16(6):167-74. doi: 10.15171/jlms.2015.13.

With Pingyangmycin: In a study of 109 patients with post-acne hypertrophic (raised) scars, combining PDL with injections of pingyangmycin resulted in a significantly higher total effective rate compared to control treatment.²

Guo R, Xuan W, He X, Xu K. Clinical Efficacy and Safety of Pulsed Dye Laser Combined with Pingyangmycin on Hyperplastic Scar after Acne. Mediators Inflamm. 2022;2022:3305107. doi:10.1155/2022/3305107.

The Science

These combinations create a synergistic effect. The PDL targets redness and inflammation while the second modality provides a different action: salicylic acid exfoliates and unclogs pores, while pingyangmycin (an anti-tumor agent) inhibits the excessive cell growth that causes hypertrophic scars.

Limitations

These are very specific combinations for specific scar types and are not general-purpose treatments.
Combining treatments increases complexity, potential side effects, and cost.
Pingyangmycin is not widely available or used for this purpose in all regions (e.g., US, Europe).

Expected Time-to-Results

Varies by combination, but generally requires multiple sessions over several months.

Cost

Will be higher than a standard PDL session due to the cost of the additional product or procedure.

Products

These are professional procedures combining a PDL device with prescription-strength peels or injectable medications.

Bottom Line

For patients with the right kind of scarring (active acne with redness or raised scars), combining PDL with another modality like a salicylic acid peel or specific injectables is an evidence-based way to achieve superior results compared to using the laser alone.

General Non-Ablative Fractional Lasers (NAFL)

What Is It?

A category of lasers that heat columns of tissue deep in the skin to stimulate collagen without breaking the outer skin surface. This class includes popular treatments like Fraxel, Clear + Brilliant, Moxi, and CoolPeel, all offering scar improvement with minimal downtime. (Availability: Procedure)

Effectiveness Rating

Good — Clinical evidence, including a meta-analysis, suggests NAFLs are effective for atrophic scars and may even be more effective than ablative lasers, with a much better safety profile. User experiences, however, are very mixed.

Who It’s Best For

Patients with mild to moderate atrophic scars who prioritize safety and minimal downtime. They are a good option for patients with darker skin tones or those with co-existing conditions like rosacea.

Evidence Snapshot

Clinical Data

A meta-analysis of 7 studies (n=186) found that non-ablative lasers were more effective for treating atrophic acne scars than ablative lasers.¹

Ke R, Cai B, Ni X, Lin Q, Chen L, Xie Y, Wan X, Shan X, Wang B. Efficacy and safety of non-ablative vs ablative lasers for acne scarring: A meta-analysis. J Dtsch Dermatol Ges. 2025;23(4):[e-pub ahead of print]. doi: 10.1111/ddg.15651. PMID: 40066600.

In a study of patients with both rosacea and acne scars, 1440-nm NAFL therapy significantly reduced scar scores without worsening the rosacea.²

Wang B, Deng Y, Yan S, Xie H, Li J, Jian D. Efficacy of non-ablative fractional 1440-nm laser therapy for treatment of facial acne scars in patients with rosacea: a prospective, interventional study. Lasers Med Sci. 2020;35(7):1831-1838. doi: 10.1007/s10103-020-03107-x

A retrospective study found atrophic scars responded significantly better to 1550-nm NAFL than hypertrophic or keloid scars.³

Gokalp H. Evaluation of nonablative fractional laser treatment in scar reduction. Lasers Med Sci. 2017;32:1629–35. doi: 10.1007/s10103-017-2303-x.

User Reports

Moxi: One user saw minor improvement in pitted scars after two sessions, while another achieved more significant results by switching from Moxi to CoolPeel.
CoolPeel: A user reported it was more effective than Moxi.
Clear + Brilliant: Users report mixed and minimal results for rolling scars, with some questioning if the “glowy” complexion justifies the high cost for actual scar revision.
Profractional: One user reported major improvement in rolling scars from two rounds, stating it was far more effective than microneedling. (Note: Profractional can be Erbium-based).

The Science

NAFLs create thousands of microscopic thermal zones deep within the dermis, leaving the surrounding tissue and the skin’s surface untouched. This targeted heating triggers a natural healing process that replaces damaged tissue and stimulates the growth of new, healthy collagen, gradually improving scar texture.

Limitations

Results are generally less dramatic than with ablative lasers.
Multiple sessions are almost always required.
High cost per session.
User reports indicate a high degree of variability and potential for disappointment, especially with milder devices in this class.

Expected Time-to-Results

Improvement is gradual, with full results from collagen remodeling taking 3-6 months to become apparent.

Cost

Varies by device and location. Clear + Brilliant and Moxi are typically less expensive per session than Fraxel.

Products

This is a professional procedure. Common device brands include Fraxel Re:store, Clear + Brilliant, Moxi, CoolPeel (a specific CO2 protocol), and Sciton ProFractional.

Bottom Line

NAFLs are a clinically solid and safer alternative to ablative lasers for treating mild-to-moderate atrophic scars, especially for those with sensitive skin, skin of color, or who cannot tolerate downtime. However, patients should have realistic expectations, as results are more subtle, require multiple sessions, and user satisfaction can be inconsistent.

Diode Laser (1450nm)

What Is It?

A non-ablative laser that uses a specific 1450nm wavelength to heat the dermis and stimulate collagen production. It is an effective treatment for facial acne scars with a good safety profile. (Availability: Procedure)

Effectiveness Rating

Good — Supported by clinical studies demonstrating significant improvement in facial acne scars with minimal side effects.

Who It’s Best For

Patients with atrophic facial acne scars looking for a non-ablative option with a proven track record and a very low incidence of side effects.

Evidence Snapshot

Clinical Data

In a multi-center study of 48 patients, a low-energy, double-pass 1450nm diode laser resulted in greater than 30% improvement in facial acne scars for 92.9% of patients at the 3-month follow-up.¹

Rathod D, Foroughi A, Mekokishvili L, Wollina U, Lotti T, Rajan A, Goldust M. A cross‐sectional, multi‐center study on treatment of facial acne scars with low‐energy double‐pass 1450‐nm diode laser. Dermatologic Therapy. 2020;33(2):e13326.

A split-face comparison study (n=20) found that the 1450nm diode laser produced a better clinical scar response than the 1320nm Nd:YAG laser after three monthly treatments.²

Chilicka K, Rusztowicz M, Szyguła R, Nowicka D. Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review. J Clin Med. 2022 May 1;11(10):2744. doi: 10.3390/jcm11102744. PMID: 35628870; PMCID: PMC9147527.

The incidence of side effects is low; transient hyperpigmentation was observed in only 1 of 48 patients (2.1%) and resolved within 2 months.¹

Rathod D, Foroughi A, Mekokishvili L, Wollina U, Lotti T, Rajan A, Goldust M. A cross‐sectional, multi‐center study on treatment of facial acne scars with low‐energy double‐pass 1450‐nm diode laser. Dermatologic Therapy. 2020;33(2):e13326.

The Science

The 1450nm wavelength is absorbed by water in the dermis, causing bulk heating of the tissue. This controlled thermal injury stimulates fibroblasts, the cells responsible for producing collagen, leading to dermal remodeling and improvement in scar appearance over time.

Limitations

Less well-known and less commonly available than other NAFLs like Fraxel.
Requires multiple sessions.
Results are not as dramatic as ablative lasers.

Expected Time-to-Results

Visible improvements are typically seen after a course of several treatments, with final results apparent 3-6 months after the last session.

Cost

Varies by provider and location; likely comparable to other NAFL treatments.

Products

This is a professional procedure. Device brands include Smoothbeam and Aerolase.

Bottom Line

The 1450nm diode laser is a well-supported, safe, and effective non-ablative treatment for facial atrophic acne scars. While perhaps not as widely available as other lasers, it offers a reliable option with a low risk profile.

Nd:YAG Laser Therapies

Nd:YAG Laser (1064nm, 1320nm)

What Is It?

A type of non-ablative laser that uses a neodymium-doped yttrium aluminum garnet crystal. It is used in different modes (long-pulsed, Q-switched, picosecond) for various indications, including the redness of macular scars and, in picosecond form, atrophic scar texture. (Availability: Procedure)

Effectiveness Rating

Poor — for atrophic (indented) acne scars when used in long-pulsed or Q-switched modes, with studies showing a lack of significant improvement and low patient satisfaction. The picosecond version of this laser is effective and covered separately.

Who It’s Best For

Patients with macular acne scars (flat red/brown marks), as it can effectively manage the discoloration. It is not recommended for improving the texture of atrophic scars.

Evidence Snapshot

Clinical Data

One study found that Q-switched 1064nm Nd:YAG laser did not result in statistically significant improvement for mild to moderate atrophic scars after five sessions, with very low (20%) patient satisfaction.¹

Maluki A, Mohammad FH. Treatment of atrophic facial scars of acne vulgaris by Q-Switched Nd:YAG (Neodymium: Yttrium-Aluminum-Garnet) laser 1064 nm wavelength. J Cosmet Laser Ther. 2012;14(5):282-286. doi: 10.3109/14764172.2012.723807. PMID: 23016531.

A split-face study found that fractional Er:YAG laser produced significantly higher subjective improvement and patient satisfaction than the long-pulsed 1064nm Nd:YAG laser for atrophic scars.²

Al-Dhalimi M, Dahham Z. Split-face clinical comparative study of fractional Er:YAG (2940nm) laser versus long pulsed Nd:YAG (1064nm) laser in treatment of atrophic acne scar. J Cosmet Laser Ther. 2021;23(2):112-118. doi: 10.1080/14764172.2021.1967996.

A split-face comparison found the 1320-nm Nd:YAG laser was less effective for scars than the 1450-nm diode laser.³

Chilicka K, Rusztowicz M, Szyguła R, Nowicka D. Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review. J Clin Med. 2022 May 1;11(10):2744. doi: 10.3390/jcm11102744. PMID: 35628870; PMCID: PMC9147527.

In contrast, a systematic review found that Nd:YAG laser is highly effective in managing the erythema (redness) and dyspigmentation in macular acne scars.⁴

Sarvipour N, Akbari Z, Shafie’ei M, Jamali M, Ahmadzade M, Ahramiyanpour N. Lasers for the treatment of erythema, dyspigmentation, and decreased elasticity in macular acne scars: a systematic review. Lasers Med Sci. 2022 Dec;37(12):3621-3630. doi: 10.1007/s10103-022-03621-0. PMID: 35918567.

The Science

The 1064nm wavelength penetrates deeply into the skin. In long-pulsed mode, it provides bulk heating to stimulate some collagen, but its primary target is hemoglobin and melanin, making it better for vascular and pigmented lesions. Q-switched mode is primarily for shattering pigment.

Limitations

Ineffective for improving the texture of atrophic scars.
Multiple sessions are needed.
Evidence shows it is inferior to other laser types (Diode, Er:YAG) for scar texture.

Expected Time-to-Results

For redness, improvement can be seen within weeks. For texture, significant improvement is not expected.

Cost

Varies by provider, but generally in the range of several hundred dollars per session.

Products

This is a professional procedure. Device brands include GentleYAG (Candela), Cutera, and others. (Note: Picosecond Nd:YAG lasers like PicoWay are different and more effective for texture).

Bottom Line

The traditional Nd:YAG laser is not an effective choice for treating indented acne scars and patients should look to other technologies. It is, however, a viable option for addressing the red and brown discoloration left behind by acne.

Isotretinoin + Laser Therapy

What Is It?

A modern treatment approach that combines oral isotretinoin (Accutane), typically at a low dose, with concurrent laser or energy-based device treatments for acne scars. This challenges the older guideline of waiting 6 months after finishing isotretinoin. (Availability: Rx, Procedure)

Effectiveness Rating

Good — Emerging clinical and user evidence suggests this combination is safe and can be significantly more effective for both active acne and scars than either treatment alone.

Who It’s Best For

Patients with active acne and pre-existing atrophic scars (especially boxcar type) who want to address both issues simultaneously for a more efficient and potentially better outcome.

Evidence Snapshot

Clinical Data

Combining low-dose oral isotretinoin with a 1550nm non-ablative fractional laser resulted in significant improvement of atrophic boxcar scars compared to isotretinoin alone (p<0.05 for superficial; p<0.01 for deep scars).¹

Xia J, Hu G, Hu D, Geng S, Zeng W. Concomitant Use of 1,550-nm Nonablative Fractional Laser With Low-Dose Isotretinoin for the Treatment of Acne Vulgaris in Asian Patients: A Randomized Split-Face Controlled Study. Dermatol Surg. 2018 Sep;44(9):1198-1205. doi: 10.1097/DSS.0000000000001546. PMID: 29781900.

A review noted that adding devices like fractional CO2 laser to oral isotretinoin resulted in significantly better scar improvement compared to the devices alone.²

Xu Y, Wang H, Guo L, Hamblin MR, Wen X. Combinations of Energy-based Devices plus isotretinoin for management of acne and acne scars: A systematic review. J Cosmet Dermatol. 2024 Oct 1;23(10):[pii]: 10.1111/jocd.16407. PMID: 38845186.

User Reports

A user reported a novel combination of aggressive CO2RE laser followed by a 6-month course of low-dose isotretinoin yielded ~70% scar improvement.
Users anecdotally report that combining isotretinoin with CO2 laser can enhance efficacy by up to 40%, contrary to outdated guidelines.
Another user reported that their doctor performed fractional CO2 laser safely and effectively while they were concurrently on low-dose Accutane and using topical Tazarotene.

The Science

Isotretinoin controls acne by dramatically reducing sebum production and inflammation. Performing laser therapy concurrently may leverage the skin’s altered state to enhance collagen remodeling and healing, leading to a synergistic effect on both active lesions and old scars.

Limitations

This is a modern approach that goes against historical guidelines; it requires a knowledgeable and experienced practitioner.
Combining treatments increases complexity and potential for side effects, requiring careful monitoring.
The evidence base, while growing and positive, is still newer than for standalone treatments.

Expected Time-to-Results

Improvement in both active acne and scars would be seen over the course of the treatment, typically several months.

Cost

Combines the cost of a prescription for isotretinoin with the high cost of laser sessions.

Products

This is a professional protocol combining a prescription medication (e.g., Accutane, Absorica) with a professional laser device (e.g., Fraxel, CO2RE).

Bottom Line

Combining low-dose isotretinoin with laser therapy is an emerging, evidence-based strategy that can safely and effectively treat active acne and atrophic scars at the same time. This approach can lead to superior results but should only be performed under the care of an experienced dermatologist familiar with the latest research.

TCA Peel + Subcision + Fractional Laser

What Is It?

An aggressive, single-session combination therapy for rolling acne scars that involves applying a TCA chemical peel, performing extensive subcision, and finishing with a fractional laser (CO2 or Erbium) treatment. (Availability: Procedure)

Effectiveness Rating

Good — Supported by retrospective clinical studies showing it to be a safe and effective single-session approach for improving rolling acne scars.

Who It’s Best For

Patients with extensive rolling acne scars who are looking for a powerful, “one and done” (or few-session) treatment approach and are able to tolerate the associated downtime.

Evidence Snapshot

Clinical Data

Two large retrospective studies (n=114 and n=56) on this single-session combination for rolling scars reported it as safe and effective, with mean improvement scores of 2.9 out of 4 and 2.52 out of 4, respectively.¹, ²

Taylor MB, Zaleski-Larsen LA, McGraw T. Single Session Treatment of Rolling Acne Scars Using Tumescent Anesthesia, 20% Trichloracetic Acid Extensive Subcision, and Fractional CO2 Laser. Dermatologic Surgery. 2017; doi: 10.1097/DSS.0000000000000895.
Taylor MB, Koron N. Combined Treatment of Rolling Acne Scars in Ethnic Skin Using Extensive Subcision, Trichloracetic Acid Peel, and Fractional Ablative Erbium Laser. Dermatologic Surgery. 2021 Apr;47(4):496-9. doi: 10.1097/DSS.0000000000002858. PMID: 33795570; PMCID: PMC9518968.

User Reports

One user reported their cosmetic doctor advised it was safe to conceive one month after a combination treatment that included TCA, subcision, and laser.

The Science

This is a multi-pronged attack. Subcision mechanically breaks the tethers holding scars down. The TCA peel chemically removes the surface layer of skin and stimulates collagen. The fractional laser then creates deep micro-injuries to powerfully trigger dermal remodeling and new collagen growth.

Limitations

This is a very aggressive procedure with significant downtime (swelling, bruising, redness, peeling).
High risk of side effects like hyperpigmentation if not performed by a highly skilled expert.
The evidence comes from retrospective studies from a single practice, not broader randomized controlled trials.
High cost associated with combining three separate procedures.

Expected Time-to-Results

Initial healing will take 1-3 weeks, but the final, dramatic results will take 6+ months to fully mature.

Cost

Likely very high, in the range of several thousand dollars for a single session.

Products

This is a professional procedure combining three modalities: TCA (trichloroacetic acid) solution, subcision tools, and a fractional laser device (CO2 or Er:YAG).

Bottom Line

This intensive, single-session combination therapy offers a potentially powerful and efficient solution for rolling acne scars. However, it is a highly aggressive approach with significant downtime and risks, and should only be considered with a board-certified dermatologist or plastic surgeon with specific experience in this technique.

Low-Level Laser Therapy (LLLT)

What Is It?

A non-invasive treatment that uses low-power lasers or light-emitting diodes (LEDs) to stimulate cellular function. It is sometimes used in at-home devices for skin rejuvenation and wound healing. (Availability: OTC, Procedure)

Effectiveness Rating

Very Poor — There is currently very limited and low-quality evidence to support its use for improving the texture of atrophic acne scars.

Who It’s Best For

May be considered by patients for general skin health or reducing inflammation, but it should not be relied upon as a primary treatment for atrophic acne scarring.

Evidence Snapshot

Clinical Data

A 2013 review paper reports that LLLT has beneficial effects on scars by stimulating tissue repair, but cites this as a general principle rather than strong evidence from acne scar trials.¹

Avci P, Gupta A, Sadasivam M, Vecchio D, Pam Z, Pam N, Hamblin MR. Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. Seminars in cutaneous medicine and surgery. 2013;32(1):1-10.

The Science

The proposed mechanism is that photons from the light are absorbed by mitochondria (the powerhouses of cells), which increases cellular energy production (ATP). This boost in energy is thought to stimulate healing, reduce inflammation, and promote tissue repair.

Limitations

Lack of robust clinical evidence for efficacy on atrophic acne scars.
Any potential effects are likely to be very subtle and slow to appear.
The at-home device market is poorly regulated, with variable quality and effectiveness.

Expected Time-to-Results

Not established for acne scarring; likely would require consistent use over many months for any subtle effect.

Cost

At-home devices range from ~$100 to $600+.

Products

Bottom Line

While LLLT may have benefits for general skin health and inflammation, there is no compelling evidence that it can significantly improve the texture of established atrophic acne scars. It is not a recommended primary treatment for this concern.

BroadBand Light (BBL) / IPL

What Is It?

BBL and IPL (Intense Pulsed Light) are treatments that use broad-spectrum light to target pigment (brown and red) in the skin. They are primarily used for sun damage, hyperpigmentation, and redness, not for textural scar improvement. (Availability: Procedure)

Effectiveness Rating

Poor — for atrophic (indented) acne scars. However, some users report unexpected textural improvement, and it can be effective for the red/brown discoloration associated with scarring.

