Acne Scar Treatment: Which One Works for Your Scar Type?

The short answer

The best acne scar treatment depends on the type of scar, because each type sits at a different depth in the skin. Rolling and boxcar scars respond best to microneedling, which reaches the dermis where they sit. Ice pick scars are narrow and deep, and are usually treated one at a time with a procedure such as TCA CROSS or punch excision at a medical clinic. Raised scars need injections or laser. And the flat brown or red marks that most people call acne scars are not scars at all: they fade on their own, and surface treatments speed that up.

Scarring is common. About 5.6 million Canadians have acne, including 20 to 30 per cent of adults aged 20 to 40, according to the Canadian Dermatology Association. A 2023 review of 37 studies covering 24,649 patients found that 47% of people with acne had acne scars, and that severe acne carried 5.5 times the odds of scarring that mild acne did. As a rough guide, that puts the number of Canadians living with some acne scarring in the order of 2.6 million.

Scar or mark? Work out which kind you have

Before choosing a treatment, it helps to know what you are treating. Three checks in front of a mirror get most people most of the way there:

1. Side light. Stand with light coming from one side; a phone torch held flat to the skin works. Indented scars cast a small shadow. Flat marks do not.
2. Stretch. Gently stretch the skin either side of the scar between two fingers. Rolling scars soften or almost disappear. Boxcar and ice pick scars stay.
3. Press. Press a clear glass against a red mark. Redness from blood vessels fades while the pressure lasts. Brown pigment does not change.

Acne scar types, and what works for each

Indented scars, where tissue was lost as a spot healed, outnumber raised scars by about three to one. They come in three shapes, set out in a 2001 classification that is still the standard reference, and the shape decides the treatment. One widely cited review estimates that ice pick scars make up 60 to 70% of indented acne scars, boxcar scars 20 to 30% and rolling scars 15 to 25%. These are estimates, and many people have more than one type.

Ice pick scars

Indented · under 2 mm across · very deep

Ice pick scars are narrow pits, under 2 mm across, that run straight down into the deep dermis or below, like a deep, open pore. Their depth is below what conventional resurfacing reaches, which is why they are the hardest type to improve with any treatment applied across the whole face.

They are usually treated one scar at a time. TCA CROSS places a high-strength acid into each pit so that it heals shallower; punch excision removes the scar and closes the skin with a stitch or two. Both are done at medical clinics. Microneedling responds less predictably here than on other types, but it can improve the texture around ice pick scars once the deepest pits have been dealt with.

At Femme: we will tell you at consultation if we expect microneedling to make a meaningful change to your ice pick scars, and if another approach would suit you better.

Boxcar scars

Indented · 1.5 to 4 mm across · shallow or deep

Boxcar scars are round or oval depressions with sharp, vertical edges, similar to chickenpox scars, and most are 1.5 to 4 mm across. They can be shallow, 0.1 to 0.5 mm deep, or deep, at 0.5 mm or more.

Shallow boxcar scars sit within reach of resurfacing, and microneedling is one of the more effective options for them: it creates controlled micro-injuries in the dermis that prompt new collagen to lift the floor of the scar from underneath. Deeper boxcar scars respond more slowly, and the deepest may need punch elevation or excision at a medical clinic before resurfacing.

At Femme: microneedling at 1.0 to 2.0 mm, the depth our protocol sets for scar tissue, planned as a course of six or more sessions.

Rolling scars

Indented · wider than 4 to 5 mm · tethered from below

Rolling scars are broad, shallow dips, usually wider than 4 to 5 mm, that give the skin a wavy look, most obvious in side light. Bands of fibrous tissue tether the skin to the layer underneath and pull the surface down, which is why rolling scars soften when you stretch the skin.

The tether is the problem. Microneedling worked in vertical, horizontal and diagonal passes loosens the bands and rebuilds collagen, and rolling scars are among the types that respond best to it. Where the tethering is strong, subcision, a medical procedure that releases the bands with a needle passed under the skin, is often done first, with microneedling afterwards to rebuild the surface.

At Femme: microneedling in multiple directions, at scar depth. See microneedling for acne scars for the full protocol.

Raised scars

Raised · hypertrophic or keloid

Hypertrophic scars are firm, raised bumps that stay within the area of the original spot; keloids grow beyond it. Both form when the skin lays down too much collagen while it heals, which is the opposite problem to an indented scar.

