What Is the Best Treatment for Acne Scars? Lasers, Microneedling, Peels and Fillers Compared

No. A 2016 Cochrane review of 24 trials (789 adults) found a lack of high-quality evidence on which acne scar treatments are most effective and safe, and a 2025 network meta-analysis of 68 randomized trials (4,480 patients) ranked combination treatments, not any single device, on top.

The American Academy of Dermatology (AAD) builds the plan from the scar type, the number and age of the scars, your skin tone and your budget — and often combines more than one treatment.

Two things come before the device choice.

Scar treatment typically begins once active acne is under control, and AAD says your provider should know every acne treatment you have used in the last two years, because some scar treatments during or soon after certain acne medicines cause side effects.

Expect improvement rather than erasure: scars can fade but rarely go away completely on their own, and laser treatment replaces one scar with a less noticeable one rather than removing it.

One check first: flat red, pink, brown or bluish-gray marks left after acne are usually post-inflammatory hyperpigmentation (PIH), not scars, and PIH usually fades over time.

That is a different problem from the depressed scars compared here.

If you are still working out which type you have, our acne scars treatments overview covers the types and causes.

AAD says ice pick scars need different treatment than rolling scars, but the AAD guidance we reviewed names no best device for a given scar type — the match is made clinically.

What the sources give you is a menu for depressed scars: chemical peels, fillers, laser resurfacing, microneedling, radiofrequency and RF microneedling, PRP as an add-on, scar surgery (including surgically lifting a scar) and dermabrasion, with a topical retinoid or salicylic acid for mild scarring.

Microdermabrasion is not a scar treatment on that list — AAD says it will not treat acne scars, though dermatologists use it to even out skin tone.

Depth is what separates the types.

Ice pick scars look small but go deep into the skin — AAD calls them the most common type of acne scar.

Rolling scars are wide and shallow, giving a wavy look, and boxcar scars are round or oval depressions between the two in width.

Raised scars are a different problem entirely: hypertrophic, keloid and papular scars come from too much collagen, are more common in darker skin tones, and keloids grow larger than the original breakout, usually starting 3 to 12 months after acne clears.

Two menu items are tied to specifics.

Subcision — AAD's term for surgically freeing a depressed scar from the tissue beneath it, so the skin rises — is described by AAD as scar surgery done under local anesthesia in a medical office or outpatient center; whether a nurse or other non-physician at a med spa may perform it is a state scope-of-practice question we could not confirm a general answer to, so ask who will perform it and check your state's rules.

And one filler, Bellafill, is FDA-approved for moderate to severe, atrophic, distensible facial acne scars on the cheek in patients over the age of 21 — a narrow wording that not every scar will fit.

The acne scar treatment overview walks through each option on this menu in depth.

A 2018 systematic review of energy-based acne scar treatments compared the classes directly: ablative lasers — such as the CO2 laser — achieve the highest degree of efficacy, but with significant pain, downtime and risk of long-term pigment change; non-ablative fractional lasers are safer but less effective; and RF and RF microneedling come in slightly below non-ablative fractional lasers on effectiveness with an even safer profile.

A 2022 international consensus panel of 24 dermatologists and plastic surgeons put energy-based devices — ablative fractional lasers, non-ablative fractional lasers, vascular lasers and RF devices — among the first-line treatments for many acne scar types.

Then check what each device is actually cleared for, because the wording differs.

Solta lists acne scars among the skin-resurfacing indications for the Fraxel 1550 nm wavelength.

Sofwave holds a 510(k) clearance (K250146, cleared 18 April 2025) that lists treatment of acne scars.

The Morpheus8 90 applicator's 510(k) (K240017, cleared 13 June 2024), by contrast, is a general clearance for dermatological procedures needing coagulation or contraction of soft tissue or hemostasis — it does not list acne scars, wrinkles or fat, and at energies above 62 mJ/pin it is limited to skin types I-IV.

A use that is not on the clearance is not a cleared use; the Morpheus8 and RF microneedling hubs go deeper on their clearances.

Plain microneedling is the low-tech member of this group.

AAD says microneedling with PRP (platelet-rich plasma) for acne scars may need 3 to 5 treatments given every 2 to 4 weeks, and that studies found that plan can fade acne scars by 50% to 70% — a study range, not a result any one person is promised.

Recovery is measured in days: redness (or darkening on darker skin), a sunburn-like feeling and swelling usually clear in a few days to a week, and makeup waits 24 hours.

AAD says to postpone microneedling with a tan or recent sun, a skin infection or painful deep pimples, and until at least one month after the last isotretinoin dose; it says the treatment should be avoided by people who heal poorly, have keloids, are immunosuppressed, or are getting radiation or skin cancer treatment in the area.