Who It’s Best For

Patients whose main concern is post-inflammatory hyperpigmentation (PIH) or erythema (PIE) associated with acne scars, rather than the scar texture itself.

User Reports

One user reported that a single BBL treatment, while intended for pigmentation, unexpectedly improved the appearance of their acne scars.
A user undergoing professional treatment for back scarring found that a plan including IPL contributed to significant improvement.
In a popular combination, Halo laser is frequently paired with BBL to address both texture (Halo) and pigment (BBL) in one session.

The Science

The broad spectrum of light is absorbed by melanin (brown pigment) and hemoglobin (red pigment). This generates heat that destroys the targeted cells, leading to a reduction in brown spots and redness. The generalized heating may also provide a mild stimulus for collagen production.

Limitations

Not designed or effective for treating the texture of indented acne scars.
Risk of burns or pigmentation changes if performed incorrectly, especially on darker skin tones.
Multiple sessions are required.

Expected Time-to-Results

For pigmentation, results are typically visible 1-2 weeks after each session. Textural improvement is not a reliable outcome.

Cost

~$400 - $600 per session.

Products

This is a professional procedure. The most well-known device brands are Sciton BBL and various IPL machines (e.g., Lumenis M22).

Bottom Line

BBL and IPL are excellent for clearing the red and brown discoloration that makes acne scars look more obvious, but they should not be considered a primary treatment for improving scar texture. Some patients may experience a mild textural benefit as a secondary effect.

Chemical Peels

General Chemical Peels

What Is It?

A professional treatment where a chemical solution is applied to the skin to remove the top layers, promoting new, smoother skin to grow. They are a well-established procedural option for improving atrophic (indented) acne scars. (Rx)

Effectiveness Rating

Mixed — Superficial peels help with discoloration and minor texture, while deeper peels are needed for significant indented scars but come with higher risks.

Who It’s Best For

Patients with shallow atrophic scars and/or post-inflammatory hyperpigmentation (dark spots). Deeper peels are for those with more significant textural scarring who are willing to accept more downtime and risk.

Evidence Snapshot

Clinical Data

Superficial chemical peels are considered a safe and effective treatment for atrophic acne scars, with relatively few side effects.²
For people with skin of color, chemical peels carry a higher risk of causing pigmentation issues (dyschromias) and abnormal scarring.¹
Recent evidence is challenging the traditional guideline to wait 6 months after finishing oral isotretinoin before undergoing procedures like chemical peels.³

Xiao Y, Chen L, Jing D, et al. Willingness-to-pay and benefit–cost analysis of chemical peels for acne treatment in China. Patient Prefer Adherence. 2019;13:217-227. doi: 10.2147/PPA.S194615.
Levy LL, Zeichner J. Management of Acne Scarring, Part II. Am J Clin Dermatol. 2012;13(6):363-71. doi: 10.2165/11631410-000000000-00000. PMID: 22849351.
Gallo ES, Katz U, Artzi O. Fractional Radiofrequency and Oral Isotretinoin—A Prospective Randomized Controlled Split‐Face Trial Comparing Concurrent Versus Delayed Fractional Radiofrequency Treatment for Acne Scars. Lasers Surg Med. 2024 Jun 18;56(6):e23811. doi: 10.1002/lsm.23811. PMID: 38890778.

User Reports

Users report that aggressive peels can damage the skin barrier and worsen acne, especially if active breakouts are present.
A single professional peel may not produce significant improvement for shallow scars.
Users note that initial improvement may be due to temporary swelling, with true results from collagen remodeling taking months to appear.

The Science

Chemical peels create a controlled injury to the skin, triggering an inflammatory healing response. This process stimulates the production of new collagen and other structural fibers, which helps to remodel scar tissue and smooth the skin’s surface.

Limitations

Can cause temporary or permanent side effects like redness, peeling, swelling, and changes in skin color.
Higher risk of complications in darker skin tones.
Shallower peels have limited effectiveness on deep, indented scars.
Deeper peels require significant downtime and carry risks of infection and scarring.
Effectiveness is highly dependent on the skill of the practitioner.

Expected Time-to-Results

Superficial peels may show results after a series of treatments over 1–3 months; deeper peels show improvement after healing (weeks to months) with continued remodeling over 6+ months.

Cost

Varies widely by peel type and location. Superficial peels might be $150–$400 per session, while deep peels can cost several thousand dollars. Generally not covered by insurance.

Bottom Line

Chemical peels are a valid treatment for acne scars, but setting expectations is key. Superficial peels are best for pigmentation and very shallow texture, while deeper, riskier peels are required for more significant atrophic scars. A consultation with a dermatologist is crucial to determine the right type of peel.

Glycolic Acid Peel

What Is It?

A type of alpha-hydroxy acid (AHA) peel that exfoliates the outer layer of skin. It’s used for mild acne scarring, particularly shallow atrophic scars and post-inflammatory hyperpigmentation. (OTC in low strengths, Rx for professional peels)

Effectiveness Rating

Mixed — Effective for shallow scars and discoloration, but clinical evidence shows it is significantly less effective than TCA peels or microneedling for deeper textural scars.

Who It’s Best For

Patients with fair skin and shallow, atrophic acne scars or those primarily concerned with post-inflammatory hyperpigmentation (dark spots).

Evidence Snapshot

Clinical Data

In a split-face study (n=30), a 30% TCA peel was significantly more effective for atrophic acne scars than a 70% glycolic acid peel (p=0.003).¹
Monotherapy with a 35% glycolic acid peel was found to be significantly less effective than microneedling for atrophic scars in patients with darker skin types (p<0.05).²
Biweekly 70% glycolic acid peels were shown to be more effective for atrophic scars than a daily 15% glycolic acid cream.³

Manjhi M, Sagar V, Yadav P, Dabas G, Gupta A, Pratap P. A comparative study of 70% glycolic acid and 30% trichloroacetic acid peel in the treatment of facial atrophic acne scars: A split-face study. J Cutan Aesthet Surg. 2024;17:227-33. doi: 10.25259/jcas_117_23.
Ishfaq F, Shah R, Sharif S, Waqas N, Jamgochian M, Rao B. A Comparison of Microneedling versus Glycolic Acid Chemical Peel for the Treatment of Acne Scarring. J Clin Aesthet Dermatol. 2022;15(6):26-32.
Sharad J. Glycolic acid peel therapy – a current review. Clin Cosmet Investig Dermatol. 2013;6:179-86. doi: 10.2147/CCID.S34029.

User Reports

Users report that topical glycolic acid has minimal impact on deep, atrophic scars.

The Science

Glycolic acid has the smallest molecule size of the AHAs, allowing it to penetrate the skin. It works by dissolving the bonds between dead skin cells to exfoliate the surface and stimulating collagen production in the dermis to help improve shallow scars.

Limitations

Significantly less effective than other procedures (TCA peels, microneedling) for indented scars.
Can cause irritation, redness, and sun sensitivity.
Multiple treatments are required for noticeable results.

Expected Time-to-Results

Expect visible improvement after a series of 4–6 peels spaced 2–4 weeks apart.

Cost

$100–$300 per professional peel. At-home products are much cheaper, from $15–$50.

Products

Professional: Administered by a dermatologist or esthetician.
At-Home: The Ordinary Glycolic Acid 7% Toning Solution, Medik8 Sleep Glycolic

Bottom Line

Glycolic acid peels are a good entry-level option for tackling the discoloration and very superficial texture associated with acne scarring. However, for indented boxcar or ice pick scars, more aggressive treatments are likely needed.

Lactic Acid Peel

What Is It?

A gentle alpha-hydroxy acid (AHA) peel that exfoliates the skin’s surface. It’s often used for superficial acne scarring and discoloration, and is known for being more hydrating than other acids. (OTC in low strengths, Rx for professional peels)

Effectiveness Rating

Poor — Evidence for significant scar improvement is limited and of low quality, though it may help with superficial texture and discoloration.

Who It’s Best For

Individuals with sensitive or dry skin looking for mild improvement in superficial acne scars and post-inflammatory hyperpigmentation (dark spots).

Evidence Snapshot

Clinical Data

In a small study (n=7) on Indian patients, a series of 92% lactic acid peels resulted in good to significant improvement (>51% clearance) in 57% of patients with superficial scarring.²
Another study on 88% lactic acid peels reported a significant improvement in acne scars (p=0.002), with 100% of patients reporting “full satisfaction,” but the study quality was poor.¹

Sharquie K, Noaimi AA, Al-Janabi EA. TREATMENT OF ACTIVE ACNE VULGARIS BY CHEMICAL PEELING USING 88% LACTIC ACID. Our Dermatol Online. 2014;4:59. doi: 10.7241/OURD.20144.59.
Sachdeva S. Research Letter: Lactic acid peeling in superficial acne scarring in Indian skin. J Cosmet Dermatol. 2010;9:277-80. doi: 10.1111/j.1473-2165.2010.00513.x.

User Reports

After three at-home lactic and salicylic acid peels, a user experienced a reduction in redness and dark spots, but no visible improvement in atrophic scar texture.

The Science

Lactic acid works by exfoliating dead cells from the skin’s surface, which can help improve skin tone and minor textural irregularities. As a larger molecule than glycolic acid, it doesn’t penetrate as deeply, making it a gentler option.

Limitations

Unlikely to be effective for moderate to severe atrophic scarring.
High-quality clinical evidence for its use in scarring is lacking.
High-concentration peels (as used in studies) must be done professionally to avoid burns.

Expected Time-to-Results

A series of 4–6 professional peels may be needed to see mild improvement.

Cost

$100–$250 per professional peel. At-home products range from $10–$40.

Products

Professional: Administered by a dermatologist or esthetician.
At-Home: The Ordinary Lactic Acid 10% + HA, Sunday Riley Good Genes Lactic Acid Treatment

Bottom Line

Lactic acid peels are a gentle option for improving the overall tone and brightness of scarred skin, but they are not a powerful tool for revising indented, atrophic scars.

Salicylic Acid Peel

What Is It?

A beta-hydroxy acid (BHA) peel that is oil-soluble, allowing it to penetrate into pores to exfoliate. It is primarily used to treat active acne but can also help with post-inflammatory discoloration and very superficial scarring. (OTC in low strengths, Rx for professional peels)

Effectiveness Rating

Poor — Primarily effective for managing active acne and PIH, with little evidence or user reports of significant improvement for atrophic scar texture when used alone.

Who It’s Best For

People with oily, acne-prone skin who are looking to manage breakouts and improve associated dark spots. It is not a primary treatment for indented scars.

Evidence Snapshot

Clinical Data

Studies show that 30% salicylic acid peels, when used in combination with procedures like lasers or microneedling, are well-tolerated and do not seem to increase side effects.¹

Lekakh O, Mahoney AM, Novice K, et al. Treatment of Acne Vulgaris With Salicylic Acid Chemical Peel and Pulsed Dye Laser: A Split Face, Rater-Blinded, Randomized Controlled Trial. J Lasers Med Sci. 2015;16(6):167-74. doi: 10.15171/jlms.2015.13.

User Reports

One user reported that a series of at-home lactic and salicylic acid peels helped with redness and dark spots but did not improve atrophic scar texture.

The Science

Salicylic acid exfoliates the skin and, due to its oil-solubility, can clean out pores effectively. This helps prevent new acne from forming, which in turn prevents new scars. Its anti-inflammatory properties can also help reduce the redness associated with acne marks.

Limitations

Not effective for deep or indented atrophic scars.
Its main benefit is for active acne and PIH, not textural remodeling.
Can be drying and cause peeling.

Expected Time-to-Results

For preventing new scars and fading marks, results can be seen in ≥4 weeks. No significant results should be expected for existing indented scars.

Cost

$100–$300 per professional peel. At-home products range from $10–$50.

Products

Professional: Administered by a dermatologist or esthetician.
At-Home: The Ordinary Salicylic Acid 2% Solution, Paula’s Choice 2% BHA Liquid Exfoliant

Bottom Line

While excellent for managing active acne and preventing new scars, a salicylic acid peel is not an effective treatment for remodeling existing indented acne scars. It is best used as part of a prevention strategy.

Trichloroacetic Acid (TCA) Peel

What Is It?

A medium-depth chemical peel used to treat more significant skin concerns, including sun damage, wrinkles, and atrophic acne scars. It is a powerful agent that should only be administered by a medical professional. (Rx only)

Effectiveness Rating

Good — Clinical data shows TCA peels are significantly more effective than glycolic acid for atrophic scars, and user reports suggest good results for boxcar scars, but it is less targeted than TCA CROSS.

Who It’s Best For

Patients with shallow to medium-depth atrophic scars (especially boxcar scars) and fair skin. It is not ideal for deep ice pick scars (TCA CROSS is better) or for darker skin tones due to a higher risk of pigmentation issues.

Evidence Snapshot

Clinical Data

In a split-face study (n=30), 30% TCA peels were significantly more effective for atrophic acne scars than 70% glycolic acid peels (p<0.01).¹
A study of a 35% TCA peel for active acne and scars found that 100% of patients reported “full satisfaction,” although the study quality was poor.²

Manjhi M, Sagar V, Yadav P, et al. A comparative study of 70% glycolic acid and 30% trichloroacetic acid peel in the treatment of facial atrophic acne scars: A split-face study. J Cutan Aesthet Surg. 2024;17:227-33. doi: 10.25259/jcas_117_23.
Sharquie K, Noaimi AA, Al-Janabi EA. Treatment of Active Acne Vulgaris by Chemical Peeling Using TCA 35. Journal of Cosmetics, Dermatological Sciences and Applications. 2013;3:2008. doi: 10.4236/JCDSA.2013.33A2008

User Reports

One user reported a single TCA peel gave more improvement (~40%) for mild boxcar scars than a year of tretinoin use.
Users note that TCA peels can improve boxcar scars by “sanding down” the sharp, shadow-casting edges, making them appear smoother.
It is emphasized by users that TCA concentrations above 25% are not for full-face peeling at home and require professional administration.

The Science

TCA causes coagulative necrosis, which means it denatures proteins in the epidermis and dermis, causing the top layers of skin to peel away. This deep exfoliation triggers a powerful wound-healing response that stimulates significant collagen production to remodel scars.

Limitations

Requires significant downtime (typically 7-10 days) with visible peeling and redness.
High risk of post-inflammatory hyperpigmentation (PIH), especially in darker skin tones.
Risk of infection and scarring if not performed correctly or if aftercare is poor.
Less precise than TCA CROSS for targeting individual ice pick scars.

Expected Time-to-Results

Initial results are visible after peeling subsides (1–2 weeks), with continued improvement for 3–6 months as collagen remodels.

Cost

$300–$1,000+ per peel, depending on concentration and location. This is a professional-only procedure.

Products

This is a professional-only treatment and should not be attempted at home. Seek a board-certified dermatologist experienced with medium-depth peels.

Bottom Line

A full-face TCA peel is a powerful and effective option for widespread, shallow-to-medium depth atrophic scars, particularly boxcar scars. The significant downtime and risks, especially for darker skin, mean it must be performed by an experienced professional.

TCA CROSS (Chemical Reconstruction of Skin Scars)

What Is It?

A specialized technique where a very high concentration (70-100%) of Trichloroacetic Acid (TCA) is precisely applied into the base of individual atrophic scars. This is an in-office procedure for specific scar types. (Rx only)

Effectiveness Rating

Good — Strong clinical and user evidence shows it is highly effective for ice pick and narrow boxcar scars, but it is very technique-dependent and carries a significant risk of widening scars if done improperly.

Who It’s Best For

Patients with atrophic ice pick and deep, narrow boxcar scars. It is not suitable for rolling scars or very wide boxcar scars.

Evidence Snapshot

Clinical Data

Two studies (total n=40) using 100% TCA CROSS found that over 70% of patients with ice pick scars achieved excellent improvement (>70% scar reduction).¹²
A randomized trial (n=30) found TCA CROSS was comparable to microneedling for atrophic scars, with mean improvements of 75.3% and 68.3%, respectively (p=0.47).³
In a split-face study (n=20), TCA CROSS was associated with more pigmentary changes than subcision for rolling scars.⁴
Improper application technique has been shown to lead to worsening of scars, increased atrophy, and persistent redness.⁵

Bhardwaj D, Khunger N. An Assessment of the Efficacy and Safety of CROSS Technique with 100% TCA in the Management of Ice Pick Acne Scars. J Cutan Aesthet Surg. 2010 May 1;3(2):93-6. doi: 10.4103/0974-2077.69020.
Khunger N, Bhardwaj D, Khunger M. Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types. J Cosmet Dermatol. 2011;10:111-116. doi: 10.1111/j.1473-2165.2010.00526.x
Leheta T, El Tawdy AE, Abdel Hay RA, Farid S. Percutaneous Collagen Induction Versus Full‐Concentration Trichloroacetic Acid in the Treatment of Atrophic Acne Scars. Dermatologic Surgery. 2011 Feb;37(2):222-8. doi: 10.1111/j.1524-4725.2010.01854.x.
Ramadan S, El-Komy M, Bassiouny D, El-Tobshy S. Subcision Versus 100% Trichloroacetic Acid in the Treatment of Rolling Acne Scars. Dermatologic Surgery. 2011 May;37(5):622-8. doi: 10.1111/j.1524-4725.2011.01954.x.
Veenstra J, Fakhoury J, Ozog D. Worsening of Acne Scars from Trichloroacetic Acid CROSS Delivered via Micropipette: A Case Report. J Clin Aesthet Dermatol. 2021;14(4):28-32.

User Reports

One user identified TCA CROSS as the single most effective procedure in their multi-modal plan for severe scarring.
Many users cite it as highly effective for ice pick scars, with some reporting 80-85% improvement after multiple sessions over many years.
A common and significant user-reported risk is the permanent widening of scars, making them shallower but more crater-like.
Users report a slow healing process, with visible results taking 2-3 months and full results up to 6 months post-treatment.

The Science

The high concentration of TCA causes a focused, deep chemical burn and inflammatory reaction at the base of the scar. This intense process breaks down old scar tissue and stimulates a robust production of new collagen, which then raises the scar floor to be more level with the surrounding skin.

Limitations

Very high risk of worsening scars (making them wider) if not performed with precision.
Highly dependent on practitioner skill.
Downtime involves scabbing on treated spots for 5–7 days, followed by redness that can last for weeks or months.
Risk of pigment changes (lightening or darkening of the skin).
Multiple sessions are almost always required.

Expected Time-to-Results

Scabs fall off in about one week; redness persists for weeks. True improvement is slow, with noticeable changes at ≥2–3 months and full results taking up to 6 months per session.

Cost

$250–$750+ per session in the US. This is a professional-only procedure and should never be attempted at home.

Products

This is a professional-only technique. It is critical to find a board-certified dermatologist with extensive, specific experience in performing TCA CROSS.

Bottom Line

For the right type of scar (ice pick, narrow boxcar), TCA CROSS can be one of the most effective treatments available. However, the results are extremely dependent on the practitioner’s skill, and there is a real risk of making scars worse.

Phenol Peel / Phenol CROSS

What Is It?

The deepest and most aggressive type of chemical peel, using phenol (carbolic acid) to treat severe wrinkles and deep acne scars. Phenol CROSS is the targeted application of phenol into individual scars, similar to TCA CROSS. (Rx only)

Effectiveness Rating

Good — Clinical data shows it is a highly effective treatment for atrophic scars, comparable to multiple sessions of other procedures in a single treatment. However, it carries the most significant risks and downtime of any peel.

