By Jessica Bishop | Updated June 2026
Acne scars fall into two broad categories: atrophic (depressed or pitted, the most common) and hypertrophic (raised). Each type responds to completely different treatments — using the wrong approach wastes money and can make things worse. This guide maps each scar type to what actually works, what to skip, and what realistic results look like on a real timeline.
I’ve been dealing with boxcar scars on my cheeks for a decade. I’ve spent money on treatments that did nothing, and a couple that genuinely helped. I’ll share what I know — but first, the important disclaimer: this article is for informational purposes only. Consult a dermatologist before starting any treatment for acne scarring. Individual results vary. This is not medical advice.
Why Scar Type Matters More Than Most People Think
Most acne-scar content skips the diagnostic step. It tells you “try microneedling” or “use retinol” without explaining that microneedling is excellent for rolling scars and boxcar scars but largely ineffective for deep ice-pick scars, where the channel is too narrow for the needles to reach the floor. Retinol, meanwhile, does nothing structural — it can improve skin texture and lighten discolouration, but it won’t fill a depressed scar.
Before spending anything, identify what you’re actually dealing with. The sections below give you the visual and tactile cues for each type.
The 5 Types of Acne Scars (and How to Identify Yours)
1. Ice Pick Scars — Deep, Narrow, and the Hardest to Treat
Ice pick scars look exactly like their name: small, sharply defined holes that go deep into the skin. They’re usually under 2mm wide but can extend quite far down into the dermis — sometimes reaching the subcutaneous fat layer. That depth is the problem.
You’ll find them most often on the cheeks and temples. They form when a cyst or deep papule destroys the skin’s follicular wall and leaves a narrow channel behind. The surrounding skin is normal; the scar is a true structural hole.
Because the opening is so narrow, surface-level treatments — chemical peels, laser resurfacing, dermaplaning — can’t reach the base of the channel. You’d need to remove dozens of microns of skin before you touched the floor of the scar, and that level of ablation is neither practical nor safe for most skin types.
What works: TCA CROSS (trichloroacetic acid chemical reconstruction of skin scars) is the gold standard. A dermatologist places a high-concentration TCA solution (65–100%) precisely into the ice-pick channel using a wooden toothpick or fine applicator. It triggers controlled inflammation that causes the channel walls to contract and fill over 6–12 weeks. A single session often produces visible improvement; most people need 3–6 sessions spaced 6 weeks apart. Punch excision — physically removing the scar plug and suturing the skin closed — is the most aggressive option and works when the scar is large and very deep.
Avoid: Dermaplaning and most peels (too superficial). IPL. Dermarollers at standard depths. These will not reach the base of the channel.
2. Boxcar Scars — Wide, Defined Edges, More Treatable
Boxcar scars are wide depressions with sharp, vertical walls and a flat base. Think of a small square or oval crater punched into the skin’s surface. They vary in depth: shallow boxcar scars (less than 0.5mm deep) respond well to surface treatments, while deeper ones need more aggressive approaches.
These scars form when inflammatory acne destroys collagen in a contained area. The skin collapses inward, but because the destruction was broad rather than narrow, the base of the scar is accessible.
This is the type I have — mostly on my lower cheeks and jaw. Took a long time to find what actually helped.
What works: Fractional laser resurfacing (CO₂ or erbium) is the most evidence-backed treatment for moderate to deep boxcar scars. The laser creates thousands of tiny channels in the skin, triggering collagen remodelling. Studies published in journals including the Journal of the American Academy of Dermatology show 50–75% improvement over 3–5 sessions. Microneedling (including radiofrequency microneedling) is a solid second-line option with less downtime and lower cost. For shallow boxcar scars, filler (hyaluronic acid injections into the base of the scar) can provide immediate improvement, though it’s temporary — results last 6–18 months before the filler is absorbed.
Avoid: Single-session IPL (photorejuvenation) — it targets pigmentation and vascular lesions, not structural depressions. It won’t touch a boxcar scar’s depth.
3. Rolling Scars — Wavy Skin, the Best Response to Subcision
Rolling scars create an undulating, wavy texture across a broader area of skin. Unlike boxcar scars, which have defined edges, rolling scars have sloped edges and the depression shifts as you stretch the skin. They’re often described as making skin look “uneven” rather than pitted.
