Laser Treatment for Acne Scars: Which Laser for Which Scar?

The American Academy of Dermatology (AAD) says most people get depressed (sunken) acne scars: ice pick scars are the most common type — small but deep — rolling scars are wide and shallow, and boxcar scars are round or oval depressions wider than ice pick scars.

Raised scars work differently.

The AAD says hypertrophic, keloid and papular scars form when skin makes too much collagen while healing, are more common in people with darker skin tones, and keloids may begin 3 to 12 months after acne clears.

Flat, discolored spots left after a breakout (post-inflammatory hyperpigmentation) are usually not scars at all, per the AAD.

Cleveland Clinic counts acne and chickenpox scars among the concerns that make someone a good candidate for laser resurfacing.

The AAD lists laser resurfacing among the treatments for depressed acne scars — with chemical peels, fillers, topical retinoids or salicylic acid for mild scarring, microneedling, PRP as an add-on, radiofrequency and RF microneedling, and scar surgery — and our acne scar treatment guide covers the full list.

Lasers are not only for depressed scars: the AAD says raised hypertrophic scars may be treated with lasers, corticosteroid or other injections, or prescription topicals, lasers are used for papular scars, and keloids often need combined treatments and can return.

Two AAD points frame everything else: scar type drives the choice (ice pick scars need different treatment than rolling scars), and scar treatment usually begins once active acne is under control.

The AAD also advises telling the dermatologist about every acne treatment used in the last two years, because some scar treatments can cause side effects during or soon after certain acne medicines.

A 2022 international consensus of 24 dermatologists and plastic surgeons from 12 countries concluded energy-based devices are a first-line treatment for many acne scar types, with ablative fractional lasers, non-ablative fractional lasers, vascular lasers and RF devices preferred by most of the panel.

A 2018 systematic review of 59 articles ranks them by trade-off: ablative lasers achieve the highest efficacy, with significant pain, downtime and risk of long-term pigment change; non-ablative fractional lasers are safer but less effective; RF and RF microneedling are slightly less effective still, with an even safer profile.

CO2 lasers are ablative — they remove layers of skin — and ASDS names CO2 and erbium as the two most common resurfacing lasers.

CO2 systems are 510(k)-cleared devices, not FDA-approved; one example, the Candela/Syneron CO2RE fractional system, was cleared in 2018 (K181523) for dermatological procedures requiring ablation, coagulation and resurfacing of soft tissue including skin.

Traditional CO2 treats the whole area uniformly, while fractional CO2 drills many narrow columns and leaves the surrounding skin intact.

The CO2 laser resurfacing guide covers recovery, cost and risks in depth.

Erbium (Er:YAG) is the other of the two.

ASDS describes it for superficial and moderately deep lines on the face, hands, neck and chest, with fewer side effects than CO2, and Cleveland Clinic says erbium may be a better choice for darker skin.

Fraxel is a brand name, not a category.

The current model is the Fraxel FTX (Solta Medical), 510(k)-cleared in August 2024, with 1550 nm and 1927 nm wavelengths.

Solta's stated indications for the 1550 nm wavelength include skin resurfacing for acne scars and surgical scars; the 1927 nm wavelength's listed indications cover actinic keratosis and pigmented lesions such as age spots and sun spots.

Fraxel is prescription-only, and its listed adverse events include blistering and burns, temporary or permanent skin color change, eye injury, infection, keloids and scarring.

The Fraxel guide covers sessions, downtime and who it suits.

The picosecond lasers in our research are PicoSure (Cynosure) and PicoWay (Candela), both 510(k)-cleared Class II laser instruments — cleared, not FDA-approved.

PicoSure's 2 mm and 6 mm handpieces and Focus Array are cleared for acne scars and wrinkles in skin types I–IV, and PicoWay's Resolve fractional handpieces are also cleared for acne scars and wrinkles.

The device families the 2022 consensus panel preferred were ablative fractional lasers, non-ablative fractional lasers, vascular lasers and RF devices — picosecond lasers are not on that list as our source reports it — and we could not find a review quantifying picosecond results for acne scars in our sources.

A dermatologist can tell you what the evidence says for your scar type.