Who It’s Best For

Patients with fair skin and severe, deep atrophic acne scars (ice pick, boxcar) who have not responded to other treatments and are willing to undergo a very aggressive procedure with extensive downtime.

Evidence Snapshot

Clinical Data

A single deep phenol peel was found to be as effective for atrophic scars as four sessions of microneedling with TCA, yielding a 75% mean improvement in a randomized controlled trial (n=24).¹
In a split-face trial, 88% phenol CROSS was as effective as 90% TCA CROSS for ice pick and boxcar scars (p<0.001) but was associated with less pain and fewer adverse effects like scar enlargement.²

Leheta T, Abdel Hay RA, El Garem YE. Deep peeling using phenol versus percutaneous collagen induction combined with trichloroacetic acid 20% in atrophic post-acne scars; a randomized controlled trial. J Dermatol Treat. 2014;25(2):122-6. doi: 10.3109/09546634.2012.674192.
Dalpizzol M, Weber MB, Mattiazzi A, Manzoni A. Comparative Study of the Use of Trichloroacetic Acid and Phenolic Acid in the Treatment of Atrophic-Type Acne Scars. Dermatologic Surgery. 2016;42(3):322-328. doi: 10.1097/DSS.0000000000000606. PMID: 26849087

User Reports

One user reported an ~80% reduction in boxcar and ice pick scars from phenol cross after 6 treatments over 2+ years, but noted extended healing time for redness.
Another user reported only a 20-30% improvement after two phenol peel treatments for rolling and boxcar scars.
One user reported a medium phenol peel provided no noticeable benefit despite a dermatologist’s promise of dramatic improvement.

The Science

Phenol causes extensive protein coagulation deep within the dermis, resulting in a profound injury that removes the epidermis and a significant portion of the dermis. The subsequent, dramatic wound healing response leads to massive new collagen formation and skin restructuring.

Limitations

Extremely high risk. Should only be performed by a highly experienced plastic surgeon or dermatologist.
Involves very long and difficult downtime (weeks to months of peeling, oozing, and severe redness).
High risk of permanent hypopigmentation (loss of skin color), creating a distinct line between treated and untreated skin.
Carries systemic risks, including potential heart, liver, and kidney toxicity, requiring cardiac monitoring during the procedure.
Not suitable for darker skin tones.

Expected Time-to-Results

Initial healing takes several weeks, but redness can persist for 6 months or more. Final results can take 6–12 months to fully appear.

Cost

$2,500–$6,000+ for a full-face peel. This is a serious medical procedure.

Products

This is a professional-only medical procedure. Seek a board-certified dermatologist or plastic surgeon with specific, extensive experience in deep phenol peels.

Bottom Line

Phenol peels are the most powerful non-surgical tool for severe atrophic scarring but also the most dangerous. They offer the potential for dramatic results in a single treatment but should be considered a last resort due to the extreme downtime, high cost, and significant health risks.

VI Peel

What Is It?

A branded, medium-depth chemical peel that combines a blend of acids (including TCA, salicylic acid, and retinoic acid) and vitamin C. It is marketed as being less painful with less downtime than a traditional TCA peel. (Rx)

Effectiveness Rating

Poor — User reports suggest it is ineffective for improving the texture of atrophic scars, working primarily on superficial concerns like pigmentation and skin tone.

Who It’s Best For

Individuals looking to improve skin tone, mild sun damage, and post-inflammatory hyperpigmentation, rather than those seeking to treat indented acne scars.

User Reports

A combination of multiple VI Peels and Hydrafacials was reported by users to be ineffective for textural acne scars (ice pick, boxcar).
One user found two VI Peel sessions for $245 (on discount) to be satisfactory for their scarring but stated it would not be worth the typical full price of $399 for a single peel.

The Science

The blend of ingredients works to exfoliate the skin and stimulate cell turnover. The TCA and salicylic acid provide the peeling action, while retinoic acid and vitamin C promote collagen production and brighten the skin. However, the overall depth is generally not sufficient to remodel significant scar tissue.

Limitations

Not effective for indented, atrophic scars.
Marketed as gentle, but still a medium-depth peel with associated risks of redness, peeling, and potential pigmentation changes.
Cost can be high for the limited results on scar texture.

Expected Time-to-Results

Skin tone and brightness may improve within 1–2 weeks post-peel. Not effective for textural change.

Cost

$300–$500 per peel.

Products

This is a professional-only treatment provided by authorized practitioners. Find a provider at VIAesthetics.com.

Bottom Line

The VI Peel can be a good option for general skin rejuvenation and fading dark spots left by acne, but based on user reports, it is not an effective solution for treating the texture of indented acne scars.

Combination: Microneedling + Jessner’s Solution

What Is It?

A combination in-office treatment where the skin is first treated with a Jessner’s chemical peel, followed by microneedling. A Jessner’s peel is a superficial peel containing salicylic acid, lactic acid, and resorcinol. (Rx only)

Effectiveness Rating

Excellent — One strong clinical trial shows this combination provides significantly better improvement for atrophic acne scars than using either microneedling or a Jessner’s peel by itself.

Who It’s Best For

Patients with atrophic acne scars who are looking for a more effective result than single-modality treatments can provide.

Evidence Snapshot

Clinical Data

A randomized trial (n=60) found that combining microneedling with a Jessner’s solution peel led to significantly greater clinical improvement for atrophic acne scars compared to microneedling alone or a Jessner’s peel alone.¹

Ali B, Elmahdy N, Elfar NN. Microneedling (Dermapen) and Jessner’s solution peeling in treatment of atrophic acne scars: a comparative randomized clinical study. J Cosmet Laser Ther. 2019;21(4):213-218. doi: 10.1080/14764172.2019.1661490. PMID: 31495242.

The Science

The Jessner’s peel first exfoliates the surface layer of the skin, removing dead cells and preparing the skin. The subsequent microneedling creates micro-injuries that penetrate deeper, triggering a more robust collagen-stimulating wound healing response in a pre-exfoliated environment.

Limitations

Increased downtime and irritation compared to a single treatment.
Combines the risks of both procedures, including redness, peeling, sun sensitivity, and a risk of infection or pigmentation changes.
Requires a skilled practitioner to perform both modalities safely in one session.

Expected Time-to-Results

Visible improvement may be seen after 4–6 weeks, with continued collagen remodeling for 3–6 months.

Cost

$600–$1,200+ per session, as it combines two separate procedures.

Products

This is a professional-only treatment that must be performed by a board-certified dermatologist or plastic surgeon.

Bottom Line

Combining a Jessner’s peel with microneedling is a clinically proven, highly effective strategy for atrophic acne scars, offering superior results to either treatment alone. This synergistic approach is a powerful option for those seeking significant improvement.

Combination: Glycolic Acid + Vitamin C

What Is It?

A professional treatment protocol that involves a series of high-strength (e.g., 70%) glycolic acid peels combined with the application of Vitamin C. This is an in-office treatment. (Rx)

Effectiveness Rating

Good — A clinical study showed this combination significantly improved both acne scarring and post-inflammatory hyperpigmentation, suggesting a strong synergistic effect.

Who It’s Best For

Asian patients or those with both atrophic scarring and significant post-inflammatory hyperpigmentation (dark spots).

Evidence Snapshot

Clinical Data

A study in Asian patients (n=13) found that a combination of three 70% glycolic acid peels with vitamin C resulted in a statistically significant improvement in both acne scarring and post-inflammatory hyperpigmentation.¹

Khee HJ, May LM, Sam YS, Aw CW, Ho S-A. The efficacy and safety of a 70% glycolic acid peel with vitamin C for the treatment of acne scars. J Surg Dermatol. 2017;2(4):94. doi: 10.18282/JSD.V2.I4.94.

The Science

Glycolic acid provides deep exfoliation and stimulates collagen. Vitamin C is a powerful antioxidant that is also crucial for collagen synthesis and helps to inhibit melanin production, which fades hyperpigmentation. Combining them likely enhances collagen remodeling while actively treating the discoloration common with acne scars.

Limitations

The supporting study is small.
High-strength glycolic acid can be very irritating.
Requires a series of professional treatments.

Expected Time-to-Results

Visible results can be expected after a series of treatments over 2–3 months.

Cost

$200–$400 per session.

Bottom Line

Combining high-strength glycolic acid peels with vitamin C appears to be a very effective strategy for tackling both the textural and pigmentary aspects of acne scarring, with clinical evidence supporting its use, particularly in Asian skin types.

Microneedling

What Is It?

A procedure that uses fine, sterile needles to create tiny punctures in the skin. This controlled injury stimulates the body’s natural healing process to produce new collagen and elastin, improving scar texture. It is an in-office procedure, though at-home devices exist and are generally discouraged due to safety risks.

Effectiveness Rating

Good — Strong clinical evidence supports its use for atrophic (indented) scars, but user reports are mixed, with many finding it ineffective for deep ice-pick scars and noting that initial improvement is often just temporary swelling.

Who It’s Best For

Patients with shallow atrophic scars (e.g., rolling, boxcar), textural issues, and enlarged pores. It is generally safer for darker skin tones than many lasers, but some users report a risk of hyperpigmentation or keloids. It is not effective for deeply tethered or very deep ice-pick scars.

Evidence Snapshot

Clinical Data

A meta-analysis of 12 randomized controlled trials (414 participants) found that microneedling led to superior objective scar improvement compared to control treatments.⁻

Shen Y-C, Chiu W, Kang Y, Chen C. Microneedling Monotherapy for Acne Scar: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Aesthetic Plast Surg. 2022 Apr 14;46(2):765-774. doi: 10.1007/s00266-022-02845-3. PMID: 35426044.
In a randomized trial (n=30), microneedling was found to be more effective than a 35% glycolic acid peel for atrophic scars in darker skin types (Fitzpatrick IV-VI), with 73.3% of patients in the microneedling group improving compared to 33.3% in the peel group.⁸

Ishfaq F, Shah R, Sharif S, Waqas N, Jamgochian M, Rao B. A Comparison of Microneedling versus Glycolic Acid Chemical Peel for the Treatment of Acne Scarring. J Clin Aesthet Dermatol. 2022;15(6):26-32.

A split-face study (n=10) found the Dermapen device resulted in significantly greater improvement (62.2% vs. 56%, p=0.02) and higher patient satisfaction for atrophic scars compared to a Dermaroller.⁵

El-Domyati M, Fathi MM, Abdel-Aziz RTA. Atrophic facial acne scars; bilateral comparison of two microneedle devices. J Cosmet Laser Ther. 2024 Nov 16;26(6):10.1080/14764172.2024.2433219.

A study on 10 patients showed that microneedling significantly increased collagen types I, III, and VII (p<0.05), providing a histological basis for its effectiveness.²

Juhász M, Cohen JL. Microneedling for the Treatment of Scars: An Update for Clinicians. Clin Cosmet Investig Dermatol. 2020;13:1077-1091. doi: 10.2147/CCID.S267192.

Contradictory evidence suggests microneedling may be less effective than other procedures. One study found that after 3 sessions, an ‘excellent’ response was seen in only 6.67% of microneedling patients, compared to 20% for subcision and 13.33% for fractional CO2 laser.¹

Abdel Kareem IM, Fouad MA, Ibrahim M. Effectiveness of subcision using carboxytherapy plus fractional carbon dioxide laser resurfacing in the treatment of atrophic acne scars: comparative split face study. J Dermatol Treat. 2020;31(2):162-166. doi: 10.1080/09546634.2019.1595505

User Reports

User experiences are highly mixed. Many report microneedling is a “waste of money” for deep scars, especially ice-pick types, with initial improvements being only temporary swelling.
Some users with shallower scars (e.g., boxcar) report significant improvement after a series of 3–8 professional sessions.
At-home microneedling is strongly discouraged by the community due to risks of infection, skin damage, and making scars worse.
RF (radiofrequency) microneedling is also reported as having “hit or miss” outcomes, with multiple users seeing no improvement after several expensive sessions.

The Science

Microneedling creates thousands of controlled micro-injuries in the skin, triggering the body’s wound-healing response. This process stimulates the production of new, healthy collagen and elastin, which helps to remodel scar tissue and smooth the skin’s surface.

Limitations

Requires multiple sessions (typically 3–6) spaced weeks apart.
Results are not immediate and can take up to 6 months to become fully apparent.
Common side effects include temporary redness, swelling, and minor pain.
Risk of infection, post-inflammatory hyperpigmentation (PIH), broken capillaries, or worsening texture if not performed correctly.
At-home devices carry significant risks and are not recommended.
Ineffective for certain scar types (e.g., deep ice-pick, tethered scars).

Expected Time-to-Results

Noticeable changes after 3 sessions; full results may take 3–6 months after the final treatment.

Cost

Approximately $200–$1,000 per professional session in the US. RF microneedling is often at the higher end of this range.

Products

Professional Devices: SkinPen®, Dermapen™, Morpheus8 (RF), Vivace (RF).
At-Home Devices (Use with Extreme Caution): Dr. Pen, Derminator. Community consensus strongly advises against at-home use for scarring.

Bottom Line

Microneedling is a clinically-proven procedure for improving the texture of shallow atrophic acne scars. However, its effectiveness is variable, with many users reporting minimal or no lasting results, especially for deeper scars. For best results, it should be performed by a qualified professional as part of a comprehensive treatment plan and is often more effective when combined with other therapies.

Subcision

What Is It?

A minor surgical procedure where a special needle or blunt-tipped cannula is inserted beneath the skin to cut the fibrous bands that pull the skin down, creating indented scars. This is an in-office procedure performed by a dermatologist or plastic surgeon.

Effectiveness Rating

Excellent — Considered the gold-standard and essential first step for treating rolling and tethered (anchored) acne scars, a view supported by strong clinical evidence and user reports.

Who It’s Best For

Patients with rolling scars, which have a wave-like appearance, and other atrophic scars that are “tethered” or anchored to deeper tissue. It is not designed for ice-pick or keloid scars.

Evidence Snapshot

Clinical Data

A prospective study (n=34) showed subcision significantly improved the average scar score from 13.26 to 9.47 (p<0.0000001) at 6 months.¹

Chen B, Haq M, Ma MS, Ahmed A, Shi VJ, Koza E, Brieva JC, Yoo SS, Lucas J, Alam M. Split face randomized, evaluator blinded study on the effect of multiple subcisions on rolling acne scars. Arch Dermatol Res. 2024 Jun 8;10.1007/s00403-024-03142-6.

In a comparative study, subcision was found to be more effective than other monotherapies, with 20% of patients achieving an ‘excellent’ response compared to 13.33% for fractional CO2 laser and 6.67% for microneedling.²

Abdel Kareem IM, Fouad MA, Ibrahim M. Effectiveness of subcision using carboxytherapy plus fractional carbon dioxide laser resurfacing in the treatment of atrophic acne scars: comparative split face study. J Dermatol Treat. 2020;31(2):162-166. doi: 10.1080/09546634.2019.1595505

A systematic review found subcision demonstrated a wide range of improvement (10-100%). One study cited showed a reduction in rolling scars from 24.8 to 12.8 (p<0.05).⁵

Kravvas G, Al‐Niaimi F. A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques. Scars Burns Heal. 2017;6:10.1177/2059513117695312.

User Reports

Consistently reported as a crucial and highly effective treatment for rolling and tethered scars.
Many users emphasize it must be done before resurfacing treatments like lasers to be effective.
Success is highly dependent on practitioner skill; users note that an effective procedure should cause significant swelling and immediate lift.
A common complaint is that scars can re-tether over time. Combining subcision with a “spacer” like a dermal filler or collagen stimulator is strongly recommended by users to prevent this and improve results.

The Science

Subcision works by physically severing the fibrotic tethers that anchor the scar to the underlying tissue. This releases the downward tension, allowing the surface of the skin to rise. The procedure also creates a pocket that fills with blood and stimulates a wound-healing response, promoting new collagen formation to support the lifted skin.

Limitations

Common side effects include significant bruising, swelling, and pain for several days to weeks.
A major risk is the re-tethering of scars, which can undo the results.
Effectiveness is highly dependent on the skill and aggressiveness of the practitioner.
Not effective for non-tethered scars like shallow boxcar or ice-pick scars.
Must be avoided if active acne is present in the treatment area.

Expected Time-to-Results

Initial improvement is visible once swelling and bruising subside (1-3 weeks), but final collagen remodeling can take 3–6 months. Multiple sessions may be needed.

Cost

Approximately $400–$2,000 per session in the US. Costs vary widely by location and whether it’s combined with fillers.

Bottom Line

Subcision is an indispensable and highly effective treatment for rolling and tethered acne scars. While it has downtime, its ability to physically release scars is unmatched by other non-excisional procedures. For the best and most lasting results, it should be performed by an experienced provider and is often best combined with a filler to prevent re-tethering.

Other Surgical & Mechanical Procedures

Punch Excision, Grafting & Elevation

What Is It?

A group of minor surgical techniques used for deep, well-defined acne scars. Punch excision removes the scar with a small cookie-cutter-like tool and stitches the skin closed. Punch grafting fills the removed area with a skin graft (often from behind the ear). Punch elevation lifts the base of the scar to be level with the surrounding skin. These are in-office procedures.

Who It’s Best For

Patients with deep, narrow scars like ice-pick and deep boxcar scars that do not respond well to resurfacing treatments like lasers or microneedling.

Effectiveness Rating

Excellent — Considered a definitive and established treatment for the right type of scar, as it physically removes or elevates the scarred tissue.

Evidence Snapshot

Clinical Data

Surgical modalities like punch excision and punch elevation are described in multiple review articles as established and viable treatment options for specific types of acne scars.¹

Boen M, Jacob C. A Review and Update of Treatment Options Using the Acne Scar Classification System. Dermatologic Surgery. 2019;45(3):349-358. doi: 10.1097/DSS.0000000000001765.

User Reports

One user reported a 50% visual improvement just 20 days after a punch graft transplant for a deep ice-pick scar on the nose.
Another user mentioned surgical revision can be a surprisingly affordable option, reporting a cost of $100 per scar from a plastic surgeon.

The Science

These techniques physically alter the scar tissue. Excision removes it entirely, grafting replaces it with healthy skin, and elevation raises the depressed scar floor. This directly addresses the structural problem of the scar in a way that resurfacing techniques cannot.

Limitations

Leaves a small linear scar in place of the original scar (for excision).
Risk of graft failure or textural mismatch (for grafting).
As it is a surgical technique, there are risks of infection and poor wound healing.
Only practical for a limited number of well-defined scars, not widespread scarring.

Expected Time-to-Results

Initial results are visible after healing (1-2 weeks), with final appearance improving over several months as the new scar settles.

Cost

Highly variable, but user reports suggest it can range from $100 to $500+ per scar, depending on the practitioner and location.

Products

This is a surgical procedure performed by a physician.

Bottom Line

For deep ice-pick or boxcar scars, punch techniques are often the most effective and direct solution. While they replace one scar with another, smaller, less noticeable scar, they can provide dramatic improvement where other treatments fail.

Dermabrasion

What Is It?

A surgical skin-resurfacing procedure where a rapidly rotating tool is used to sand away the outer layers of skin. It is more aggressive than microdermabrasion and is used to treat deeper scars and textural issues. This is an in-office procedure requiring anesthesia.

