Acne scarring is a prevalent, lifelong sequela with substantial psychosocial and functional impact. This book chapter integrates epidemiology, mechanisms, morphology, risk stratification, and treatment algorithms to guide phenotype-matched care. Scarring arises when intense, prolonged perifollicular inflammation, follicular rupture, and dysregulated TGF-β-mediated remodeling degrade elastic and collagen matrices, leading predominantly to atrophic scars (ice-pick, boxcar, rolling) and less often to hypertrophic/keloid phenotypes on tension-prone sites. Early, effective control of inflammatory acne and avoidance of mechanical manipulation are central to prevention. Management is morphology-driven: ice-pick scars respond best to focal reconstruction (TCA/phenol CROSS) and punch techniques, boxcar scars to depth-stratified approaches (CROSS or punch elevation plus fractional resurfacing), and rolling scars to subcision with immediate spacers (fillers) followed by collagen induction (fractional CO₂ or microneedle RF). Phototype-aware selection favors non-ablative and RF options in higher phototypes with pigment priming when ablative lasers are used. Adjuncts (MFU-V, fat/SVF, PRP, biostimulatory fillers) enhance durability, while session completion (≥3) and patient factors influence outcomes. A practical, staged, mixed-modality pathway yields the most consistent improvements across scar landscapes.