Types of Acne Scars (Ice Pick, Boxcar, Rolling) and the Best Treatment for Each

Acne scars come in three main depressed types: ice pick scars, which are narrow and deep; boxcar scars, which are wider with sharp edges; and rolling scars, which are broad, shallow dips with soft edges. Each type responds best to a different approach. Ice pick scars usually need targeted techniques such as TCA CROSS or punch excision, boxcar scars often respond to fractional lasers, RF microneedling or punch techniques, and rolling scars typically improve most with subcision combined with collagen-stimulating treatments. Most people have a mix of types, so the best results usually come from combining methods.

Understanding which scars you have is the first step toward choosing a treatment that actually works. This guide explains how to tell the types apart and what dermatologists commonly recommend for each.

Why Acne Leaves Different Kinds of Scars

When an inflamed acne lesion damages the deeper layers of the skin, the body tries to repair it with new collagen. If too little collagen is produced, a depression forms. If the healing process pulls the skin down with fibrous bands, the surface becomes tethered. The shape of the resulting scar depends on how deep the inflammation went, how wide it spread, and how the tissue healed.

It is also important to separate true scars from temporary marks. Red or brown flat spots left after acne, known as post-inflammatory erythema or hyperpigmentation, are not scars and often fade with time, sun protection and gentle treatments.

Ice Pick Scars: Narrow and Deep

Ice pick scars look like small, deep holes, as if the skin were punctured with a sharp tool. They are usually less than two millimetres wide but can extend deep into the dermis. Because they are so narrow and deep, surface treatments alone rarely reach the bottom.

Commonly recommended treatments

• TCA CROSS: a high-strength trichloroacetic acid is applied precisely into the base of each scar with a fine applicator. This triggers collagen production from within and gradually raises the scar over several sessions.
• Punch excision: the scar is cut out with a small circular tool and the edges are stitched closed, replacing a deep pit with a fine line.
• Follow-up resurfacing: fractional laser or RF microneedling can soften the edges once the depth has been addressed.

Boxcar Scars: Wide With Sharp Edges

Boxcar scars are round or oval depressions with steep, well-defined walls, similar to chickenpox scars. They can be shallow or deep. Shallow boxcar scars generally respond better to treatment than deep ones.

Commonly recommended treatments

• Fractional lasers: both ablative (such as fractional CO2) and non-ablative devices create tiny columns of controlled injury that stimulate remodelling and can soften the edges.
• RF microneedling: delivers heat at controlled depths to encourage collagen, often with less pigment risk for darker skin.
• Punch elevation or punch excision: for deep boxcar scars with a normal-looking base, the base can be lifted to the skin surface.
• TCA CROSS: sometimes used for smaller, deeper boxcar scars.

Rolling Scars: Broad, Wavy Dips

Rolling scars create an uneven, undulating surface. They are caused by fibrous bands that tether the skin to deeper tissue, pulling it downward. They are often most visible in side lighting and may look less obvious when you stretch the skin.

Commonly recommended treatments

• Subcision: a needle or blunt cannula is inserted under the skin to release the fibrous bands, allowing the skin to lift.
• Dermal fillers or biostimulators: can add volume beneath depressed areas and help prevent the bands from reattaching.
• RF microneedling and fractional lasers: used after subcision to improve texture and thicken the skin.

Other Scar Types to Know

Not all acne scars are depressed. Some people develop raised scars:

• Hypertrophic scars are raised but stay within the original wound area. They are more common on the chest, back and jawline.
• Keloids extend beyond the original wound and can keep growing. They need careful management, as aggressive treatment can make them worse.

Raised scars are usually treated with steroid injections, silicone products, and sometimes vascular lasers, rather than resurfacing treatments.

Why Combination Treatment Usually Works Best

Most people with acne scarring have more than one type. A treatment that helps rolling scars may do little for ice pick scars, and vice versa. A typical plan may involve:

1. Making sure active acne is controlled first, since new breakouts create new scars.
2. Treating deep, narrow scars with targeted methods such as TCA CROSS or punch techniques.
3. Releasing tethered scars with subcision.
4. Following with a series of fractional laser or RF microneedling sessions to refine texture.
5. Adding fillers or skin boosters where volume loss remains.

Improvement is typically gradual and builds over months. Most people see meaningful softening rather than complete disappearance, and expectations should reflect that.

Practical Tips for Visitors

Korea is known for offering many scar treatments, often in combination. Because scar revision usually requires a series of sessions and some treatments involve several days of redness or crusting, plan carefully if you are visiting for a limited time. Ask which treatments can safely be done in one visit, how much downtime to expect, and what can be continued in your home country.

Frequently asked questions

How do I know which scar type I have?

Look at your skin in side lighting. Narrow holes suggest ice pick scars, sharp-edged craters suggest boxcar, and soft waves suggest rolling scars. A dermatologist can confirm this during an examination.

Can acne scars be completely removed?

Complete removal is uncommon. Most treatments aim for a significant, visible improvement in depth and texture.

Should I treat scars while I still have active acne?

It is generally better to control active acne first, though some treatments can be adapted. Your doctor will advise on timing.

Are home microneedling tools effective for scars?

Home devices are much shallower and carry infection risk if not sterile. They are not a substitute for professional treatment of established scars.

Next Steps

Because scar types overlap and every skin heals differently, a personalised plan matters more than any single device. A qualified dermatologist can assess your scars in person, explain which combination is most suitable for you, and set realistic expectations for the number of sessions and the level of improvement.