Effectiveness Rating

Good — An established, albeit older, treatment for acne scarring that can produce significant results, but has been largely replaced by lasers due to its significant downtime and risks.

Who It’s Best For

Patients with widespread, shallow-to-moderate depth acne scarring and fair skin. It is generally not recommended for darker skin types due to a high risk of pigment changes.

Evidence Snapshot

Clinical Data

Dermabrasion is cited in reviews as an established and viable treatment option for specific types of acne scars.¹

¹ Basta-Juzbašić A. Current therapeutic approach to acne scars. Acta dermatovenerologica Croatica : ADC. 2010;20887698

When combined with autologous cell suspension (ReCell®), dermabrasion’s wound healing time was significantly reduced (5.27 days vs. 12.30 days for dermabrasion alone, p<0.001) with higher patient satisfaction in one study.²

² Chen Q, Yu N, Liu Z, Zhang W-C, Long F, Zeng A, Zhu L, Wang X. The Clinical Efficacy of ReCell® Autologous Cell Regeneration Techniques Combined with Dermabrasion Treatment in Acne Scars. Aesthetic Plast Surg. 2019 Aug;43(4):1263-1270. doi: 10.1007/s00266-019-01481-8. PMID: 31451856.

The Science

By mechanically removing the top layers of the epidermis and upper dermis, dermabrasion removes superficial scar tissue and stimulates the growth of new, smoother skin as the area heals.

Limitations

Significant downtime is required, with the skin remaining red, swollen, and raw for 1-2 weeks.
High risk of permanent pigment changes (lightening or darkening), especially in darker skin types.
Risk of infection and scarring.
Largely superseded by fractional laser technology, which offers similar results with better safety profiles.

Expected Time-to-Results

Final results are visible after the skin fully heals and redness subsides, which can take 3–6 months.

Cost

$1,500–$4,000+ for a full-face treatment.

Products

This is a surgical procedure performed by a physician.

Bottom Line

Dermabrasion is a powerful but aggressive tool for scar revision that has largely fallen out of favor due to its high risk and long downtime compared to modern fractional lasers. It can be effective but should only be considered after a thorough consultation with an experienced surgeon.

Microdermabrasion

What Is It?

A minimally invasive procedure that gently exfoliates the skin using a fine spray of crystals or a diamond-tipped wand to remove the outermost layer of dead skin cells. It is an in-office procedure available at dermatologist offices and medical spas.

Effectiveness Rating

Very Poor — Strong clinical evidence and user reports agree that this procedure is ineffective for treating atrophic (indented) acne scarring.

Who It’s Best For

Patients looking for a temporary improvement in skin brightness and texture, or mild discoloration. It is not suitable for anyone seeking improvement in indented acne scars.

Evidence Snapshot

Clinical Data

A major study found fractional CO2 laser to be significantly more effective than microdermabrasion for acne scars, with much better scar grade improvements (1.78 vs. 2.62, p=0.0001).¹

Ahmed R, Mohammed G, Ismail NI, Elakhras A. Randomized clinical trial of CO2 LASER pinpoint irradiation technique versus chemical reconstruction of skin scars (CROSS) in treating ice pick acne scars. J Cosmet Laser Ther. 2014;16(1):1-7. doi: 10.3109/14764172.2013.854633. PMID: 24131091

One study noted that after eight sessions of microdermabrasion, 27.3% of patients saw no benefit at all, and only 9.1% achieved “good” results.²

Kravvas G, Al‐Niaimi F. A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques. Scars Burns Heal. 2017;6:10.1177/2059513117695312.

User Reports

One user reported seeing no improvement in atrophic scarring even after multiple sessions of microdermabrasion.

The Science

Microdermabrasion works only on the very surface layer of the skin (the stratum corneum). Since atrophic scars are caused by a loss of collagen in the deeper dermal layer, this superficial exfoliation cannot induce the collagen remodeling needed to improve their appearance.

Limitations

Does not penetrate deep enough to affect scar tissue.
Any perceived improvement is minimal and temporary.
Can be costly for a procedure with no lasting benefit for scars.

Expected Time-to-Results

No significant improvement expected for atrophic scars.

Cost

$100–$250 per session.

Products

This is a professional procedure. At-home kits are available but are even less powerful.

Bottom Line

Do not waste money on microdermabrasion for the treatment of indented acne scars. It is a superficial exfoliation treatment that cannot improve scars that lie deep in the dermis.

Comedone Extraction

What Is It?

The use of a metal tool (comedone extractor) to apply pressure around a blackhead or whitehead to force the contents out. These tools are available OTC for at-home use.

Effectiveness Rating

Very Poor — This is not a treatment for scars and is identified by users as a potential cause of scarring.

Who It’s Best For

This tool is not recommended for at-home use due to the high risk of damaging the skin and causing scars. Professional extraction by an esthetician or dermatologist is a safer alternative.

Evidence Snapshot

User Reports

At least one Reddit user directly attributes the formation of their acne scars to using a comedone extractor at home.

The Science

Improper use of an extractor can apply excessive and uneven pressure on the follicle, causing the follicle wall to rupture beneath the skin. This releases inflammatory contents into the dermis, leading to a more severe inflammatory response, tissue damage, and a higher likelihood of atrophic or hypertrophic scarring.

Limitations

High risk of causing or worsening acne scars.
Can easily damage surrounding tissue and spread bacteria.
Requires proper technique, angle, and pressure, which is difficult for a layperson to achieve.

Expected Time-to-Results

Not applicable. This is a risk factor for scarring, not a treatment.

Cost

$5–$15 OTC.

Products

Widely available from brands like Tweezerman and others on Amazon.

Bottom Line

Avoid using comedone extractors at home to prevent acne scarring. The risk of applying improper pressure and damaging the skin is very high, potentially turning a minor pimple into a permanent scar. Leave extractions to professionals.

Surgery + Radiotherapy

What Is It?

A combination treatment for severe, extensive keloid scars that involves surgically cutting out the scar (excision) followed by a course of low-dose radiation therapy to the area. This is a specialized medical procedure.

Effectiveness Rating

Good — A viable and effective therapeutic option for extensive inflammatory keloid scarring that is resistant to other treatments.

Who It’s Best For

Patients with extensive and inflammatory keloid scars resulting from acne, for whom other treatments have failed. This is a significant intervention reserved for severe cases.

Evidence Snapshot

Clinical Data

A 2021 review on acne treatments identifies surgical excision followed by postoperative radiotherapy as a possible and effective therapeutic approach for extensive inflammatory keloid scarring.¹

Kurokawa I, Layton A, Ogawa R. Updated Treatment for Acne: Targeted Therapy Based on Pathogenesis. Dermatology and Therapy. 2021;11(2):137-157. doi: 10.1007/s13555-021-00552-6. PMID: 34115308; PMCID: PMC8322376.

The Science

Surgical excision physically removes the bulk of the keloid’s excessive scar tissue. However, keloids have a very high recurrence rate after surgery alone. Postoperative radiotherapy helps prevent recurrence by suppressing the overactive fibroblast cells that are responsible for producing the excess collagen that forms the keloid.

Limitations

This is an aggressive treatment reserved for severe cases.
Involves surgery and radiation, with all their associated risks.
Risk of long-term skin changes from radiation.
May not be covered by all insurance plans.

Expected Time-to-Results

Results are visible after surgical healing, with the primary outcome being the long-term prevention of keloid regrowth over many months to years.

Cost

Several thousand dollars, depending on insurance coverage and treatment specifics.

Products

This is a medical procedure performed by surgeons and radiation oncologists.

Bottom Line

For severe, extensive, and treatment-resistant keloid scars from acne, surgical excision combined with radiotherapy is a powerful and effective option to both remove the scar and prevent its return.

Microneedling + Chemical Peel

What Is It?

This approach combines two popular resurfacing treatments: microneedling to stimulate deep collagen and a chemical peel to exfoliate the surface and further enhance results. This is an in-office procedure.

Effectiveness Rating

Excellent — Strong clinical evidence, including a network meta-analysis, identifies this combination as the most effective treatment for acne scars compared to many other therapies.

Who It’s Best For

Patients with atrophic acne scars and associated post-inflammatory hyperpigmentation (PIH) who want to maximize their results from procedural treatments.

Evidence Snapshot

Clinical Data

A network meta-analysis of 24 randomized controlled trials (1546 participants) found that combining microneedling with a chemical peel was the most effective treatment for acne scars in terms of improvement, patient satisfaction, and efficacy.¹

Li H, Jia B, Zhang X. Comparing the efficacy and safety of microneedling and its combination with other treatments in patients with acne scars: a network meta-analysis of randomized controlled trials. Arch Dermatol Res. 2024 Aug 7;10.1007/s00403-024-03256-x.

The Science

Microneedling creates micro-channels that stimulate collagen production in the dermis. Applying a chemical peel (like TCA or Glycolic Acid) either during or between sessions enhances the effect by removing the superficial, damaged skin layers and further stimulating cell turnover and collagen synthesis.

Limitations

Increased downtime, redness, and peeling compared to either treatment alone.
Higher risk of adverse effects like hyperpigmentation if post-care instructions are not followed, especially in darker skin tones.
Requires a skilled practitioner to safely combine these modalities.

Expected Time-to-Results

Visible improvement after 1-2 sessions, with optimal results 3-6 months after completing a series of treatments.

Cost

$500–$1,500+ per combination session.

Products

This is a professional procedure. The type of peel (TCA, Glycolic Acid) will be chosen by the practitioner.

Bottom Line

Based on a powerful meta-analysis, combining microneedling with a chemical peel is one of the most effective strategies available for treating atrophic acne scars. The synergistic effect of deep collagen remodeling and superficial resurfacing leads to superior results.

Microneedling + TCA Peel

What Is It?

A specific type of combination therapy where microneedling is paired with a Trichloroacetic Acid (TCA) peel. TCA is a medium-depth peel that is very effective for scar revision. This is an in-office procedure.

Effectiveness Rating

Excellent — Clinical trials show this combination is significantly more effective than microneedling alone and provides results comparable to some more aggressive treatments.

Who It’s Best For

Patients with atrophic acne scars seeking significant improvement. It is a powerful combination that can be tailored by adjusting the TCA concentration.

Evidence Snapshot

Clinical Data

A split-face trial (n=24) found that microneedling combined with a 15% TCA peel showed significantly greater clinical improvement for atrophic acne scars than microneedling alone (p=0.011).¹

El-Domyati M, Abdel-Wahab H, Hossam A. Microneedling combined with platelet‐rich plasma or trichloroacetic acid peeling for management of acne scarring: A split‐face clinical and histologic comparison. J Cosmet Dermatol. 2018 Feb;17(1):122-129. doi: 10.1111/jocd.12459. PMID: 29226630.

An RCT (n=24) found that four sessions of microneedling with 20% TCA produced a 69.43% mean improvement in atrophic scars, a result comparable to a single deep phenol peel (75.12% improvement).²

Leheta T, Abdel Hay RA, El Garem YE. Deep peeling using phenol versus percutaneous collagen induction combined with trichloroacetic acid 20% in atrophic post-acne scars; a randomized controlled trial. J Dermatol Treat. 2014;25(2):122-6. doi: 10.3109/09546634.2012.674192.

A randomized trial found that combining this therapy with a fractional laser in alternating sessions produced even better results (78.3% improvement) than the combo alone (59.8% improvement, p=0.004).³

Leheta T, Abdel Hay RA, Hegazy R, El Garem YE. Do combined alternating sessions of 1540 nm nonablative fractional laser and percutaneous collagen induction with trichloroacetic acid 20% show better results than each individual modality in the treatment of atrophic acne scars? A randomized controlled trial. J Dermatol Treat. 2014;25(2):112-117. doi: 10.3109/09546634.2012.698249.

The Science

Microneedling triggers deep collagen repair, while the TCA peel causes controlled chemical injury to the epidermis and upper dermis. This dual action removes damaged surface layers and robustly stimulates new collagen and elastin formation, leading to better scar-filling and resurfacing.

Limitations

Significant downtime with redness, swelling, and prominent skin peeling for up to a week.
Risk of post-inflammatory hyperpigmentation (PIH), especially if sun exposure is not strictly avoided.
Not suitable for all skin types; requires an experienced practitioner.

Expected Time-to-Results

Visible improvement after a single session, with best results seen 3-6 months after a series of 3-4 treatments.

Cost

$600–$1,500+ per session.

Bottom Line

The combination of microneedling and TCA peel is a potent, evidence-backed therapy for atrophic acne scars. It offers results that can rival more aggressive procedures, making it an excellent option for those seeking dramatic improvement.

Microneedling + Glycolic Acid Peel

What Is It?

This combination treatment pairs microneedling with a glycolic acid (GA) peel. GA is an alpha-hydroxy acid (AHA) that provides superficial exfoliation, making this a slightly gentler combo than using TCA. This is an in-office procedure.

Effectiveness Rating

Excellent — Clinical studies consistently show this combination is significantly more effective than microneedling or a GA peel alone, especially for patients with darker skin.

Who It’s Best For

Patients with atrophic acne scars, particularly those with darker skin tones (Fitzpatrick types IV-VI) who may be at higher risk for pigmentary side effects from stronger peels like TCA.

Evidence Snapshot

Clinical Data

A study showed combination therapy with microneedling and a GA peel resulted in a 63% mean improvement, significantly greater than microneedling alone (31%).¹

Harris A, Naidoo C, Murrell D. Skin needling as a treatment for acne scarring: An up-to-date review of the literature☆. Int J Womens Dermatol. 2015;1(2):77-81. doi: 10.1016/j.ijwd.2015.03.004.

An RCT found the combination to be significantly more effective than microneedling monotherapy based on ECCA scar scores (39.65 vs 29.58 point reduction, p<.001).²

Rana S, Mendiratta V, Chander R. Efficacy of microneedling with 70% glycolic acid peel vs microneedling alone in treatment of atrophic acne scars—A randomized controlled trial. J Cosmet Dermatol. 2017 Dec;16(4):762-768. doi: 10.1111/jocd.12377. PMID: 29072375.

Studies in patients with dark skin confirm the combination is superior to microneedling alone for both superficial and moderately deep atrophic scars.³

Sharad J. Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin. J Cosmet Dermatol. 2011;10:372-7. doi: 10.1111/j.1473-2165.2011.00583.x. PMID: 22151943.

The Science

Microneedling stimulates collagen deep within the dermis. The glycolic acid peel works on the surface, ungluing dead skin cells, improving texture, and providing a secondary stimulus for collagen production. This two-pronged attack improves both scar depth and skin tone.

Limitations

Can cause more irritation, redness, and peeling than microneedling alone.
Requires strict sun avoidance to prevent hyperpigmentation.
Multiple sessions are required.

Expected Time-to-Results

Noticeable improvement after 2-3 sessions, with full results appearing several months after the final treatment.

Cost

$400–$1,200 per session.

Bottom Line

Microneedling with a glycolic acid peel is a highly effective and evidence-based combination for atrophic scars. It is a particularly strong option for patients with darker skin tones looking for significant scar improvement with a better safety profile than more aggressive peels.

Microneedling + Platelet-Rich Plasma (PRP)

What Is It?

This popular treatment, often called a “vampire facial,” combines microneedling with the application of Platelet-Rich Plasma (PRP). PRP is derived from your own blood and contains concentrated growth factors that enhance healing and collagen production. This is an in-office procedure.

Effectiveness Rating

Good — Strong evidence from multiple studies and a meta-analysis shows that adding PRP to microneedling provides a significant benefit over microneedling alone. However, a few studies found no statistical difference, and user reports are mixed.

Who It’s Best For

Patients with atrophic acne scars who want to boost the results of their microneedling treatments and potentially speed up recovery time.

Evidence Snapshot

Clinical Data

A meta-analysis of 7 studies (n=249) found that adding PRP to primary therapies like microneedling resulted in a significantly higher degree of improvement in atrophic scars (OR = 8.19, p < 0.00001).¹

Hsieh T, Chiu W, Yang T-F, Wang H, Chen C. A Meta-analysis of the Evidence for Assisted Therapy with Platelet-Rich Plasma for Atrophic Acne Scars. Aesthetic Plast Surg. 2019 Sep;43(5):1471-1480. doi: 10.1007/s00266-019-01471-w. PMID: 31506783.

In a large split-face study (n=50), the side treated with microneedling plus PRP showed a significantly greater improvement (62.20%) compared to the side treated with microneedling alone (45.84%; p < 0.00001).³

Mohd Asif, Sanjay Kanodia, Kishor Singh. Combined autologous platelet-rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split-face study. J Cosmet Dermatol. 2016 Dec;15(6):812-820. doi: 10.1111/jocd.12207. PMID: 26748836.

Contradictory evidence exists. A split-face study (n=36) found no statistically significant added benefit of PRP with microneedling for scar count reduction (p=0.094).⁸

Gupta M, Barman KB, Sarkar R. A Comparative Study of Microneedling Alone Versus Along with Platelet-Rich Plasma in Acne Scars. J Cutan Aesthet Surg. 2021;14(1):64–71. doi: 10.4103/JCAS.JCAS_190_20.

User Reports

Users show strong skepticism about the efficacy of PRP for significant scarring, with some attributing perceived improvements in before/after photos to better lighting or reduced inflammation rather than true scar revision.
Some users with mild scarring report good results when combining microneedling with growth factors, which is a similar principle.
Many users who had unsatisfactory results with microneedling alone also had unsatisfactory results when adding PRP.

The Science

Microneedling creates channels into the dermis, allowing the PRP to penetrate deeply. The concentrated growth factors in PRP act as a powerful booster to the body’s own wound-healing response, leading to more robust collagen and elastin production than with microneedling alone.

Limitations

More expensive than standard microneedling.
Involves a blood draw.
The evidence, while mostly positive, is not unanimous, with some studies showing no added benefit.
User skepticism is high regarding its value for money.

Expected Time-to-Results

Visible improvement after 2-3 sessions, with full results 3-6 months after the final treatment.

Cost

$700–$1,500 per session.

Bottom Line

The clinical evidence strongly suggests that adding PRP enhances the results of microneedling for atrophic acne scars. However, given the mixed clinical findings, high user skepticism, and increased cost, its value may be patient-dependent. It appears most beneficial for those looking to maximize results and potentially shorten downtime.

Microneedling + Platelet-Rich Fibrin (PRF)

What Is It?

An advanced version of PRP therapy where microneedling is combined with Platelet-Rich Fibrin (PRF). PRF is also derived from your own blood but is processed differently to create a fibrin matrix that releases growth factors more slowly over time. This is an in-office procedure.

Effectiveness Rating

Excellent — Clinical trials show that combining microneedling with PRF is significantly more effective than combining it with PRP or using microneedling alone.

Who It’s Best For

Patients with atrophic acne scars who want the most powerful growth factor-based enhancement for their microneedling treatment.

Evidence Snapshot

Clinical Data

A split-face trial found PRF with microneedling resulted in significantly greater improvement in atrophic acne scars compared to PRP with microneedling (p=0.003).¹

Diab N, Ibrahim AM, Abdallah A. Fluid Platelet-Rich Fibrin (PRF) Versus Platelet-Rich Plasma (PRP) in the Treatment of Atrophic Acne Scars: A Comparative Study. Arch Dermatol Res. 2022;36520210. doi: 10.1007/s00403-022-02511-3.

