You’ve been there. You look in the mirror, and the active breakout is finally gone, but what’s left behind feels even worse. Those little pits, the uneven texture, the literal "craters" that seem to catch every shadow. It’s frustrating. Honestly, it’s exhausting. We’re talking about deep pimple scars, specifically the atrophic ones that sit below the surface of the skin. Most people think they can just slub some expensive "scar cream" on their face and call it a day, but the reality is much more complicated. And frankly, a bit more expensive.
Most creams don't do anything for deep pits. Not a thing.
When we talk about deep scarring, we’re usually referring to ice pick, rolling, or boxcar scars. These aren't just dark spots or "hyperpigmentation" that fade with a little Vitamin C. These are structural changes in your dermis. Your skin basically lost its scaffolding during a war with cystic acne, and now it’s tethered down by fibrous bands. If you want to know how to get rid of deep pimple scars, you have to stop thinking about the surface and start thinking about the architecture underneath.
Why Your Current Routine Isn't Working for Deep Pimple Scars
Look, I love a good retinol as much as the next person. But let’s be real: no over-the-counter serum is going to fill a hole in your face. If you have deep pimple scars, your skin's collagen has been destroyed. Tretinoin (Retin-A) can help a little with texture over a period of two years, but it won’t move the needle on a deep boxcar scar.
The problem is the tethering. Think of a deep scar like a button on a tufted sofa. There’s a string pulling the fabric down from the inside. You can steam the fabric all you want, but until you snip that string, the "dent" stays. In dermatology, we call the process of snipping that string Subcision.
Dr. Davin Lim, a world-renowned laser dermatologist, often talks about this "bottom-up" approach. You can’t just sand down the top; you have to lift the bottom. If you go to a medspa and they try to sell you a "standard facial" to fix deep pitting, they are wasting your time and your money. You need medical-grade intervention.
The Realistic Timeline
It takes months. Maybe a year. Collagen doesn't just "grow" overnight because you had one session of microneedling. It takes about 12 weeks for your body to remodel collagen after a treatment. This is why you see people complaining on Reddit that their laser treatment "didn't work" after two weeks. Patience is the hardest part of the process, but it’s the only way to see actual change.
The Big Three: Lasers, Needles, and Knives
If you’re serious about how to get rid of deep pimple scars, you’re looking at a combination of these three categories. Very rarely does a single treatment fix everything.
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1. Subcision: The Game Changer.
I mentioned this earlier, but it deserves its own spotlight. A doctor takes a small needle (or a cannula) and sweeps it under the scar to break those fibrous bands. You’ll hear a "pop" or "crunch" sound. It’s gross. It’s effective. It releases the skin so it can float back to the surface. Without this, lasers often fail because the skin is still being pulled down from below.
2. CO2 and Erbium Lasers.
These are the heavy hitters. Fully ablative CO2 lasers essentially vaporize the top layer of skin. It’s a brutal recovery. You’ll look like you had a bad run-in with a grill for about 10 days. But for deep boxcar scars? It’s often the gold standard. Non-ablative lasers (like Fraxel) are "easier" but require 5-6 sessions to reach what one CO2 session can do.
3. TCA CROSS.
This is for the "ice pick" scars—those tiny, deep holes that look like they were made with a toothpick. The doctor drops high-concentration trichloroacetic acid (TCA) directly into the hole. It creates a local chemical burn that forces the skin to heal itself from the inside out, narrowing the hole.
The "Natural" Myth and Other Misconceptions
There is a massive amount of misinformation on TikTok and Instagram right now. Someone with naturally great genetics gets one pimple, uses a snail mucin serum, and claims it "cured their deep scarring."
It didn't.
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They had post-inflammatory erythema (redness), not structural scarring. There is no oil, no DIY lemon juice mask, and no "holistic" jade rolling technique that can rebuild the dermis. Honestly, some of these DIY "hacks" can make things worse. Putting lemon juice on a deep scar can cause a chemical burn or "phytophotodermatitis," leaving you with a dark brown stain that lasts for months.
Microneedling vs. RF Microneedling
Standard microneedling (like the SkinPen) is great for general texture and very shallow scars. But for deep pimple scars, you usually need Radiofrequency (RF) Microneedling. Brands like Morpheus8 or Potenza use needles to deliver heat deep into the tissue. The heat causes more "controlled trauma" than the needles alone, which triggers a much more aggressive collagen response.
Is it painful? Yes. Does it work? Usually, but it’s highly dependent on the settings the technician uses. If they play it too safe, you won’t see results. If they go too deep, you risk fat loss in the face. This is why you go to a board-certified dermatologist, not a discount "laser bar" you found on Groupon.
Real Talk About Cost and Expectations
Let’s talk money. Fixing deep scars is an investment. A single CO2 laser session can run you $1,500 to $3,000. RF Microneedling is usually $600 to $1,000 per session, and you need three.
And here is the hard truth: you will likely never have "perfect" skin again.
Most experts aim for a 50% to 70% improvement. That might sound disappointing, but in the world of scarring, 70% is a miracle. It’s the difference between feeling like you need to hide under a pound of foundation and being able to go to the grocery store with just sunscreen on. Your skin will look smoother in "harsh lighting," which is the ultimate test.
What You Can Do at Home (The Maintenance Phase)
While you can’t fix the scars at home, you can prevent them from getting worse and prep your skin for professional treatments.
- Sunscreen is non-negotiable. UV rays break down collagen. If you are trying to build collagen with expensive lasers but skipping SPF, you are essentially pouring water into a leaky bucket.
- Retinoids. Get a prescription for Tretinoin. It helps with cell turnover and keeps your pores clear so you don't get new scars while trying to fix the old ones.
- Hydration. Dehydrated skin makes pits look deeper. Use a glycerin-based moisturizer to plump the surface.
Actionable Next Steps for Your Skin Journey
If you’re staring at deep scars and feeling overwhelmed, don't just go out and buy another $80 cream. It won't work. Instead, follow this roadmap:
- Identify your scar type. Use a flashlight held at an angle to your face in a dark room. Are they narrow and deep (Ice pick)? Sloped and wavy (Rolling)? Or sharp-edged and flat-bottomed (Boxcar)?
- Find a specialist. Look for a dermatologist who specifically mentions "acne scar revision." Ask if they perform subcision. If they only offer one type of laser, keep looking. A good doctor needs a "toolbox" of different methods.
- Treat the active acne first. There is no point in resurfacing your skin if you are still breaking out. Get the inflammation under control with your doctor before you start the scar revision process.
- Manage your "lighting" anxiety. Deep scars look worst in overhead lighting (elevators, bathrooms). They look best in "flat" lighting. Remember that nobody sees your skin under a microscope except you.
- Budget for a series. Plan for at least 3-4 professional sessions over the next 12 months. This is a marathon, not a sprint.
The path to smoother skin is paved with patience and medical-grade procedures. It’s a process of rebuilding, not just "erasing." Focus on gradual improvement, stay out of the sun, and stop comparing your texture to filtered photos on social media.