What’s happening underneath: fibrous bands of scar tissue tether the skin surface down to the deeper layers. Pulling the skin taut temporarily stretches those bands and makes the surface look smoother — that’s the diagnostic clue.
What works: Subcision is the most targeted treatment. A dermatologist inserts a fine needle under the skin at the scar’s base to physically cut those tethering bands. Combined with PRP (platelet-rich plasma, derived from a small blood draw) or filler, the released skin tends to stay elevated as new tissue fills in. Many people see significant improvement from 2–4 subcision sessions. Microneedling also works well here because the rolling surface is accessible — multiple needle passes create diffuse collagen stimulation across the wavy terrain.
Avoid: Topical skincare. Nothing you apply to the surface will cut a fibrous tethering band. This is one of the clearest cases where “wait and see” with serums isn’t a plan — it’s time wasted.
4. Hypertrophic and Keloid Scars — Raised, Not Pitted
These are the raised scars — the opposite problem to everything above. They form when the skin overproduces collagen during healing. Hypertrophic scars stay within the original wound boundary; keloids grow beyond it and can become quite large and firm.
Both are more common in people with darker skin tones (Fitzpatrick types IV–VI), and the back, chest, and jaw are particularly prone to them. On the face from acne, hypertrophic scars are the more common of the two.
What works: Silicone gel sheets worn for 12+ hours per day have good evidence behind them — the consistent pressure and occlusion flatten raised scars over 2–3 months. Intralesional steroid injections (triamcinolone, administered by a dermatologist) can reduce bulk and soften the scar within weeks; most protocols use 3–5 injections spaced a month apart. Pulsed-dye laser targets the blood vessels that feed hypertrophic tissue and has good supporting evidence for both flattening and redness reduction.
Avoid: Aggressive exfoliation or chemical peels, which can irritate raised scars further. Aggressive retinol around active hypertrophic tissue. Any treatment that increases local inflammation risks triggering more collagen overproduction.
5. Post-Inflammatory Hyperpigmentation (PIH) — Dark Spots, Not True Scars
PIH is technically not a scar — the skin’s structure is intact. It’s discolouration left after inflammation: the melanocytes (pigment cells) overrespond during healing and deposit excess melanin. The result is a flat, dark mark in the same spot the pimple was.
It’s worth separating from true scars because the treatment approach is completely different, and because many people treat PIH with the same aggressive interventions meant for atrophic scars — which either doesn’t work or makes things worse. PIH also fades on its own over 3–24 months (sun protection dramatically speeds this up).
What works: Vitamin C (ascorbic acid, ideally L-ascorbic acid at 10–20%) inhibits tyrosinase, the enzyme involved in melanin production. Niacinamide (4–5%) reduces melanin transfer from melanocytes to skin cells. Chemical exfoliation — AHAs like glycolic acid or lactic acid — accelerates cell turnover and brings fresh skin to the surface faster. Azelaic acid (15–20%) is particularly effective for PIH without causing irritation. For stubborn PIH, hydroquinone under dermatologist supervision is the most potent option, but it’s not recommended for long-term unsupervised use.
Avoid: Unsupervised long-term hydroquinone use (risk of paradoxical darkening, a condition called ochronosis with misuse). Picking at marks — guaranteed to restart the inflammation cycle.
Treatment Matrix: Scar Type vs. What Works
| Scar Type | Best Treatments | Avoid |
|---|---|---|
| Ice pick | TCA CROSS, punch excision | Dermaplaning, standard peels (too superficial) |
| Boxcar | Fractional laser (CO₂ or erbium), microneedling, HA fillers | Single-session IPL, topical-only approaches for deep scars |
| Rolling | Subcision + PRP, microneedling, RF microneedling | Topical serums (won’t cut tethering bands) |
| Hypertrophic | Silicone gel sheets, steroid injections, pulsed-dye laser | Aggressive exfoliation, inflammatory treatments |
| PIH (dark spots) | Vitamin C, niacinamide, AHAs, azelaic acid | Long-term unsupervised hydroquinone, picking |
At-Home vs. Clinic: What’s Realistic Without a Dermatologist?
The honest answer is that atrophic scars (ice pick, boxcar, rolling) cannot be significantly treated at home. You can prevent them from getting darker, you can maintain good skin health, and you can improve your overall skin texture — but you won’t fill a depressed scar with niacinamide.