A chemical peel resurfaces from the top down.

For acne scars, AAD describes mild peels as often a plan of 3 to 5 treatments given every 2 to 4 weeks, usually after 2 to 4 weeks of at-home pre-peel priming, and healing time scales with depth: a light peel heals in 1 to 7 days, a medium peel in 7 to 14 days with swelling and crusting, and a deep peel in 14 to 21 days with 2 to 3 weeks at home and 3 to 6 months of total sun avoidance.

Peels also appear in the combinations the evidence ranks highest — in the 2025 meta-analysis, laser combined with chemical peeling ranked best for patient satisfaction.

Dermal fillers work from below, raising the depressed scar rather than resurfacing around it.

Bellafill — PMMA microspheres in bovine collagen — is the filler FDA-approved for acne scars (PMA P020012/S009, approved 23 December 2014), and its acne scar indication covers only moderate to severe, atrophic, distensible facial acne scars on the cheek in patients over the age of 21; it is a permanent, non-absorbable filler. Hyaluronic acid fillers hold no acne scar approval, so using them in scars is off-label — not on any current US label for those products.

FDA also says filler safety is unknown in people prone to keloids or hypertrophic scars, and that filler should be delayed while there is active acne, rash or infection.

Subcision belongs to the surgical column rather than the device column, for the reasons in the section above.

And if a practice offers exosome serums as a microneedling add-on: FDA says there are currently no FDA-approved exosome products.

Skin tone changes the ranking.

A 2016 review found that in Fitzpatrick types IV-VI, traditional resurfacing — dermabrasion, peels and lasers — carries a higher risk of pigment change and scarring, and microneedling may offer a more favorable safety profile.

A later review considers non-ablative fractional lasers first line for acne scars in skin types IV-VI because of their better safety profile, though they are less effective and need more sessions than ablative lasers; the same review describes RF microneedling data in darker skin as limited but promising.

AAD describes microneedling, radiofrequency and RF microneedling as safe across all skin tones, while noting the RF microneedling studies it cites included a small number of people with darker skin tones.

Three cautions from the sources.

Pigment risk with lasers depends on the phototype, the device, the fluence and especially the density settings, and a 2026 systematic review found post-inflammatory hyperpigmentation was the most common facial laser complication — particularly in Fitzpatrick IV-VI, and ablative lasers (CO2, Er:YAG) carried the highest risks of scarring and infection. Chemical peels can cause permanent pigment problems without experience in darker skin, though AAD says people with skin of color can have peels safely with an experienced dermatologist.

And device labels can set their own limits: above 62 mJ/pin, the Morpheus8 90 applicator is limited to skin types I-IV.

Insurance generally does not cover acne scar treatment or laser scar treatment — insurers treat both as cosmetic — so the plan's price is what you pay.

None of the sources reviewed for this page gives a national dollar figure for acne scar treatment, and prices vary by practice and city; because several of these options come as a series, ask each practice to price the full plan, not a single session.

Laser plans also stretch the calendar before treatment: AAD says a laser cannot be used on tanned or sunburned skin, and dermatologists advise stopping smoking for at least 2 weeks before laser treatment and stopping retinoid or glycolic acid products for 2 to 4 weeks before.

The 2025 network meta-analysis is the clearest signal: across 68 randomized trials and 4,480 patients, laser combined with PRP or with filler injections ranked best for reducing scar severity, and laser combined with chemical peeling ranked best for patient satisfaction.

Microneedling was the most tolerable option for pain, and no treatment clearly lowered the risk of redness or post-inflammatory hyperpigmentation against the others.

That is a ranking of averages across trials — not a result any one person is promised — and it points the same way AAD does: plans often combine more than one treatment, matched to the scar types a provider finds.

Start with the consultation, not the device.

AAD's warning about laser scar treatment applies across this page: if someone promises to treat your scar before providing a medical consultation, walk away.

AAD also says at-home microneedling and microneedling at a non-medical spa are not meant to puncture the skin, give less noticeable results, and risk infection, scarring and color change.

AAD's list of questions to ask before a cosmetic procedure works as a vetting script: Is the provider board-certified? (For a physician, that means certification by an ABMS member board, which you can check free at CertificationMatters.org.) How many times have they done this exact procedure?

How often do they treat patients with your skin tone and type?

What results can you realistically expect — ask for before-and-after photos of patients with similar skin tones — and what are the risks, recovery time, number of treatments and cost?

Ask how the plan maps to your specific scar types and skin tone, and get the total cost of the multi-session plan in writing.

Our how to choose a med spa guide covers the vetting checklist, from the medical director to price.