In another split-face study (n=40), microneedling with injectable PRF led to a significantly greater reduction in scar grade compared to microneedling with saline.²

Krishnegowda R, Pradhan S, Belgaumkar V. A Split-Face Study to Evaluate Efficacy of Autologous Injectable Platelet-Rich Fibrin With Microneedling Against Microneedling With Normal Saline (Placebo Control) in Atrophic Acne Scars. Dermatologic Surgery. 2023 Aug 10;doi: 10.1097/DSS.0000000000003893. PMID: 37584506.

One study showed that after four sessions of PRF with microneedling, 46.7% of patients achieved ‘excellent’ improvement (>75% reduction in scars).³

Zhu J, Xuan M, Zhang Y, Liu H, Cai J, Wu Y, Xiang X, Shan G, Cheng B. The efficacy of autologous platelet-rich plasma combined with erbium fractional laser therapy for facial acne scars or acne. Mol Med Rep. 2013;8(1):233-240. doi: 10.3892/mmr.2013.1455.

The Science

Like PRP, PRF is rich in growth factors. However, the fibrin matrix in PRF acts like a scaffold, trapping platelets and white blood cells and allowing for a much slower, more sustained release of growth factors over several days. This prolonged stimulation may lead to a more effective and durable healing and collagen-building response compared to the rapid release from PRP.

Limitations

Involves a blood draw.
Even more expensive than microneedling with PRP.
Less widely available than PRP as it is a newer technique.

Expected Time-to-Results

Noticeable improvement after 1-2 sessions, with optimal results 3-6 months after completing a series of treatments.

Cost

$800–$2,000+ per session.

Bottom Line

PRF with microneedling appears to be a superior evolution of the popular PRP treatment. The clinical data suggests it provides a significantly better outcome for atrophic acne scars, making it a top-tier combination therapy for those who can access and afford it.

Subcision + Other Therapies

What Is It?

This describes the common practice of combining subcision with other modalities in the same treatment plan to maximize results. Common additions include PRP, needling/microneedling, chemical peels (TCA CROSS), cryorollers, and suctioning. This is an in-office approach.

Effectiveness Rating

Excellent — The evidence strongly supports that combining subcision with other treatments, particularly a “spacer” like filler or a collagen stimulator like PRP, is more effective than subcision alone.

Who It’s Best For

Virtually all patients undergoing subcision for rolling or tethered scars. The choice of add-on therapy depends on the specific scar characteristics and treatment goals.

Evidence Snapshot

Clinical Data

Subcision + PRP: A split-face study (n=40) showed subcision with PRP demonstrated better improvement in rolling scars than subcision alone.¹

Chilicka K, Rusztowicz M, Szyguła R, Nowicka D. Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review. J Clin Med. 2022 May 1;11(10):2744. doi: 10.3390/jcm11102744. PMID: 35628870; PMCID: PMC9147527.

Subcision + Microneedling + TCA Peel: A study of 49 patients found this triple combination resulted in at least one grade of improvement in 100% of patients, with results sustained at a 1-year follow-up.²

Garg S, Baveja S. Combination Therapy in the Management of Atrophic Acne Scars. J Cutan Aesthet Surg. 2014;7(1):11-7. doi: 10.4103/0974-2077.129964.

Subcision + Cryoroller: This combination showed a significantly greater improvement (57%) compared to subcision with a standard dermaroller (40%).³

Harris A, Naidoo C, Murrell D. Skin needling as a treatment for acne scarring: An up-to-date review of the literature☆. Int J Womens Dermatol. 2015;1(2):77-81. doi: 10.1016/j.ijwd.2015.03.004.

Subcision + Suctioning: A study found that frequent post-subcision suctioning (every other day for 2 weeks) significantly boosted efficacy, with a 71.7% improvement compared to 43.7% for those with irregular suctioning.⁴

Harandi SA, Balighi K, Lajevardi V, Akbari E. Subcision‐suction method: a new successful combination therapy in treatment of atrophic acne scars and other depressed scars. J Eur Acad Dermatol Venereol. 2011;25(1):112-8. doi: 10.1111/j.1468-3083.2010.03711.x.

User Reports

A strong consensus among users is that subcision fails if not combined with a “spacer” (like filler or a collagen stimulator) to prevent the severed scar bands from re-tethering.
Users frequently report successful outcomes from multi-modal plans that start with subcision to release tethers, followed by other treatments like TCA CROSS or lasers to address texture.

The Science

Subcision releases the scar, and the adjunctive therapy enhances the result. Fillers act as a physical spacer to prevent re-tethering. PRP/PRF provides growth factors to boost collagen formation in the new space. Microneedling and peels help remodel the surface texture after the scar has been lifted.

Limitations

Cost increases significantly with each added therapy.
Downtime and risk of side effects can be greater than with monotherapy.
Requires a highly skilled practitioner to sequence and perform the combination treatments correctly.

Expected Time-to-Results

Varies by combination, but typically 3-6 months to see the full benefit from a series of treatments.

Cost

Can range from $1,000 to $5,000+ for a single comprehensive session, or as part of a multi-session package.

Bottom Line

Combining subcision with other therapies is the standard of care for achieving the best results for tethered, rolling scars. The addition of a spacer like filler or a collagen-booster like PRP/PRF is particularly crucial to prevent re-tethering and make the results of subcision permanent.

Cryotherapy

What Is It?

This is an in-clinic procedure where a dermatologist uses extreme cold (usually liquid nitrogen) to freeze and destroy raised scar tissue. It is specifically used for hypertrophic and keloid acne scars. (Professional)

Effectiveness Rating

Good — supported by clinical guidelines as an effective treatment for flattening and reducing raised, thick (hypertrophic and keloid) acne scars.

Who It’s Best For

Patients with raised, firm, or lumpy acne scars (hypertrophic or keloid types), particularly those located on the trunk (chest, shoulders, and back).

Evidence Snapshot

Clinical Data

A 2022 review identified cryotherapy as a promising procedural treatment for hypertrophic acne scars on the trunk.³
Two separate review papers from 2010 and 2017 recommend cryotherapy as a standard procedural treatment for both hypertrophic and keloidal scars.¹˒²

Fabbrocini G, Annunziata M, D’Arco V, Vita V, Lodi G, Mauriello M, Pastore F, Monfrecola G. Acne Scars: Pathogenesis, Classification and Treatment. Dermatology Research and Practice. 2010;2010:893080. doi:10.1155/2010/893080.
Ogawa R. Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular DermisC. Int J Mol Sci. 2017;18(3):606. doi: 10.3390/ijms18030606.
Woo Y, Kim HS. Truncal Acne: An Overview. J Clin Med. 2022;11(13):3660. doi: 10.3390/jcm11133660. PMID: 35806952; PMCID: PMC9267677.

The Science

The extreme cold damages the cells that make up the scar tissue, causing them to die off. This process flattens the scar and reduces its overall volume over time.

Limitations

Risk of skin discoloration (lightening or darkening), especially in darker skin tones.
Not effective for indented (atrophic) acne scars.
Can cause temporary pain, blistering, or swelling at the treatment site.
Multiple treatment sessions are typically required.

Expected Time-to-Results

Visible flattening may occur after 1-2 treatments, with full results seen over a course of several sessions spaced 4-8 weeks apart.

Cost

Approximately $100–$400+ per session; may be covered by insurance if deemed medically necessary.

Products

This is a professional, in-clinic procedure performed by a healthcare provider and is not available as an at-home product.

Bottom Line

Cryotherapy is a well-established and effective professional treatment for tackling raised hypertrophic and keloid acne scars, but it is not suitable for indented scarring and carries a risk of pigment changes.

Cryotherapy + Silicone Gel Sheeting + Pulsed-Dye Laser

What Is It?

A powerful, multi-modal treatment plan combining in-clinic procedures (freezing and laser) with an at-home product (silicone sheets) to treat stubborn raised scars. (Professional/OTC)

Effectiveness Rating

Excellent — recommended in clinical guidelines as a multi-pronged strategy for difficult, treatment-resistant raised scars.

Who It’s Best For

Patients with hypertrophic or keloid scars that have not improved with other treatments, such as corticosteroid injections.

Evidence Snapshot

Clinical Data

A 2021 clinical review recommends this multi-modal therapy (cryotherapy, silicone gel sheeting, and pulsed-dye laser) for hypertrophic or keloid scars that are resistant to first-line treatments.¹

Leung AKC, Barankin B, Lam J, Leong K, Hon K. Dermatology: how to manage acne vulgaris. Drugs Context. 2021;10:11. doi: 10.7573/dic.2021-8-6.

The Science

This approach attacks the scar from multiple angles: cryotherapy freezes and breaks down the dense scar tissue, the pulsed-dye laser targets blood vessels to reduce redness and inhibit scar growth, and silicone sheeting hydrates, protects, and flattens the scar.

Limitations

Requires significant patient commitment for multiple clinic visits and consistent at-home care.
High cost, as it combines multiple expensive procedures.
Potential for side effects from each individual treatment (e.g., discoloration, bruising, skin irritation).

Expected Time-to-Results

Expect a multi-month treatment course, with improvements seen gradually after the first few sessions.

Cost

Can be very expensive, potentially running into thousands of dollars for a full course of treatment. Insurance coverage may be limited.

Products

The cryotherapy and laser are in-clinic procedures. Silicone sheeting is available over-the-counter.

Bottom Line

This intensive combination therapy is a highly effective strategy for tackling the most stubborn and treatment-resistant hypertrophic and keloid scars, but it requires a significant investment of time and money.

Dermal Fillers

Hyaluronic Acid (HA) Fillers

What Is It?

A gel-like substance made of hyaluronic acid, which occurs naturally in the skin, injected to fill in depressed (atrophic) scars by adding volume from underneath. This is an in-clinic, prescription (Rx) procedure.

Effectiveness Rating

Good — provides immediate volume to lift scars and can stimulate some collagen, but results can be temporary and user reports are mixed.

Who It’s Best For

Patients with atrophic (indented) acne scars, particularly rolling or “hill and valley” type scars that would benefit from volume replacement.

Evidence Snapshot

Clinical Data

A novel HA filler with high and low molecular weight complexes showed more pronounced, though delayed, improvement in atrophic acne scars compared to a traditional cross-linked filler.¹
A single session of needle-free HA injection significantly reduced atrophic scar volume at 2 months post-treatment, but not at 1 month.²
Adding cross-linked HA filler to subcision resulted in significantly better improvement in atrophic acne scars compared to subcision alone (p=0.015).³

Mehrabi J, Shehadeh W, Gallo E, Artzi O, Horovitz T. Comparison of 2 Hyaluronic Acid-based Fillers for the Treatment of Acne Scars: Structural Lifting Versus Biostimulatory Effect. Dermatologic Surgery. 2023; doi: 10.1097/DSS.0000000000003789. PMID: 37052609.
Patel T, Tevet O. Effective treatment of acne scars using pneumatic injection of hyaluronic acid. J Drugs Dermatol. 2015;14:e118-20.
Abdelwahab AA, Omar GAE-B, Hamdino M. A combined subcision approach with either fractional CO2 laser (10,600 nm) or cross-linked hyaluronic acid versus subcision alone in atrophic post-acne scar treatment. Lasers Med Sci. 2022;37(12):3677-3688. doi: 10.1007/s10103-022-03677-y. PMID: 36564573; PMCID: PMC9789008.

User Reports

One Reddit user found that adding dermal filler provided immediate lifting of indentations.
Another user reported that Restylane filler only improved their pitted scarring for one week.
One user noted that while the initial plumping from HA in Juvelook injections can fade, the polylactic acid component provides more lasting improvement.
Some users who metabolize fillers quickly reported that HA fillers like Restylane or Radiesse provided only very brief improvement (1-2 months).

The Science

HA fillers physically plump up the skin from beneath, immediately raising the indented scar to be level with the surrounding skin. Some HA formulations also act as biostimulants, encouraging your body to produce its own new collagen for longer-lasting, structural improvement.

Limitations

Results are often temporary (typically 6-18 months).
Risk of lumps or a “donut effect” if injected into a tethered scar without prior subcision.
Temporary swelling can make initial results look more dramatic than the final outcome.
Effectiveness varies based on the specific product used and individual metabolism.

Expected Time-to-Results

Immediate visible improvement, with final results settling in after 2-4 weeks as swelling subsides.

Cost

Approximately $600–$1200+ per syringe; typically not covered by insurance.

Products

Restylane
Juvéderm
Radiesse (Calcium Hydroxylapatite-based)
Juvelook (HA + PLLA, more common in Asia/Europe)

Bottom Line

HA fillers are a reliable and well-studied option for immediately improving the appearance of indented acne scars, especially when combined with subcision. However, the results are temporary and can be costly to maintain.

Poly-L-Lactic Acid (PLLA) Fillers

What Is It?

An injectable biostimulator that works by kick-starting your skin’s natural collagen production to gradually fill in and smooth out indented scars over time. This is an in-clinic, prescription (Rx) procedure.

Effectiveness Rating

Excellent — addresses the root cause of atrophic scarring (collagen loss) for gradual, long-lasting, and natural-looking results, supported by both clinical studies and strong user reports.

Who It’s Best For

Patients with widespread, rolling, or “hill and valley” atrophic scars who are seeking gradual, long-lasting improvement rather than an instant fix.

Evidence Snapshot

Clinical Data

In a Phase II trial, 3 to 4 sessions of PLLA injections led to 45.5% to 68.2% of patients achieving ‘much to excellent’ improvement in ‘hill and valley’ acne scarring.¹
Case reports suggest that a needle-free jet injection method for PLLA is an effective treatment for atrophic acne scars.²

Sapra S, Stewart J, Mraud K, Schupp R. A Canadian Study of the Use of Poly-L-Lactic Acid Dermal Implant for the Treatment of Hill and Valley Acne Scarring. Dermatologic Surgery. 2015;41(5):586-92. doi: 10.1097/DSS.0000000000000366.
Rho NK, Kim HJ, Kim HS, Lee W. Needle-Free Jet Injection of Poly-(Lactic Acid) for Atrophic Acne Scars: Literature Review and Report of Clinical Cases. J Clin Med. 2024;13(2):440. doi: 10.3390/jcm13020440. PMID: 38256575; PMCID: PMC10815974.

User Reports

One Reddit user reported a 70-80% improvement in acne scars from a combination of subcision and Sculptra.
Another user shared that Sculptra improved their scars, with benefits continuing to develop for up to 12 months post-treatment.
A user advised requesting that the vial be spread across multiple facial areas to avoid excessive volume in one spot.

The Science

PLLA particles stimulate your body’s fibroblasts (collagen-producing cells) to create a new collagen framework. This gradually restores volume and structure to the skin, lifting depressed scars from within for a smoother surface.

Limitations

Results are not immediate and appear gradually over several months.
Multiple treatment sessions (typically 3) are usually required.
Requires post-treatment massage to ensure even distribution and prevent nodules.
Improper injection technique can lead to lumps.

Expected Time-to-Results

Initial results may appear after 6 weeks, with optimal improvement seen 4–6 months after the final session.

Cost

Approximately $800–$1,500 per vial, with multiple vials often needed per session. Not covered by insurance.

Products

Sculptra® Aesthetic
Juvelook / Lenisna (PLLA + HA)

Bottom Line

PLLA is an excellent, long-term solution for treating atrophic acne scars by rebuilding lost collagen. It requires patience and a financial investment, but the results are natural, durable, and address the underlying cause of indented scars.

Polymethylmethacrylate (PMMA) Fillers

What Is It?

A permanent, biostimulatory filler containing tiny microspheres suspended in a collagen gel, injected to provide immediate lift and long-term structural support for atrophic scars. This is an in-clinic, prescription (Rx) procedure.

Effectiveness Rating

Excellent — offers a permanent solution for certain types of atrophic scars with a strong evidence base showing high success and patient satisfaction rates.

Who It’s Best For

Patients with moderate to severe, soft, rolling atrophic acne scars who are looking for a permanent, one-time correction and have had a required skin test to rule out allergies.

Evidence Snapshot

Clinical Data

A large randomized trial (n=147) found PMMA injections corrected scars in 84% of participants, compared to 54% in the saline control group (p=0.0003).¹²
In another controlled trial, PMMA had a 64% success rate for correcting moderate to severe rolling scars, significantly higher than the 33% success rate of the saline control (P = .0005).²
An open-label study (n=42) showed 95% of subjects had at least a one-point improvement on the acne scar assessment scale after 7 months.³

Gupta A, Kaur M, Patra S, Khunger N, Gupta S. Evidence-based Surgical Management of Post-acne Scarring in Skin of Color. J Cutan Aesthet Surg. 2020;13(2):124–41.
Karnik JA, Baumann L, Bruce S, Callender V, Cohen SR, Grimes P, Joseph J, Shamban A, Spencer J, Tedaldi R, Werschler W, Smith S. A double-blind, randomized, multicenter, controlled trial of suspended polymethylmethacrylate microspheres for the correction of atrophic facial acne scars. J Am Acad Dermatol. 2014 Jul;71(1):141-8. doi: 10.1016/j.jaad.2014.02.034. PMID: 24725475.
Joseph J, Shamban A, Eaton L, Lehman A, Cohen SR, Spencer J, Bruce S, Grimes P, Tedaldi R, Callender V, Werschler P. Polymethylmethacrylate Collagen Gel-Injectable Dermal Filler for Full Face Atrophic Acne Scar Correction. Dermatologic Surgery. 2019;45(2):226-234. doi: 10.1097/DSS.0000000000001863.

User Reports

One Reddit user reported a “good improvement” in pitted scars after two syringes of Bellafill, justifying repeat treatment.
Another user had a good initial experience with Bellafill, noting firmer, ‘bouncier’ skin with no adverse effects.

The Science

The collagen gel provides immediate lift, while the PMMA microspheres create a scaffold that your body builds its own collagen around. Over time, the initial gel is absorbed, leaving the new collagen structure in place for a permanent correction.

Limitations

The results are permanent and cannot be easily dissolved or removed.
There is a risk of delayed-onset nodules or granulomas (inflammatory lumps).
An allergy skin test is required before treatment.
Technique-dependent; requires a highly skilled and experienced injector.

Expected Time-to-Results

Immediate improvement from the collagen gel, with long-term, permanent results developing over 3-6 months as new collagen forms.

Cost

Approximately $1,000–$1,500 per syringe; not covered by insurance.

Products

Bellafill® (formerly Artefill)

Bottom Line

PMMA filler is the only FDA-approved permanent filler for acne scars and is highly effective for the right candidate (those with rolling scars). While the results are excellent and long-lasting, the permanence requires careful consideration and treatment by an expert injector.

Fat Grafting (Autologous Fat Transfer)

What Is It?

A procedure where fat is harvested from another part of your body (like the abdomen or thighs), processed, and then injected into facial areas to restore volume lost due to severe acne scarring. This is an in-clinic surgical procedure.

Effectiveness Rating

Mixed — can provide significant volume replacement for large-scale depressions, but the unpredictability of fat survival and reabsorption leads to variable outcomes.

Who It’s Best For

Patients with significant, widespread volume loss and deep, soft, atrophic scars, who need more correction than standard fillers can provide.

Evidence Snapshot

User Reports

One Reddit user with severe, cratered scars reported that a fat graft initially improved volume, but an estimated 70-100% of the fat was reabsorbed within two weeks.
Another user found that fat transfer yielded only minimal (10-20%) improvement.