The usual treatments are corticosteroid injections, silicone gel or sheeting, and laser, at a dermatology clinic.

At Femme: we do not treat raised scars, and a history of keloids rules out microneedling, because skin that forms keloids may respond to controlled injury in ways you would not want.

Brown or grey marks: not a scar

Flat · post-inflammatory hyperpigmentation

Flat brown, grey or dark marks are post-inflammatory hyperpigmentation, or PIH: pigment the skin over-produced while a spot healed. There is no change to the skin’s structure, only to its colour, and PIH fades on its own, often over many months and sometimes over a year. Deeper skin tones are more prone to it.

Daily SPF comes first, because sun exposure keeps restarting the clock. Chemical peels and bio microneedling speed up the turnover of the pigmented surface layer; a course of peels is usually four to six sessions, three to four weeks apart. More in our hyperpigmentation treatment guide.

At Femme: chemical peels and bio microneedling, each offered at nine of our Ontario clinics.

Red or purple marks: not a scar either

Flat · post-inflammatory erythema

Flat red, pink or purple marks are post-inflammatory erythema, or PIE: small blood vessels left dilated by the inflammation, rather than pigment. Pressing a clear glass against one makes it fade while the pressure lasts, which a brown mark does not. PIE is more common on lighter skin, and it fades with time.

Sun protection, gentle skincare and patience are the basics, and picking or scrubbing keeps the inflammation going. Treatments that clear pigment do little for redness. The in-clinic option is a vascular laser at a dermatology clinic.

At Femme: we do not offer vascular laser, and we will tell you if we think redness is the main thing you are seeing.

How deep each scar sits, and what reaches it

Depth below the skin surface, in millimetres. Scar depths from the 2001 classification; treatment depths from our protocol and SQT’s published spicule length. Approximate and simplified.

Treatments

Hydro facialSurface only

Chemical peelWithin the epidermis, the outer layer

Bio microneedlingSpicules about 0.2 mm long

Microneedling, scar depth1.0 to 2.0 mm, into the dermis

Scars

Shallow boxcar0.1 to 0.5 mm

Deep boxcar0.5 mm and deeper

RollingShallow dip, tethered from beneath the dermis

Ice pickTo the deep dermis or below

0 mm0.51.01.52.02.5+

Microneedling at scar depthSurface treatmentsWhere the scar sits

That is the whole argument in one picture. A peel or a hydro facial works at the surface, so it can even out colour but cannot lift the floor of a scar. Bio microneedling’s spicules are about a fifth of a millimetre long. Microneedling at scar depth reaches 1.0 to 2.0 mm, into the dermis where boxcar and rolling scars sit. Ice pick scars, and the tethers under rolling scars, go deeper still, which is why they are often treated individually first.

Acne scar treatments compared

Combinations are common, and often work better than any single treatment: subcision or TCA CROSS for the scars that need individual work, then a microneedling course for the overall texture, with a peel or bio microneedling for the marks. If you have both scars and pigmentation, our chemical peel vs microneedling guide covers how the two fit together.

Why microneedling is the core treatment for indented scars

Microneedling creates controlled micro-channels in the dermis. The skin treats each one as a small wound and lays down new collagen as it repairs, which gradually lifts the floor of an indented scar from underneath. How that works in detail is in what microneedling does to your skin.

The evidence is reasonably good. In a randomised split-face trial published in JAMA Dermatology in 2014, three needling sessions two weeks apart improved scar scores on the treated side of the face compared with the untreated side, and the improvement was only statistically clear at six months, not at three. A 2026 analysis that pooled 17 studies found no significant difference between needling and fractional CO2 laser in overall scar-score improvement; the laser more often met the studies’ threshold for success, but carried a significantly higher risk of post-inflammatory hyperpigmentation than standard microneedling. The American Academy of Dermatology describes microneedling as safe for all skin tones, which is a real advantage over heat-based resurfacing for deeper skin.

At Femme, every scar session uses the Dr. Pen A20, a motorized pen with sterile single-use cartridges, at 1.0 to 2.0 mm, the depth our protocol sets for scar tissue, in vertical, horizontal and diagonal passes. Numbing cream is applied first and given time to work. The appointment starts with mapping which scar types you have, because they respond differently. A course for acne scarring is planned as six or more sessions, spaced four to six weeks apart.