What at-home treatment can realistically do:
- Fade PIH: vitamin C + niacinamide + consistent SPF 30+ = genuine improvement over 3–6 months
- Improve overall skin texture: low-concentration retinol (0.025–0.05%) used 3× weekly, increasing slowly
- Flatten mild hypertrophic scars: silicone gel sheets (Scaraway, Cica-Care) are available OTC and have solid supporting evidence
- Prevent new scars: treating active acne aggressively is still the single best scar prevention strategy
What requires a clinic:
- TCA CROSS — high-concentration acid must be placed precisely; incorrect use causes severe burns
- Fractional laser — requires trained operators, specific wavelength selection, and proper cooling
- Subcision — an in-office surgical procedure
- Steroid injections — require proper dosing; too much triamcinolone causes skin atrophy
- RF microneedling — the devices used in clinics (Morpheus8, Potenza) are significantly more powerful than home dermarollers
At-home microneedling (dermarollers, 0.25–0.5mm) can provide mild collagen stimulation for shallow scars and better serum penetration, but the results are modest compared to professional RF microneedling at 1.5–3.5mm depths. The difference isn’t brand loyalty — it’s physics.
What I’ve Actually Tried for My Boxcar Scars (10 Years, 6 Treatments)
I want to be specific here, not general. My scars are mild-to-moderate boxcar scars on both cheeks, some shallow, a few deeper ones near my jaw. Fitzpatrick type II (pale, burns easily). Here’s the honest rundown.
Topical retinol (0.05%) — 8 months: Improved texture and made the skin around the scars smoother. The scars themselves? No change in depth. Not a waste — my skin just looked healthier overall — but it didn’t do what I’d hoped.
Chemical peel series (30% salicylic acid, 4 sessions): Helped a lot with the PIH I had after the active acne stage. Scars got lighter. Still no change in depth. Derm was upfront about this: peels improve the surface; they don’t rebuild the dermis.
Dermaroller (0.5mm, weekly, 6 months): Very mild improvement in the shallowest scars. The deeper ones didn’t budge. I kept at it because the investment was low (~$30 for the device) but realistic expectations: this is not a substitute for professional needling.
HA filler in the deepest scars (2 sessions, 18 months apart): This was the biggest visible difference — immediate, significant improvement in the three or four deepest scars. Lasted about 14 months before things settled back. The cost adds up ($350–$450 per session at a medical aesthetics clinic) but for specific, localised deep scars, filler is the most immediate result I found.
Professional microneedling with PRP (3 sessions, 8 weeks apart): Best overall result. Not dramatic after the first session but by session three, my skin looked genuinely smoother. The PRP (drawn from my own blood, centrifuged, and applied during needling) may have helped or the needling alone may have been sufficient — the evidence on PRP as an add-on is mixed. Total cost: around $1,100 across all three sessions.
Fractional CO₂ laser (1 session — stopped here): Significant downtime (red, swollen, peeling for 7–10 days). After healing, improvement was real — roughly comparable to three microneedling sessions in one go. I didn’t continue because one session already pushed into my budget limit. If I were starting over with a defined treatment budget, I’d go straight to fractional laser and skip the dermaroller stage entirely.
What I’d tell someone starting from scratch: identify your scar type first. Then set a realistic budget. For most people with mild-to-moderate atrophic scars, 3–4 professional microneedling sessions ($900–$1,500 total) is the most cost-effective starting point. Go from there.
How Long Do Treatments Actually Take?
Every treatment works over months, not weeks. Here’s the realistic timeline for common approaches:
| Treatment | Sessions | Spacing | Cost Range (USD) | Full Results Timeline |
|---|---|---|---|---|
| TCA CROSS | 3–6 | 6 weeks apart | $150–$350/session ($450–$2,100 total) | 6–9 months from first session |
| Fractional CO₂ laser | 3–5 | 4–8 weeks apart | $400–$900/session ($1,500–$4,000+ total) | Up to 6 months after final session |
| Professional microneedling | 3–6 | 4–8 weeks apart | $200–$400/session (+$100–$200 for PRP) | 3–6 months from start |
| Subcision | 2–4 | 6–8 weeks apart | $300–$600/session ($600–$2,400 total) | 6–12 weeks per round; full at 3–4 months |
| HA fillers | 1–2/year | As needed | $350–$700 per treatment area | Immediate; lasts 9–18 months |
| Silicone sheets (hypertrophic) | Daily use | Continuous | $20–$50 OTC | 2–3 months for noticeable flattening |
| At-home topicals (PIH) | Daily | Ongoing | $30–$120/month in products | 2–6 months for meaningful fading |
The common mistake is expecting one session of anything to produce a dramatic result. Scar treatment works through cumulative collagen remodelling — a biological process that simply takes time.