The Science

Injected fat cells provide immediate volume to fill depressed areas. Some of the transferred fat cells establish a new blood supply and survive long-term, while the stem cells within the fat can also help rejuvenate the overlying skin.

Limitations

Unpredictable results; a significant percentage of the transferred fat may not survive and will be reabsorbed by the body.
Often requires multiple sessions to achieve the desired outcome (“overfilling” is common to compensate for reabsorption).
More invasive than other fillers, as it requires a liposuction procedure to harvest the fat.
Potential for swelling, bruising, and lumpiness.

Expected Time-to-Results

Initial volume is seen immediately, but final results are not clear for 3–6 months after the fat has “settled” and reabsorption has occurred.

Cost

Typically $3,000–$7,000+ per session, depending on the extent of the procedure. Not covered by insurance.

Products

This procedure uses the patient’s own fat, so there are no commercial products.

Bottom Line

Fat grafting can be a powerful tool for large-scale volume correction in severe acne scarring, but its outcomes are less predictable than synthetic fillers. It is best considered for significant volume loss when other options are insufficient.

Polyacrylamide and Polyalkylimide Fillers

What Is It?

Synthetic, permanent dermal fillers designed to add volume to the skin. Their use for acne scarring is not well-established. This is an in-clinic, prescription (Rx) procedure.

Effectiveness Rating

Very Poor — there is a lack of clinical evidence to support their use for acne scarring.

Who It’s Best For

Currently, these fillers are not recommended for acne scarring due to a lack of supporting safety and efficacy data for this specific use.

Evidence Snapshot

Clinical Data

A 2017 clinical review concluded that evidence supporting the use of polyacrylamide and polyalkylimide fillers for treating acne scars is currently lacking.¹

Forbat E, Ali FR, Al-Niaimi F. The role of fillers in the management of acne scars. Clin Exp Dermatol. 2017;42(4):354-360. doi: 10.1111/ced.13058. PMID: 28397293

The Science

These fillers work by physically occupying space to provide volume. As they are non-biodegradable, the volumizing effect is intended to be permanent.

Limitations

Lack of evidence for acne scar treatment.
High risk of long-term complications, such as migration, inflammation, and granuloma formation.
Results are permanent and extremely difficult to remove if complications arise.

Expected Time-to-Results

Not applicable due to lack of evidence.

Cost

Varies, but generally not recommended. Not covered by insurance.

Products

Aquamid (Polyacrylamide)
Bio-Alcamid (Polyalkylimide)

Bottom Line

Due to a complete lack of evidence for acne scarring and a known risk of serious, permanent side effects, these fillers should be avoided for this purpose.

Intralesional Medical Injections

Corticosteroid Injections

What Is It?

A targeted injection of a corticosteroid solution directly into a raised (hypertrophic) or keloid scar to reduce inflammation and break down excess collagen. This is an in-clinic, prescription (Rx) procedure.

Effectiveness Rating

Excellent — considered a first-line, gold-standard treatment for flattening and softening raised acne scars, with strong backing from clinical guidelines.

Who It’s Best For

Patients with raised, firm, and often pink or red hypertrophic scars or keloids. It can also be injected into deep, painful acne cysts to quickly reduce inflammation and prevent a scar from forming.

Evidence Snapshot

Clinical Data

Intralesional glucocorticoids like triamcinolone acetonide are a highly recommended (Level I Evidence) treatment for hypertrophic scars and keloids.¹
Corticosteroids are effective for the rapid treatment of deep inflammatory nodules to help prevent subsequent scarring.²
In a study on Asian patients with plaque-type Acne Keloidalis Nuchae, combining intralesional corticosteroids with cryotherapy showed limited efficacy, with plaque reduction in only 43% of patients (3 of 7).³

Yang SA, Lu Z, Lin T, Zhou G, Yao M, Liu Y, Yang RY, Liu Z, Li YH, Li DN, Chen X, Yan SX, Gao L, Sun Q, Cai HR, Liang Y, Xiao RX, Jia X, Chen J, Cai J, Tu CX. Consensus on Treatment of Acne Scars in China (2021). Int J Dermatol Venereol. 2022 Sep;5(3):121-31. doi: 10.1097/JD9.0000000000000229.
Dréno B, Bagatin E, Blume-Peytavi U, Rocha M, Gollnick H. Female type of adult acne: Physiological and psychological considerations and management. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2018;16(9):723-731. doi: 10.1111/ddg.13664.
Na K, Oh S, Kim S. Acne keloidalis nuchae in Asian: A single institutional experience. PLoS One. 2017;12(12):e0189790.

The Science

Corticosteroids reduce inflammation and inhibit the activity of fibroblasts, the cells that produce collagen. This process helps to break down the dense collagen bundles that form a raised scar, causing it to flatten and soften over time.

Limitations

Main risk is over-correction, which can lead to a depressed or atrophic scar (a divot in the skin).
Other side effects include skin lightening (hypopigmentation) and visible tiny blood vessels (telangiectasias) at the injection site.
Multiple sessions, spaced 4-6 weeks apart, are usually necessary.

Expected Time-to-Results

Visible flattening and softening of the scar may begin within 3-4 weeks, with continued improvement after each session.

Cost

Approximately $100–$300 per session; often covered by insurance when medically necessary.

Products

Triamcinolone Acetonide (Brand name: Kenalog®)

Bottom Line

Corticosteroid injections are a highly effective and recommended treatment for flattening existing hypertrophic and keloid acne scars. They are also an excellent preventative measure when used to treat large, inflammatory acne cysts before they have a chance to form a scar.

Fluorouracil (5-FU) Injections

What Is It?

An injection of 5-fluorouracil (5-FU), a chemotherapy agent, directly into hypertrophic or keloid scars to inhibit the rapid growth of scar-forming cells. This is an in-clinic, prescription (Rx) procedure.

Effectiveness Rating

Good — a recognized and effective treatment for raised scars, often used when corticosteroid injections are ineffective or in combination with them.

Who It’s Best For

Patients with hypertrophic scars or keloids, particularly those that have not responded to first-line treatments like corticosteroid injections.

Evidence Snapshot

Clinical Data

Intralesional 5-FU is cited as a procedural option for managing hypertrophic scars on the trunk.¹
A systematic review found that a combination of 5-FU and triamcinolone delivered via jet injection had good efficacy and tolerability for hypertrophic scars.²

Woo Y, Kim HS. Truncal Acne: An Overview. J Clin Med. 2022;11(13):3660. doi: 10.3390/jcm11133660. PMID: 35806952; PMCID: PMC9267677.
Vazula Zulfra Bekkers, Liora Bik, Johanna Catharina van Huijstee, Albert Wolkerstorfer, Errol Prospero Prens, Martijn Bastiaan Adriaan van Doorn. Efficacy and safety of needle-free jet injector-assisted intralesional treatments in dermatology-a systematic review. Drug Delivery and Translational Research. 2023;10.1007/s13346-023-01295-x.

The Science

5-FU is an anti-metabolite that interferes with the DNA synthesis of rapidly dividing cells. In scars, it selectively targets and slows the proliferation of fibroblasts, the cells responsible for producing the excess collagen that creates the raised texture.

Limitations

Common side effects include pain during injection, ulceration, and hyperpigmentation (skin darkening), which can be slow to resolve.
Not recommended for pregnant women.
Often requires multiple treatment sessions.

Expected Time-to-Results

Improvement can be seen over a series of treatments, typically spaced several weeks apart.

Cost

Approximately $200–$500 per session; may be covered by insurance.

Products

Generic 5-fluorouracil for injection.

Bottom Line

Intralesional 5-FU is a strong second-line option for treating tough hypertrophic and keloid acne scars. It is particularly effective when combined with corticosteroids to maximize scar flattening while minimizing side effects.

Bleomycin Injections

What Is It?

An intralesional injection of bleomycin, a chemotherapy agent, used off-label to treat stubborn hypertrophic and keloid scars by breaking down scar tissue. This is an in-clinic, prescription (Rx) procedure.

Effectiveness Rating

Good — a recognized and effective procedural option for raised scars, typically reserved for cases that are resistant to other therapies.

Who It’s Best For

Patients with difficult-to-treat hypertrophic or keloid scars, especially on the trunk, that have failed to respond to corticosteroids or 5-FU.

Evidence Snapshot

Clinical Data

Intralesional bleomycin is recognized in a 2022 clinical overview as a procedural option for managing hypertrophic truncal scars.¹

Woo Y, Kim HS. Truncal Acne: An Overview. J Clin Med. 2022;11(13):3660. doi: 10.3390/jcm11133660. PMID: 35806952; PMCID: PMC9267677.

The Science

Bleomycin is a cytotoxic agent that works by inhibiting DNA and collagen synthesis within the scar. This action halts the overproduction of scar tissue and encourages its breakdown, leading to scar flattening.

Limitations

Potential for significant side effects, including skin atrophy (thinning), hyperpigmentation (darkening), and ulceration.
Due to its potency, it is used in very small doses and requires a highly skilled practitioner.
Not a first-line treatment due to its side effect profile.

Expected Time-to-Results

Visible results can take several weeks to months to appear over a course of treatment.

Cost

Approximately $300–$600+ per session. Coverage by insurance is variable.

Products

Generic bleomycin for injection.

Bottom Line

Bleomycin injection is a powerful but specialized treatment for persistent hypertrophic and keloid acne scars. It should only be considered after first-line therapies have failed and must be performed by an expert dermatologist.

Biologic & Regenerative Injections

Platelet-Rich Plasma (PRP) & Platelet-Rich Fibrin (PRF)

What Is It?

Treatments that use a concentration of your own blood platelets (PRP) or platelets and white blood cells within a fibrin matrix (PRF), which is injected into atrophic scars to stimulate healing and collagen growth. This is an in-clinic procedure.

Effectiveness Rating

Good — clinical evidence shows it is effective for atrophic scars, particularly rolling scars, and superior to some other treatments like TCA CROSS, though best results are seen with combination therapy.

Who It’s Best For

Patients with atrophic acne scars, especially rolling scars, who prefer a natural treatment using their own biological material to stimulate long-term skin remodeling.

Evidence Snapshot

Clinical Data

A trial with 92 patients found three monthly sessions of PRP were significantly more effective for atrophic scars than 50% TCA CROSS (p<0.001).¹
One study found that rolling scars respond better to PRP therapy than boxcar or ice-pick scars.²
Evidence is mixed when comparing PRP and PRF. One study found PRF was significantly superior to PRP based on a quartile grading scale (p=0.008), while another found no significant difference in scar score reduction between the two (p=0.339).³⁴

Mumtaz M, Hassan T, Shahzad MK, Hanif N, Anwar S, Anjum R. Comparing the Efficacy of Intra-dermal Platelet Rich Plasma (PRP) Versus 50% Trichloracetic Acid (TCA) using Cross Technique for Atrophic Acne Scars. J Coll Physicians Surg Pak. 2021;31(1):55-60. doi: 10.29271/jcpsp.2021.01.55. PMID: 33546534.
Nanda S, Chauhan K, Shetty VH, Dashore S, Bhatia S. Platelet-Rich Plasma in Aesthetics. Indian Dermatol Online J. 2021 Nov;12(Suppl 1):S41-54. doi: 10.4103/idoj.idoj_290_21. PMID: 34976880; PMCID: PMC8664171.
Diab N, Ibrahim AM, Abdallah A. Fluid Platelet-Rich Fibrin (PRF) Versus Platelet-Rich Plasma (PRP) in the Treatment of Atrophic Acne Scars: A Comparative Study. Arch Dermatol Res. 2022;36520210. doi: 10.1007/s00403-022-02511-3.
Diab N, Ibrahim AM, Abdallah A. Fluid Platelet-Rich Fibrin (PRF) Versus Platelet-Rich Plasma (PRP) in the Treatment of Atrophic Acne Scars: A Comparative Study. Arch Dermatol Res. 2022;36520210. doi: 10.1007/s00403-022-02511-3.

The Science

Your blood is drawn and spun in a centrifuge to concentrate the platelets. When this “liquid gold” is injected back into the skin, the platelets release growth factors that signal your skin to repair itself by producing new collagen, elastin, and blood vessels, gradually improving scar texture and volume.

Limitations

Results are gradual and not as immediate as fillers.
Multiple sessions (typically 3-6) are needed for best results.
Efficacy can be less dramatic than more aggressive procedures, and it is most effective when combined with treatments like microneedling.
Some temporary swelling, redness, and bruising is expected.

Expected Time-to-Results

Initial improvements in skin texture may be seen in 4-6 weeks, with optimal scar improvement after a full series of treatments (3-6 months).

Cost

Approximately $500–$1,500 per session. Not covered by insurance.

Products

This procedure uses the patient’s own blood and specialized centrifuge equipment.

Bottom Line

PRP and PRF are safe and effective natural options for improving atrophic acne scars by stimulating your body’s own repair mechanisms. For the most significant improvement, it is best used as an add-on to other procedures like microneedling or laser resurfacing.

Biofiller (from Platelet-Poor Plasma)

What Is It?

A filler created from your own blood by taking the platelet-poor plasma (PPP), heating it to form a gel, and then injecting it into atrophic scars for volume. This is an in-clinic procedure.

Effectiveness Rating

Good — emerging evidence shows it significantly reduces the severity of atrophic scars and is a cost-effective option, though more research is needed.

Who It’s Best For

Patients with atrophic acne scars looking for a natural, autologous (from your own body) filler option that is more affordable than synthetic fillers or PRP.

Evidence Snapshot

Clinical Data

In a study of 30 patients, monthly biofiller injections for atrophic acne scars significantly reduced the mean scar severity score from 28 at baseline to 8.2 at final follow-up (p < 0.001).¹
The same study described the procedure as cost-effective.¹

Bhatt M, Jamale VP, Kale M, Hussain A, Nikam B. Monotherapy of Biofiller for Atrophic Acne Scars: A Prospective Nonrandomized Study. Journal of Cutaneous and Aesthetic Surgery. 2022;15(1):1-7. doi: 10.4103/JCAS.JCAS_58_22. PMID: 36561404; PMCID: PMC9764951.

The Science

This technique uses the albumin and fibrinogen proteins in your plasma. When heated, these proteins denature and cross-link, forming a natural gel that can be injected to provide immediate volume, similar to a synthetic filler, but made entirely from your own biological material.

Limitations

Newer technique with less long-term data compared to standard fillers or PRP.
The longevity of the results is not as well-established as synthetic fillers.
Requires blood draw and on-site processing.

Expected Time-to-Results

Immediate volumizing effect, with multiple monthly sessions recommended for best results.

Cost

Described as “cost-effective” in studies, likely less expensive than PRP or synthetic fillers. Unlikely to be covered by insurance.

Products

This procedure uses the patient’s own blood and a heating device to create the gel.

Bottom Line

Biofiller from PPP is a promising, cost-effective, and natural alternative for filling atrophic acne scars. While early results are strong, more research is needed to understand its long-term durability compared to other injectable options.

Adipose-derived Stem Cell Gels (ECM/SVF-gel)

What Is It?

A regenerative treatment where a small amount of your fat is processed to create a gel rich in stem cells and extracellular matrix (ECM/SVF), which is then injected to repair and rebuild atrophic scar tissue. This is an in-clinic surgical procedure.

Effectiveness Rating

Excellent — evidence suggests a single injection can be more effective than multiple laser sessions for certain scar types, with high patient satisfaction.

Who It’s Best For

Patients with moderate-to-severe atrophic acne scars, particularly M-shaped (rolling) and U-shaped (boxcar) scars, seeking significant, long-term improvement from a single treatment session.

Evidence Snapshot

Clinical Data

A single injection was more effective for moderate-to-severe atrophic scars than two sessions of fractional CO2 laser, showing a significantly greater reduction in scar scores at 24 weeks (p<0.001).¹
This gel injection was superior to fractional CO2 laser for treating M-shaped (rolling) scars (p<0.001), but less effective for V-shaped (ice pick) scars (p=0.039).¹
Patients reported significantly higher satisfaction with scar improvement and skin texture after a single injection of the gel compared to two sessions of fractional CO2 laser (p≤0.001).¹

Zhao T, Li M, Wang J, Liu J, Wei J, Liu X, Gao C, Li B. Comparison of the Effects of Adipose Extracellular Matrix/Stromal Vascular Fraction Gel Injection and CO. J Cosmet Dermatol. 2025 Mar 1;24(3):10.1111/jocd.70131.

The Science

This gel contains a high concentration of adipose-derived stem cells (ADSCs) and the structural scaffold (extracellular matrix) from your own fat tissue. When injected, these stem cells differentiate into new skin cells and signal a powerful regenerative response, rebuilding lost collagen and fat to repair scars from the inside out.

Limitations

Requires a mini-liposuction procedure to harvest the fat.
Less effective for deep, narrow V-shaped (ice pick) scars.
As a newer, more advanced procedure, it may be less widely available and more expensive.

Expected Time-to-Results

Significant improvement is noted by 24 weeks (6 months) after a single injection.

Cost

Likely expensive ($4,000+) due to the harvesting and processing steps involved. Not covered by insurance.

Products

This procedure uses the patient’s own fat and specialized processing equipment.

Bottom Line

Adipose-derived stem cell gel is a cutting-edge and highly effective treatment for moderate-to-severe rolling and boxcar acne scars. It offers superior results and patient satisfaction compared to multiple laser treatments in a single session, making it a compelling option for the right candidate.

Cultured Fibroblast Injections

What Is It?

A personalized cell therapy where a small sample of your own skin is taken, the fibroblasts (collagen-producing cells) are grown in a lab over several weeks, and then injected back into your acne scars. This is an in-clinic, prescription (Rx) procedure.

Effectiveness Rating

Mixed — a pilot study showed steady improvement, but the evidence is very limited, and the process is complex and costly.

Who It’s Best For

Patients with depressed acne scars who have not responded to other treatments and are willing to try an advanced, personalized cell therapy.

Evidence Snapshot

Clinical Data

In a small study, three injections of cultured autologous fibroblasts at 2-week intervals resulted in steady improvement of depressed acne scars over a 16-week period.¹

Kim JE, Lee O, Choi J, Son S, Oh C. The Efficacy of Stereoimage Optical Topometry to Evaluate Depressed Acne Scar Treatment Using Cultured Autologous Fibroblast Injection. Dermatologic Surgery. 2011 Sep;37(9):1128-35. doi: 10.1111/j.1524-4725.2011.02046.x. PMID: 21631637.

The Science

By injecting a high concentration of your own active, collagen-producing cells directly into the scar, this therapy aims to replenish the cell population responsible for creating healthy skin structure, thereby filling in depressions with new, organized collagen over time.

Limitations

Very limited clinical evidence.
A lengthy and complex process involving a skin biopsy and weeks of lab cultivation before treatment can begin.
Very expensive due to the laboratory process.
Not widely available.

Expected Time-to-Results

Gradual improvement over a 16-week period following a series of injections.

Cost

Very high, likely in the range of $5,000–$10,000+ for a course of treatment. Not covered by insurance.

Products

LaViv® (azficel-T) is an FDA-approved product of this type for smile lines, not specifically for acne scars.

Bottom Line

Cultured fibroblast injection is an innovative but experimental treatment for acne scars with minimal evidence to support it. Given its high cost and complexity, it is not a practical option for most patients at this time.