Cleveland Clinic describes resurfacing as an outpatient procedure done under local anesthesia, often with oral or IV sedation, taking 30 to 45 minutes for part of the face and 1.5 to 2 hours for a full face.

Solta says a full-face Fraxel treatment takes 20 to 25 minutes after about 60 minutes of topical numbing.

Session counts depend on the laser and the scar.

Solta says Fraxel results may show after one treatment but that up to five treatments may be appropriate.

The AAD says non-ablative lasers often require a series and results can take months to appear, and a 2023 review of acne scar treatment in skin types IV–VI found non-ablative fractional lasers need more sessions than ablative ones.

A single fractional session may not be the whole answer: in a 28-person split-face trial around the eyes, one fractional CO2 or Er:YAG session reduced wrinkle depth by about 20%, and its authors concluded multiple sessions may be needed.

Downtime is where ablative and non-ablative part ways.

Cleveland Clinic gives up to two weeks of recovery for traditional CO2 and one full week each for erbium and fractional resurfacing, with treated areas generally healing in 5 to 21 days; ASDS puts healing at 3 to 10 days depending on depth and laser, with daily soaks, ointment and re-dressing.

Solta's Fraxel timeline: a sunburn feeling for 1 to 3 hours, flaking and visible laser dots on days 1 and 2, facial peeling usually on days 3 and 4, and redness resolved by about day 15 in its example patient.

Healing is only the first stage.

Cleveland Clinic's course: skin is red, sensitive and sunburn-like at first and may be raw and ooze; around days 5 to 7 it dries and peels; new skin is pink and lightens over 2 to 3 months.

Redness generally fades in 2 to 3 months but can last 6 months to a year.

The same source says skin may keep improving for up to a year and results may last several years, though normal aging brings new wrinkles.

Before treatment, the AAD advises quitting smoking for at least 2 weeks, stopping vitamin E, aspirin and other products that delay healing as directed, stopping retinoid or glycolic acid products for 2 to 4 weeks, and not being treated with a tan or sunburn.

Fraxel's labeling lists keloid tendency, systemic steroids and isotretinoin among its contraindications.

The clearest national figure is not a med spa price.

ASPS's laser skin resurfacing cost page puts the average cost of skin resurfacing procedures like laser skin resurfacing at $1,829 'according to the latest statistics' — a plastic-surgeon fee that excludes related costs such as facility, anesthesia and prescriptions, and one the page does not split by laser or by ablative versus non-ablative treatment.

We found no national med spa average for laser acne scar treatment, and we found no tier-1 or tier-2 national figure for Fraxel either.

The total follows the shape of the plan: which laser, at what depth, and how many sessions it takes — Solta says up to five Fraxel treatments may be appropriate.

Ask providers whether a quoted price covers one session or the course, and what it includes.

Insurance does not help: the AAD says medical insurance does not cover acne scar treatment, and that insurers treat laser scar treatment as cosmetic.

Both are on the AAD's list for depressed scars, and the comparison runs along three lines: effectiveness, downtime and skin tone.

The AAD states microneedling, radiofrequency and RF microneedling are safe for all skin tones, and that RF microneedling can produce less noticeable acne scars than RF or microneedling alone.

The 2018 review put RF and RF microneedling slightly less effective than non-ablative fractional lasers, with an even safer profile — the safer, less-effective end of its ranking.

A 2026 systematic review of RF microneedling (41 studies, 15 randomized trials) came at the comparison from the other side: it consistently reduced atrophic acne scar scores with efficacy comparable to fractional lasers, with mostly redness, swelling and transient pain, and infrequent, self-limited hyperpigmentation.

Skin tone is a real dividing line in these sources.

ASDS and Cleveland Clinic say people with active acne or very dark skin usually are not good candidates for ablative resurfacing; the 2023 skin-of-color review calls non-ablative fractional lasers first line in skin of color for their better safety profile, though they are less effective and need more sessions.

Microneedling's evidence base, sessions and cost are in our microneedling guide.

Which fits is a scar-by-scar question — the AAD's point that ice pick and rolling scars need different treatments — and it is one for a licensed provider to answer for your skin.