Can You Combine Treatments?
Yes, and often the best outcomes come from combining approaches — but the sequence and timing matter. A dermatologist experienced in acne scarring will typically plan a staged approach. Some common combinations that work:
- Subcision followed by microneedling: Subcision releases the tethering bands; microneedling stimulates the new collagen that fills the space. Usually done 4–6 weeks apart.
- TCA CROSS for ice picks + fractional laser for boxcar scars: These are two separate mechanisms, and many people have both scar types. A derm can do TCA CROSS on the narrow channels and then follow with laser for the broader depressions.
- Topical vitamin C and niacinamide alongside any clinic treatment: These maintain the result, help with PIH, and support skin barrier function during recovery.
What you generally shouldn’t combine in quick succession: two aggressive ablative treatments (e.g., deep chemical peel followed immediately by laser). Stacking high-trauma treatments without recovery time between them increases complication risk.
Frequently Asked Questions
Will acne scars go away on their own?
Atrophic scars (ice pick, boxcar, rolling) are structural — the collagen is gone, and the body won’t rebuild it spontaneously. They do not go away on their own. PIH (dark spots) will fade naturally over months to years; sun protection significantly accelerates this. Mild, very shallow depressions may become less noticeable as overall skin texture improves with age, but deeper scars are permanent without treatment.
Is microneedling or laser better for acne scars?
It depends on scar type and severity. Fractional laser typically produces more dramatic improvement per session and is better for moderate-to-severe boxcar and rolling scars. Microneedling is less expensive, has less downtime, and is safer for darker skin tones (less risk of post-treatment pigmentation). For mild-to-moderate scarring, professional microneedling is a solid starting point. For more severe scarring, fractional laser tends to be more efficient. A dermatologist who sees the actual scars is better placed to recommend than any guide can be.
Can I treat acne scars at home?
You can treat PIH (dark spots) and maintain general skin health at home with vitamin C, niacinamide, AHAs, and consistent SPF. At-home dermarollers (0.25–0.5mm) provide very mild improvement in shallow scars. But true atrophic scarring — anything with depth — requires professional treatment to see meaningful change. The devices and techniques needed (laser, TCA CROSS, subcision) are not safely replicable at home.
How much does acne scar treatment cost in total?
Costs vary widely by treatment type, clinic location, and number of sessions needed. Rough ranges: topical-only approach ($50–$200 per year in products); professional microneedling course ($600–$2,000); fractional laser course ($1,500–$5,000); combined treatments including subcision + filler ($2,000–$6,000+). These are US market estimates and can differ significantly in other regions. Dermatology offices sometimes offer package pricing that reduces per-session cost.
Are darker skin tones at higher risk from acne scar treatments?
Yes, this is clinically important. Darker skin tones (Fitzpatrick IV–VI) carry higher risk of post-inflammatory hyperpigmentation from ablative laser treatments (especially CO₂ laser). Non-ablative fractional lasers, RF microneedling, and subcision have better safety profiles across all skin tones. If you have a darker complexion, it’s particularly important to see a dermatologist experienced with your skin type — the wrong laser choice can leave worse pigmentation than the original scars. Silicone sheets and steroid injections for hypertrophic scars are generally safe across all skin tones.
Before You Spend Anything: Two Internal Resources
If you’re in the early research phase, two articles on this site that are worth reading alongside this one: our breakdown of whether retinol actually helps acne scars (useful for setting expectations before going the topical route), and our look at vitamin C for acne scars and PIH. Both sit in the “at-home options” tier of this guide and give more detail on what to buy and how to use it properly.
Medical disclaimer: This article is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Consult a qualified dermatologist before beginning any treatment for acne scarring. Individual results vary. Treatment outcomes depend on scar type, severity, skin type, and many other factors not covered here.
About the author: Jessica Bishop writes about skincare and dermatology topics, drawing on her own experience navigating acne scarring treatment over a decade. She is not a medical professional. The treatments described in this article are based on published dermatological literature and her personal experience as a patient.