Autologous Bone Marrow Stem Cell Injections

What Is It?

An advanced experimental treatment where stem cells are harvested from your bone marrow, processed, and then injected into atrophic acne scars to stimulate tissue regeneration. This is an in-clinic, hospital-based surgical procedure.

Effectiveness Rating

Poor — evidence is based on a single, small pilot study, making it a highly experimental and unproven therapy for acne scars.

Who It’s Best For

This treatment is currently only appropriate within a formal clinical trial setting due to the lack of evidence and invasive nature of the procedure.

Evidence Snapshot

Clinical Data

A pilot study of 14 patients showed that autologous bone marrow stem cell injections led to significant improvement in moderate to severe atrophic acne scars at 6 months, with no significant side effects reported.¹

Ibrahim Z, Eltatawy RA, Ghaly NR, Abd El-Naby NM, Abou El Fetouh HM, Abd Elateef AE, Abdou S, Tahaa A, El Afandy MM. Autologus bone marrow stem cells in atrophic acne scars: A pilot study. J Dermatol Treat. 2015;26(3):218-223. doi: 10.3109/09546634.2014.946379.

The Science

Bone marrow is a rich source of mesenchymal stem cells (MSCs), which have a powerful ability to coordinate tissue repair. When injected into scars, they are thought to signal a profound regenerative cascade, stimulating the formation of new collagen, blood vessels, and healthy tissue.

Limitations

Highly invasive, requiring a bone marrow aspiration procedure.
Extremely limited evidence; its efficacy and safety for acne scars are not established.
Not available as a standard clinical treatment.

Expected Time-to-Results

Improvement was noted at 6 months in the pilot study.

Cost

Extremely high and would only be available in a research context.

Products

This procedure uses the patient’s own bone marrow and specialized medical equipment.

Bottom Line

While theoretically promising, using bone marrow stem cells for acne scars is highly experimental, invasive, and unproven. It is not a recommended or available treatment option outside of a research trial.

PDRN Injections

What Is It?

Injectable treatments derived from salmon DNA, known as Polydeoxyribonucleotide (PDRN), which are purported to promote skin repair and regeneration. This is an in-clinic procedure.

Effectiveness Rating

Poor — while popular in some regions for “skin boosting,” user reports for acne scarring specifically are negative, and there is no clinical data in the provided context to support its use.

Who It’s Best For

Based on the available user reports, this is not currently recommended for treating pitted or atrophic acne scars.

Evidence Snapshot

User Reports

Two Reddit users reported that sessions of PDRN injections resulted in no change for their pitted acne scars.

The Science

PDRN is thought to work by providing the building blocks for DNA synthesis and stimulating specific receptors (A2A) that promote tissue repair, reduce inflammation, and encourage cell growth and blood vessel formation.

Limitations

No clinical evidence provided to support its use for acne scars.
User reports indicate a lack of efficacy for this specific concern.
May be marketed as a general “skin booster” rather than a targeted scar treatment.

Expected Time-to-Results

Not applicable, as user reports showed no results.

Cost

Approximately $400–$800 per session. Not covered by insurance.

Products

Rejuran Healer
Plinest

Bottom Line

Based on user reports and a lack of supporting clinical evidence for acne scarring, PDRN injections do not appear to be an effective treatment for improving atrophic scars.

Other Injectable Therapies

Saline Injections

What Is It?

A simple procedure where sterile salt water (normal saline) is injected into atrophic acne scars to stimulate collagen production through mechanical trauma and pressure. This is an in-clinic procedure.

Effectiveness Rating

Good — a surprisingly effective, safe, and low-cost option for atrophic scars, supported by good quality clinical evidence.

Who It’s Best For

Patients with mild to moderate atrophic scars, particularly boxcar and rolling types, who are looking for a very safe and affordable treatment option.

Evidence Snapshot

Clinical Data

Weekly intradermal saline injections for 12 weeks significantly improved atrophic scar severity, with the proportion of patients having mild scars increasing from 6.1% to 71.4% (p=0.001).¹
A systematic review citing high-quality studies confirmed that needle-free jet injection of saline showed good efficacy for boxcar and rolling acne scars.²
One study found saline injection therapy to be effective for all types of atrophic scars, but patients with mild and moderate scars showed a better response than those with severe scars.³

Ghafoor R, Kaleem S, Khan S. Efficacy of Saline Injection Therapy for Atrophic Acne Scars. J Coll Physicians Surg Pak. 2020;30(4):359-363. doi: 10.29271/jcpsp.2020.04.359.
Vazula Zulfra Bekkers, Liora Bik, Johanna Catharina van Huijstee, Albert Wolkerstorfer, Errol Prospero Prens, Martijn Bastiaan Adriaan van Doorn. Efficacy and safety of needle-free jet injector-assisted intralesional treatments in dermatology-a systematic review. Drug Delivery and Translational Research. 2023;10.1007/s13346-023-01295-x.
Pravangsuk J, Udompataikul M, Cheyasak N, Kamanamool N. Comparison of Normal Saline Injection with Pneumatic Injector to Subcision for the Treatment of Atrophic Acne Scars. J Clin Aesthet Dermatol. 2021;14(5):28-35.

The Science

The injection of saline creates pressure that mechanically breaks up the hardened scar tissue tethering the skin down (a process similar to subcision). This controlled injury, along with the stretching of fibroblast cells, triggers a wound-healing response and stimulates new collagen production to fill in the scar.

Limitations

Requires multiple, regular sessions (e.g., weekly for 12 weeks) to see results.
Improvement is gradual.
May be less effective for severe or very deep scars.
Temporary swelling and bruising are common after treatment.

Expected Time-to-Results

Visible improvement typically requires a full course of treatment over 2-3 months.

Cost

Very low cost, approximately $50–$150 per session. Not covered by insurance.

Products

Sterile normal saline for injection.

Bottom Line

Saline injection is a safe, low-cost, and evidence-backed treatment that can significantly improve mild to moderate atrophic acne scars. Its excellent safety profile and affordability make it a compelling option, especially for those hesitant to try more aggressive or expensive procedures.

Carboxytherapy

What Is It?

A procedure that involves injecting small amounts of medical-grade carbon dioxide (CO2) gas just beneath the skin to improve circulation and stimulate collagen repair. This is an in-clinic procedure.

Effectiveness Rating

Good — clinical evidence shows it is as effective as microneedling for atrophic scars, making it a viable alternative treatment.

Who It’s Best For

Patients with atrophic post-acne scars who are looking for a treatment with efficacy comparable to microneedling. It may also help reduce acne flares when starting isotretinoin.

Evidence Snapshot

Clinical Data

In a split-face study of 32 patients, carboxytherapy was found to be equally effective as microneedling for atrophic acne scars, with no significant difference in clinical improvement (p > 0.05).¹
A small case series (n=10) suggested that adding carboxytherapy at the start of oral isotretinoin treatment may help reduce acne flares and subsequent scarring risk.²

Moftah N, El Khayyat MA, Ragai MH, Alaa H. Carboxytherapy Versus Skin Microneedling in Treatment of Atrophic Postacne Scars: A Comparative Clinical, Histopathological, and Histometrical Study. Dermatologic Surgery. 2018 Oct;44(10):1308-1317. doi: 10.1097/DSS.0000000000001560. PMID: 29846342.
Bagherani N, Mirmomeni G, Smoller BR. Carboxytherapy in management of acne flare in patients with moderate to severe acne vulgaris under treatment with oral isotretinoin: a case series. Arch Dermatol Res. 2025 Feb 22;10.1007/s00403-025-03988-4.

The Science

Injecting CO2 gas creates an oxygen deficit in the tissue. The body responds by dramatically increasing blood flow and oxygen to the area (known as the Bohr effect). This rush of oxygen and growth factors stimulates fibroblast activity, leading to new collagen formation and tissue remodeling.

Limitations

A course of multiple treatments is required.
Can be uncomfortable, with a stinging or pressure sensation during injection.
Temporary swelling and a crackling sensation under the skin (crepitus) are common but harmless side effects.

Expected Time-to-Results

Gradual improvement over a series of sessions, typically spaced 2-4 weeks apart.

Cost

Approximately $150–$400 per session. Not covered by insurance.

Products

This procedure uses medical-grade carbon dioxide gas and a specialized delivery device.

Bottom Line

Carboxytherapy is a solid, evidence-based treatment for atrophic acne scars with effectiveness on par with microneedling. It offers a unique mechanism of action and is a good alternative for patients seeking non-laser, non-filler options.

Key Combination Therapies

Subcision with Fillers

What Is It?

A two-step procedure where a special needle is first used to break up the fibrous bands that tether scars down (subcision), and then a dermal filler is injected into the space created to prevent re-scarring and add volume. This is an in-clinic procedure.

Effectiveness Rating

Excellent — clinical evidence and user reports strongly support this combination, as it addresses both the tethering and the volume loss of atrophic scars for superior results.

Who It’s Best For

Patients with tethered, rolling, or boxcar atrophic scars. The filler helps keep the scar elevated after the restrictive bands have been released.

Evidence Snapshot

Clinical Data

Combining subcision with cross-linked hyaluronic acid filler resulted in significantly greater improvement in atrophic acne scars compared to subcision alone (p=0.015).¹
A review of clinical trials concluded that adding fillers like HA or autologous platelet gel after subcision can improve outcomes and help prevent scar re-depression.²

Abdelwahab AA, Omar GAE-B, Hamdino M. A combined subcision approach with either fractional CO2 laser (10,600 nm) or cross-linked hyaluronic acid versus subcision alone in atrophic post-acne scar treatment. Lasers Med Sci. 2022;37(12):3677-3688. doi: 10.1007/s10103-022-03677-y. PMID: 36564573; PMCID: PMC9789008.
Ahramiyanpour N, Rastaghi F, Parvar SY, Karimi Sisakht A, Hosseini S, Amani M. Subcision in acne scarring: A review of clinical trials. J Cosmet Dermatol. 2022 Oct 31;21(12):4978-4988. doi: 10.1111/jocd.15480. PMID: 36315903.

User Reports

One Reddit user stated that subcision with filler was the most valuable part of their treatment plan.
Another user reported a 70-80% improvement in their scars from a combination of subcision and Sculptra.
Users caution that injecting filler into a tethered scar without subcision can cause a “donut effect,” where the filler puffs up the skin around the scar, making the indent look worse.

The Science

Subcision works by physically cutting the fibrous cords that pull the skin down and create a depression. The filler is then injected to immediately lift the scar base and, more importantly, to act as a physical spacer that prevents these bands from reattaching as the area heals.

Bottom Line

Combining subcision with a dermal filler is one of the most effective strategies for treating tethered atrophic scars. This synergistic approach addresses the two main components of these scars—fibrosis and volume loss—delivering results that are superior to either treatment performed alone.

Radiofrequency (RF) Therapy

Radiofrequency (General)

What Is It?

A professional, non-invasive treatment that uses energy waves to heat the deep layer of your skin (the dermis) to stimulate collagen production. It’s widely used in dermatology for skin tightening and treating various types of scars, including those from acne. (Availability: Rx)

Effectiveness Rating

Good — a well-established technology for collagen remodeling, though more specific types like microneedling RF are often preferred for acne scars.

Who It’s Best For

Patients with mild to moderate atrophic (indented) acne scars who are looking for a treatment with minimal downtime. It is considered safe for all skin types, including darker skin.

Evidence Snapshot

Clinical Data

A review of studies shows radiofrequency is a widely used and effective technology for treating inflammatory acne and acne scars in all skin types.⁷ ⁸
A split-face study found that fractional microplasma radiofrequency (a type of RF) did not cause the post-inflammatory hyperpigmentation that was seen with a fractional CO2 laser, making it a potentially safer option for darker skin tones. ¹
Fractional microneedling RF was found to be more effective than non-microneedling bipolar RF for treating icepick and boxcar acne scars in a comparative study.⁹

Ekelem C, Thomas L, Van Hal M, Valdebran M, Lotfizadeh A, Mlynek K, Mesinkovska N. Radiofrequency Therapy and Noncosmetic Cutaneous Conditions. Dermatologic Surgery. 2019 Jul;45(7):908–930. doi: 10.1097/DSS.0000000000001925.
Krueger N, Sadick N. New-generation radiofrequency technology. Cutis. 2013;91(4):218-22.
Lolis M, Goldberg DJ. Radiofrequency in Cosmetic Dermatology: A Review. Dermatologic Surgery. 2012 Nov;38(11):1765-76. doi: 10.1111/j.1524-4725.2012.02547.x.
Min S, Park SY, Yoon J, Suh D. Comparison of fractional microneedling radiofrequency and bipolar radiofrequency on acne and acne scar and investigation of mechanism: comparative randomized controlled clinical trial. Arch Dermatol Res. 2015 Oct 15;307(9):721-8. doi: 10.1007/s00403-015-1601-z. PMID: 26472097.

The Science

This therapy delivers controlled heat energy to the dermis without damaging the outer skin layer. This heat stimulates cells called fibroblasts to produce new collagen and elastin, which helps to plump and rebuild the skin’s support structure, thereby reducing the depth of scars.

Limitations

Common side effects are temporary and include pain, redness, swelling, and scabbing.
Results can be more subtle compared to more aggressive treatments like ablative lasers or RF microneedling.
Multiple treatment sessions are required.

Expected Time-to-Results

Noticeable improvement typically requires a series of 3-6 treatments, with final results visible 3-6 months after the last session as new collagen forms.

Cost

Approximately $500–$3,000 per session, depending on the device and location. It is considered a cosmetic procedure and is not covered by insurance.

Products

Common professional devices include Thermage®, Pellevé®, and Exilis®.

Bottom Line

Radiofrequency is a safe and reliable option for mild atrophic acne scars, particularly for those with darker skin tones concerned about hyperpigmentation. For more significant scarring, more advanced versions like microneedling RF are likely to provide better results.

Fractional Radiofrequency

What Is It?

A more advanced form of radiofrequency where the energy is delivered to the skin in a grid of tiny, targeted zones, leaving the surrounding tissue intact. This fractional approach promotes faster healing and is used to treat atrophic acne scars. (Availability: Rx)

Effectiveness Rating

Good — clinical studies show high patient satisfaction and effectiveness comparable to some fractional lasers, with potentially fewer side effects.

Who It’s Best For

Patients with mild to moderate atrophic acne scars. Studies suggest it works better for shallower scars and those that are more recent (less than 6 months old).

Evidence Snapshot

Clinical Data

In one study, patients rated their satisfaction with fractional RF treatment for established scars as 3.8 out of 5. ¹
A meta-analysis of studies in Asian patients found no significant difference in scar improvement between fractional RF and fractional laser treatments. ²
In a study of 30 patients, using a higher energy setting resulted in better immediate improvement for atrophic scars (p=0.03), though results were similar between high and moderate energy after 6 months. ³
A study on nanofractional RF found that newer scars responded significantly better; 70.8% of patients with scars less than 6 months old saw >75% improvement, compared to 0% for scars older than 24 months. ⁴

Hamadani F, Vranis NM. The Role of Fractional Radiofrequency in Long-term Acne Remission and Reduction of Acne Scar Load. Aesthetic Surgery Journal. 2025 Feb;45(Supplement_1):S23-S31. doi: 10.1093/asj/sjae150. PMID: 39817790; PMCID: PMC11736774.
Dai R, Xie H, Hua W, Li X-h, Li L. The efficacy and safety of the fractional radiofrequency technique for the treatment of atrophic acne scar in Asians: A meta-analysis. J Cosmet Laser Ther. 2017;19(2):112-118. doi: 10.1080/14764172.2017.1314507
Phothong W, Wanitphakdeedecha R, Sathaworawong A, Manuskiatti W. High versus moderate energy use of bipolar fractional radiofrequency in the treatment of acne scars: a split-face double-blinded randomized control trial pilot study. Lasers Med Sci. 2016;31:229–34. doi: 10.1007/s10103-015-1850-2.
Eubanks SW, Solomon JA. Safety and efficacy of fractional radiofrequency for the treatment and reduction of acne scarring: a prospective study. Lasers Surg Med. 2022;54:74–81. doi: 10.1002/lsm.23453

The Science

By delivering heat in a fractional pattern, this treatment creates microscopic thermal zones deep in the skin. This triggers a robust wound-healing response that boosts collagen and elastin production, resurfacing the skin and smoothing scars from the inside out.

Limitations

Most effective on mild or newer scars.
Multiple sessions are necessary.
Temporary side effects include redness, swelling, and a grid-like pattern on the skin that fades.

Expected Time-to-Results

Expect visible improvement after a series of at least 3 sessions, with optimal results seen 3-6 months after the final treatment.

Cost

Ranges from $750–$2,000 per session. Not covered by insurance.

Products

Professional devices include Venus Viva™ and eMatrix™.

Bottom Line

Fractional radiofrequency is a solid, evidence-based treatment for improving atrophic acne scars, with an effectiveness profile similar to some lasers but often with a better safety profile for darker skin. It is best suited for tackling newer and less severe scars.

Microneedling Radiofrequency (RF Microneedling)

What Is It?

A powerful professional procedure that combines two proven treatments: microneedling (using tiny needles to create micro-injuries) and radiofrequency (delivering heat energy). This dual action stimulates intense collagen production to treat atrophic (indented) acne scars. (Availability: Rx)

Effectiveness Rating

Excellent — strong clinical evidence shows significant improvement in various atrophic scar types, and it is a leading treatment in its category.

Who It’s Best For

Patients with moderate to severe atrophic acne scars, particularly rolling and boxcar scars. It’s also a safe and effective choice for darker skin types (Fitzpatrick III-VI) with a lower risk of pigmentation issues compared to some lasers.

Evidence Snapshot

Clinical Data

In a study of 31 patients, four sessions led to 80.64% of grade 3 and 4 scars improving by two grades on a clinical scale. ¹
A study confirmed the mechanism, showing treatment increases collagen production (TGF-β, collagen I) while reducing inflammatory markers. ³
Multiple studies report high response rates (≥70%) and significant improvement in scar volume, confirmed by 3D imaging (p < 0.001). ⁴ ⁵
A split-face trial (20 patients) showed that combining microneedle RF with sublative fractional RF led to at least moderate improvement in 100% of patients. ⁶

User Reports

Users report a significant risk of facial fat loss or skin sagging if the needle depth is set incorrectly by an inexperienced technician.
3 users expressed concern over this potential side effect, with some noting newer machines like SylfirmX may have better safety features.
Costs are reported to be high and variable, with users citing prices from $550 per session to a $2400 package for 4 sessions.
1 user regretted spending money on microneedling and wished they had opted for a more powerful laser treatment instead.

The Science

The sterile microneedles create precise micro-channels into the skin, and the device then releases radiofrequency heat at the needle tips. This combination of mechanical injury and targeted heat triggers a powerful, controlled healing response deep within the dermis, leading to significant collagen and elastin remodeling that fills in scars.

Limitations

Risk of facial fat loss or worsening atrophy if the procedure is performed by an unskilled operator.
Requires a series of treatments (typically 3-5).
Common side effects include temporary pain, redness, swelling, and pinpoint bleeding or scabbing.
More expensive than standard microneedling.

Expected Time-to-Results

Initial improvements may be seen after 4-6 weeks, but full results develop over 3-6 months as collagen is rebuilt.