Add-ons. PRP and PRF, made from a small draw of your own blood, can be applied through the channels at nine of our Ontario clinics and are priced separately; see PRP and PRF. PDRN is the option most often chosen alongside scar work. Exosomes are offered at eight clinics, but the evidence for them is still early, and PRP is the better-established choice. Not every add-on is offered at every clinic, so ask when you book.

Six sessions are two three-session packages. Prices are the same at every clinic. How that compares with other Canadian clinics, and a planner for your own course, are in our microneedling cost guide.

Treat the acne before the scars

New breakouts make new scars, so the order matters.

• Standard microneedling waits until the skin is clear. Needling across active breakouts can spread bacteria and worsen inflammation, so scarring is treated once the skin has settled.
• Bio microneedling does not have to wait. Its acne treatment formulation, with a zinc ferment to help regulate sebum and ingredients aimed at the bacteria inside a blocked follicle, is used on active, inflamed breakouts as well as on the marks they leave. It is $250 a session, or $675 for three, plus HST, at nine Ontario clinics. It does not reach established scars, which is the job of standard microneedling afterwards.
• Deep, painful acne needs a doctor first. If you have deep, painful lumps that last for weeks, or acne that is already scarring, see a doctor or dermatologist before anything cosmetic. It is the type most associated with scarring, and prescription treatment started earlier reduces that risk. Our guide to getting rid of acne covers what helps at each stage, and if breakouts arrive monthly along the jaw, see hormonal acne.
• Do not squeeze deep spots. Pressing a deep lesion pushes its contents further into the skin and raises the chance of a permanent scar.
• Isotretinoin. If you have taken isotretinoin (Accutane) recently, tell us at consultation. Most practitioners wait before needling, because the skin heals differently.

What will not fix an indented scar

Creams and serums. A retinoid or salicylic acid can make mild scarring and marks less noticeable over months, but no product applied to the surface reaches the dermis where an indented scar sits.

Hydro facials. A hydro facial makes skin look its best on the day. It maintains rather than corrects, and it does not reach scar tissue.

Chemical peels on their own. Peels are the strongest option for brown marks and uneven tone, but the peels a clinic offers work at the surface and do not fill an indented scar. Deep peels are a different category, done under medical supervision.

Laser hair removal. Our FEMME 4D laser targets the pigment inside the hair follicle. It is a hair removal laser, not a resurfacing laser, and it does nothing for scars.

How long acne scar treatment takes

• After each session: redness similar to mild sunburn for 24 to 48 hours. Skin looks brighter within the first week, which is surface recovery rather than the real result.
• Between sessions: the collagen remodelling that changes a scar happens over roughly four to twelve weeks, which is why sessions are spaced four to six weeks apart.
• The course: six sessions with four to six weeks between them take about five to seven months from the first to the last.
• Judging it: look again a few months after the final session. In the trial above, the improvement was only statistically clear at six months.
• Afterwards: most people maintain with a session every six to twelve months, because the treatment stimulates your own collagen and your skin continues to age normally.

The realistic goal is scars that are clearly shallower and catch less light, not skin with no trace of them. Recovery after each session is covered in our microneedling aftercare guide, what the treatment feels like in does microneedling hurt, and realistic outcomes in microneedling before and after.

Questions we hear about acne scar treatment

Prefer to talk first? Call 647-229-7397. Every price is on our pricing page, and the treatment itself is explained in our microneedling guide.

Sources

1. Canadian Dermatology Association. Acne.
2. Liu L, Xue Y, Chen Y, et al. Prevalence and risk factors of acne scars in patients with acne vulgaris. Skin Research and Technology, 2023.
3. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. Journal of the American Academy of Dermatology, 2001.
4. Fabbrocini G, Annunziata MC, D’Arco V, et al. Acne scars: pathogenesis, classification and treatment. Dermatology Research and Practice, 2010.
5. Alam M, Han S, Pongprutthipan M, et al. Efficacy of a needling device for the treatment of acne scars: a randomized clinical trial. JAMA Dermatology, 2014.
6. Batool A, et al. Comparing fractional CO2 laser and needling-based modalities in facial acne scar treatment: a systematic review and meta-analysis. Lasers in Medical Science, 2026. Summary by EMJ.
7. American Academy of Dermatology. Acne scars: consultation and treatment.