Cost

Highly variable, from approximately $550 to over $1,200 per session. Not covered by insurance.

Products

Professional devices include Morpheus8, Potenza™, Secret™ RF, Vivace®, and SylfirmX®.

Bottom Line

RF microneedling is one of the most effective and well-studied energy-based treatments for atrophic acne scarring. Its ability to deliver targeted energy deep into the skin makes it highly effective, but it’s crucial to choose an experienced, specialist provider to minimize the significant risk of improper technique causing fat loss.

Combination Energy Device Therapies

Microneedling RF + Ablative Fractional Laser

What Is It?

An intensive professional treatment that combines two powerful modalities: fractional microneedling radiofrequency (MFR) and an ablative fractional laser (AFL). This is used for significant acne scarring. (Availability: Rx)

Effectiveness Rating

Excellent — clinical data shows this combination is significantly more effective than using an ablative laser alone.

Who It’s Best For

Patients with moderate to severe acne scars who are looking for the most impactful results and are willing to undergo a more intensive procedure with more downtime.

Evidence Snapshot

Clinical Data

In a split-face study, the combination of MFR and AFL was significantly more effective than AFL alone for improving acne scars (p=0.004). ¹
Investigator satisfaction was dramatically higher with the combination therapy, with 91.3% of cases rated ‘much/very much improved’ compared to only 17.9% for the laser alone group (p<0.001). ¹
A study with 71 patients confirmed the combination is an effective treatment for acne scars, significantly improving scar scores after 3 sessions. ²

Kim J, Lee SG, Choi S, Lee J, Lee YI, Kim J, Lee JH. Combination of Fractional Microneedling Radiofrequency and Ablative Fractional Laser versus Ablative Fractional Laser Alone for Acne and Acne Scars. Yonsei Med J. 2023 Dec;64(12):721-729. doi: 10.3349/ymj.2023.0234. PMID: 37992744; PMCID: PMC10681823.
Kim J, Lee YI, Kim J, Jung J, Lee W, Lee JH. Safety of Combined Fractional Microneedle Radiofrequency and CO2 as an Early Intervention for Inflammatory Acne and Scarring Treated With Concomitant Isotretinoin. Dermatologic Surgery. 2020;46(3):392-398.

The Science

This approach tackles scarring from two angles. The RF microneedling delivers heat deep into the dermis to remodel collagen from below, while the ablative fractional laser removes microscopic columns of tissue from the surface, triggering new skin growth and resurfacing the top layer.

Limitations

Increased downtime, redness, and recovery period compared to either treatment alone.
Higher cost due to the use of two advanced technologies.
Higher risk of side effects like hyperpigmentation, especially if post-care instructions are not followed.

Expected Time-to-Results

Visible improvement after the first session, with results continuing to develop for 6 months post-treatment. A series of sessions may be recommended.

Cost

Likely $1,500–$4,000+ per combination session. Not covered by insurance.

Products

This is a protocol combining devices like a Morpheus8 (RF microneedling) and a CO2 laser (e.g., Fraxel Re:pair, AcuPulse).

Bottom Line

For those with significant acne scarring, combining RF microneedling with an ablative fractional laser is a clinically proven, high-impact strategy that delivers superior results to laser treatment alone. The trade-off is higher cost and more significant downtime.

Microneedling RF + Poly-Lactic Acid (PLA/PDLA)

What Is It?

A combination procedure where a professional applies or injects Poly-L-lactic acid (PLLA), a collagen stimulator, immediately after a microneedling radiofrequency treatment. This “treatment stacking” aims to amplify collagen production for better scar improvement. (Availability: Rx)

Effectiveness Rating

Excellent — clinical studies show adding PLA/PLLA to RF microneedling significantly improves scar smoothness, size, and overall appearance compared to RF microneedling alone.

Who It’s Best For

Patients with atrophic (indented) acne scars, particularly those with volume loss, who want to maximize the results from their RF microneedling sessions.

Evidence Snapshot

Clinical Data

A study combining MFRF with topical PLLA showed significantly better scar smoothness (p < .001) and size (p = .003) compared to MFRF with a placebo saline solution. ²
A trial where PDLA was injected via an MFRF device resulted in a 36.99% improvement in acne scar grading after 4 sessions (p < .001). ¹
Patient satisfaction and scar score improvement were higher when topical PLA was added to MFRF compared to MFRF alone. ³

Hyeong JH, Jung JW, Seo SB, Kim H, Kim K. Intradermal Injection of Poly-d, l-Lactic Acid Using Microneedle Fractional Radiofrequency for Acne Scars: An Open-Label Prospective Trial. Dermatologic Surgery. 2022 Dec;48(12):1617-1625. doi: 10.1097/DSS.0000000000003627. PMID: 36449872.
An M, Hong EH, Suh S, Park E, Kim K. Combination Therapy of Microneedle Fractional Radiofrequency and Topical Poly-Lactic Acid for Acne Scars: A Randomized Controlled Split-Face Study. Dermatologic Surgery. 2020;46(6):782-789. doi: 10.1097/DSS.0000000000002175.
Chingshubam B, Sarkar R. Topical management of acne scars: The uncharted terrain. J Cosmet Dermatol. 2023;22(4):1191-1196. doi: 10.1111/jocd.15584.

The Science

RF microneedling creates micro-channels in the skin and stimulates collagen with heat. Applying PLLA (the main ingredient in the filler Sculptra) immediately after allows it to penetrate deeply. PLLA particles then act as a scaffold, providing a long-term signal for your body to build even more of its own collagen over several months.

Limitations

The combination is more expensive than RF microneedling alone.
One study found no significant improvement in scar brightness.
Potential for temporary bumps or nodules if the PLLA is not applied or massaged correctly.

Expected Time-to-Results

Initial improvement from the RF microneedling within weeks, with the full benefit from the PLLA building gradually over 3-6 months.

Cost

Adds several hundred dollars per vial of PLLA to the cost of an RF microneedling session (approx. $1,000–$2,500+ per combo session).

Products

This is a protocol combining an RF microneedling device with a PLLA product like Sculptra® or a topical formulation.

Bottom Line

Adding poly-lactic acid to an RF microneedling treatment is a clinically supported way to boost and prolong collagen stimulation, leading to significantly better improvement in the texture and depth of atrophic acne scars.

Oral Isotretinoin + Energy-Based Devices

What Is It?

A treatment approach where patients undergo energy-based device procedures (like fractional lasers or RF microneedling) while concurrently taking low-dose oral isotretinoin (formerly Accutane). This challenges the old dogma of waiting 6-12 months after isotretinoin to perform procedures. (Availability: Rx)

Effectiveness Rating

Excellent — emerging clinical evidence shows this combination is not only safe but produces superior scar improvement compared to taking isotretinoin alone.

Who It’s Best For

Patients with active inflammatory acne and existing acne scars. This allows for treating both problems simultaneously, potentially preventing new scars while treating old ones.

Evidence Snapshot

Clinical Data

A study showed that patients on low-dose isotretinoin who also received RF microneedling and fractional laser treatments had a significantly greater reduction in their scar scores. ¹
In a randomized trial, combining low-dose isotretinoin with a nonablative fractional laser led to superior scar reduction compared to isotretinoin alone (scar scores improved from 10.4 to 3.5 vs. 10.6 to 5.8, p<0.05). ²
Performing a non-ablative fractional laser for scars within one month of finishing an isotretinoin course was found to be safe and resulted in satisfactory improvement. ³

Kim J, Lee YI, Kim J, Jung J, Lee W, Lee JH. Safety of Combined Fractional Microneedle Radiofrequency and CO2 as an Early Intervention for Inflammatory Acne and Scarring Treated With Concomitant Isotretinoin. Dermatologic Surgery. 2020;46(3):392-398. doi: 10.1097/DSS.0000000000002364.
Yoon J, Park E, Kwon I, Kim C, Lee G-S, Hann S, Kim K, Kim K-J. Concomitant use of an infrared fractional laser with low-dose isotretinoin for the treatment of acne and acne scars. J Dermatol Treat. 2014;25(2):112-6. doi: 10.3109/09546634.2013.768758. PMID: 23336106.
Saluja S, Walker ML, Summers E, Tristani‐Firouzi P, Smart D. Safety of non‐ablative fractional laser for acne scars within 1 month after treatment with oral isotretinoin: A randomized split‐face controlled trial. Lasers Surg Med. 2017;49:886–90. doi: 10.1002/lsm.22711.

The Science

Isotretinoin works by dramatically reducing oil production and inflammation, which halts the formation of new acne lesions. The energy-based device simultaneously works to remodel collagen and repair existing scars. By combining them, you get a powerful two-pronged attack on both active acne and scarring.

Limitations

This is a relatively new protocol that goes against previous safety guidelines, so it must be done under the supervision of a dermatologist who is experienced with this specific approach.
Isotretinoin has significant potential side effects (e.g., dryness, birth defects) that require careful monitoring.
The skin will be more sensitive and dry, requiring meticulous post-procedure care.

Expected Time-to-Results

Improvement in both active acne and scarring can be seen within 2-3 months of starting the combined therapy.

Cost

This involves the cost of a prescription for isotretinoin plus the cost of the energy device sessions (e.g., $800–$2,000+ per session).

Products

This protocol involves a prescription for oral Isotretinoin (brands include Absorica®, Amnesteem®, Claravis®) and a professional energy device.

Bottom Line

Combining low-dose isotretinoin with energy devices is an advanced, effective, and safe strategy for patients struggling with both active acne and scarring. This approach can accelerate results and prevent future scarring, but requires management by a knowledgeable dermatologist.

Other Combination Therapies

The evidence base also highlights other effective combination treatments, including:

Subcision + Matrix-Tunable Radiofrequency: May improve outcomes for deep boxcar scars. In a small study (n=8), this combo led to “excellent” results in 37.5% of patients with this scar type.
Microneedle RF + Sublative Fractional RF: A study of 20 Asian patients showed this combination resulted in at least moderate improvement in 100% of participants, with 70% achieving over 50% improvement.
Microneedle RF + bFGF (Basic Fibroblast Growth Factor): Adding topical bFGF after RF microneedling was found to be significantly more effective for atrophic scars and skin rejuvenation than RF microneedling alone.
Microneedle RF + Topical Insulin: Evidence here is conflicting. While one part of a study showed the combination reduced scar volume, the final analysis found no significant benefit over using RF microneedling with a placebo.
Bipolar RF + Diode Laser: A study found this combination to be a safe and effective method for treating both superficial and deep acne scars.

Other Energy Devices

Electrocautery

What Is It?

A medical procedure that uses a small probe with a controlled electric current to heat and destroy targeted tissue or seal blood vessels. It is sometimes used for small skin lesions or broken capillaries, but is less common for treating atrophic acne scars. (Availability: Rx)

Effectiveness Rating

Mixed — user reports are conflicting for scarring; it may be effective for related issues like facial veins but could be ineffective or worsen redness for certain types of atrophic scars.

Who It’s Best For

Based on user reports, it seems best suited for treating vascular concerns like broken facial veins that can be associated with acne inflammation, rather than indented scars themselves.

Evidence Snapshot

User Reports

1 user reported it successfully treated their facial veins and healed completely without causing any new scarring.
1 user reported it was ineffective for their skin-colored atrophic bumps and suggested it could potentially make redness worse.

The Science

The high-frequency electric current generates heat in the probe’s tip, which is used to precisely burn (cauterize) tissue. For blood vessels, this heat causes them to coagulate and collapse. Its application for atrophic scars is not well-defined.

Limitations

Not a standard or well-studied treatment for atrophic acne scarring.
User reports suggest it may be ineffective or even worsen some scar-related concerns like redness.
Risk of creating new scars or pigmentation changes if not performed correctly.

Expected Time-to-Results

For vascular issues, results can be immediate, with healing taking 1-2 weeks. For scarring, results are uncertain.

Cost

Approximately $100–$500 per session, depending on the area being treated.

Products

This is a professional procedure performed with a hyfrecator or similar electrocautery device.

Bottom Line

Electrocautery is not a primary treatment for atrophic acne scars and evidence for its use is very limited. While one user had a good outcome for related facial veins, another found it ineffective for atrophic bumps. Other energy devices are far more proven for scarring.

Brachytherapy

What Is It?

A form of radiation therapy where a radioactive source is placed directly on or near the area being treated. While commonly used for cancer, superficial brachytherapy is being explored for very severe, treatment-resistant scarring conditions. (Availability: Rx)

Effectiveness Rating

Poor — evidence is extremely limited to a single case report, making it an experimental option for only the most severe cases.

Who It’s Best For

Currently, it has only been documented for a patient with severe, treatment-refractory scarring nodules associated with a rare follicular occlusion syndrome, not standard acne vulgaris.

Evidence Snapshot

Clinical Data

A single case report showed that superficial brachytherapy led to significant improvement for one patient with severe, treatment-resistant scarring nodules. ¹

Paul S, Bach DQ, LeBoeuf N, Devlin PM, Lipworth AD. Successful use of brachytherapy for a severe hidradenitis suppurativa variant. Dermatologic Therapy. 2016;29(6):455-8.

The Science

The localized radiation works by reducing cellular activity and inflammation, and by inhibiting the overactive fibroblast cells that can lead to excessive, abnormal scarring (like keloids or hypertrophic scars).

Limitations

This is not a standard dermatological treatment for acne scars.
Evidence is virtually non-existent for typical acne scarring.
Carries the risks associated with radiation therapy, including long-term skin changes or secondary malignancies, although the risk is low with superficial application.

Expected Time-to-Results

Unknown for typical acne scarring.

Cost

Likely very expensive and only available in specialized hospital or oncology settings.

Products

This is a specialized medical procedure using radiation-emitting equipment.

Bottom Line

Brachytherapy is a highly specialized, experimental treatment that should not be considered for typical atrophic or even hypertrophic acne scarring. Its use is limited to extreme, treatment-resistant cases under specialist oncological and dermatological care.

Lifestyle & Coping Strategies

Weight Gain

What Is It?

An unconventional approach where a person intentionally gains weight to increase overall facial volume, which may help fill out indented scars from underneath. This is a lifestyle choice.

Effectiveness Rating

Very Poor — purely anecdotal with no scientific backing; may offer a slight, cosmetic improvement for some but does not treat the actual scar tissue.

Who It’s Best For

Individuals who are clinically underweight and have widespread atrophic (indented) scars, for whom a general increase in facial fat might be otherwise beneficial.

Evidence Snapshot

User Reports

One Reddit user suggested that gaining weight helped to “plump” their atrophic scars from underneath, making them less prominent.

The Science

Increasing subcutaneous fat can add volume beneath the skin’s surface. This added padding may lift the base of an atrophic scar, potentially making the surface depression less noticeable, but it does not repair or change the scar tissue itself.

Limitations

Not a targeted or reliable treatment for scars.
Results are unpredictable and highly individual.
Carries potential health risks associated with weight gain.
May be undesirable or inappropriate for most people.

Expected Time-to-Results

Dependent on the rate and extent of weight gain.

Cost

Not applicable.

Bottom Line

This is not a recommended or effective strategy for treating acne scars. While a single user noted a cosmetic benefit, it is an unreliable approach with no scientific basis and potential health downsides.

Lifestyle Optimisation (Hydration & Sleep)

What Is It?

Focusing on foundational health habits like getting adequate sleep and staying well-hydrated to improve overall skin health and appearance, which can affect how scars look. This is a lifestyle choice.

Effectiveness Rating

Poor — improves temporary skin plumpness which can mask the appearance of indented scars, but has no permanent effect on the underlying scar structure.

Who It’s Best For

Everyone. While not a treatment, it is a free and easy supportive measure that improves overall skin health and can temporarily reduce the daily prominence of scars.

Evidence Snapshot

User Reports

Users on Reddit report that their atrophic scars appear worse with dehydration or lack of sleep and look better in the morning or when well-hydrated, attributing this to skin “puffiness”.

The Science

Dehydration can reduce skin turgor, making it look less plump and therefore emphasizing surface texture irregularities like scars. Proper hydration and restorative sleep support skin health and can lead to a temporary increase in skin volume, making indentations less obvious.

Limitations

The effect is entirely temporary and cosmetic.
It does not change or heal the actual scar tissue.

Expected Time-to-Results

Changes in appearance can be seen on a daily basis.

Cost

Free.

Bottom Line

This is a valuable supportive habit for overall skin health that can temporarily improve how scars look day-to-day. It should be considered a foundational health practice, not an active scar treatment.

Using Makeup

What Is It?

The application of cosmetic products, such as primers and foundations, in an attempt to conceal or smooth over the appearance of acne scars. This is a cosmetic intervention.

Effectiveness Rating

Mixed — can be effective for covering discoloration (flat red or brown marks), but multiple user reports state it often makes the texture of indented scars look more obvious.

Who It’s Best For

Individuals primarily concerned with the colour of their scars (post-inflammatory hyperpigmentation or erythema) rather than their texture.

Evidence Snapshot

User Reports

Multiple Reddit users reported that makeup, including primers and foundations, paradoxically accentuated the texture of their pitted or “crater” scars instead of concealing them.

The Science

Makeup adds a layer of pigmented product on top of the skin. While this can effectively even out skin tone by covering red or brown spots, the product can also settle into the depressions of atrophic scars, inadvertently highlighting the texture and shadows.

Limitations

Can make indented scars look more prominent.
Is a temporary solution that requires daily application and removal.
Some products may clog pores and worsen acne.
Finding the right product and application technique can be difficult.

Expected Time-to-Results

Immediate cosmetic effect upon application.

Cost

£10–£50+ per product.

Products

For texture-smoothing (primer): Benefit The POREfessional Primer
For coverage (foundation): Estée Lauder Double Wear Stay-in-Place Foundation

Bottom Line

Makeup is a useful tool for temporarily hiding scar-related discoloration but is often counterproductive for textured scars. Success depends heavily on the scar type, product formulation, and application skill.

Psychological Coping Strategies

What Is It?

A behavioural approach focused on mitigating the negative emotional and social impact of scarring by consciously developing self-worth, personality, and hobbies independent of skin appearance. This is a behavioural approach.

Effectiveness Rating

Excellent — does not physically treat scars, but user reports strongly suggest it is highly effective for improving quality of life, confidence, and social success.

Who It’s Best For

Any individual experiencing emotional distress, social anxiety, low self-esteem, or a diminished quality of life because of their acne scars.

Evidence Snapshot

User Reports

Numerous Reddit users with self-described moderate-to-severe scars reported high levels of social, dating, and professional success, which they attributed to a conscious decision to build a personality and hobbies beyond their skin’s appearance.
The psychological impact is highly variable; some with severe scars report it causes panic attacks and poor social outcomes, highlighting the need for coping strategies.

The Science

This strategy shifts an individual’s cognitive focus away from a perceived physical “flaw.” By building confidence and deriving self-worth from internal qualities, skills, and relationships, the emotional power that scars hold over one’s self-perception is reduced.

Limitations

Does not change the physical appearance of scars.
May be very difficult to implement without professional support (e.g., therapy) for those with severe scarring or significant psychological distress.

Expected Time-to-Results

This is a gradual and ongoing process of personal development.

Cost

Free, though it can be significantly enhanced by professional therapy (costs vary).

Bottom Line

This does not treat the physical scars, but it is a powerful and essential strategy for managing the significant psychosocial burden of scarring. User reports indicate that focusing on personal growth is key to improving quality of life.