Acne scars come in several types, and the right treatment depends on which ones you have. Depressed scars (ice pick, boxcar and rolling) and raised scars each respond to different procedures. Most people get the best result from a combination of in-office treatments over several sessions. Just as important, many marks people call “scars” are actually flat discoloration that fades on its own. The first step is working out what you’re dealing with.
Is it a scar or a mark?
After a pimple heals, it often leaves a flat spot of color. These marks are extremely common and usually aren’t permanent:
- Post-inflammatory hyperpigmentation (PIH): flat brown or dark marks. They’re more common and longer-lasting in medium and darker skin tones.
- Post-inflammatory erythema (PIE): flat pink, red or purple marks. They’re more noticeable on lighter skin.
A quick test: run your finger over it. If the skin is smooth and flat, it’s a mark. If it’s pitted, dented or raised, it’s a scar. Marks tend to fade over several months, and sometimes longer for deep brown marks. Daily sunscreen, continued acne control and treatments such as retinoids or azelaic acid can help them fade. Scars change the skin’s structure and don’t fully resolve without procedures.
Types of acne scars
Most acne scars are atrophic (depressed), caused by lost tissue as deep inflammation heals. A widely used 2001 classification in the Journal of the American Academy of Dermatology describes three main atrophic types. Some people instead form raised scars.
Diagram with four side views of the skin surface. Ice pick: a narrow pit that goes deep. Boxcar: a wider depression with a flat floor and steep edges. Rolling: broad, shallow dips with sloping edges that make the surface wavy. Raised: a firm bump above the surrounding skin.
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Ice pick
Narrow, deep pit
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Boxcar
Wide dip with sharp edges
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Rolling
Broad, sloping waves
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Raised
Hypertrophic or keloid
| Scar type | What it looks like | Treatments commonly used |
|---|---|---|
| Ice pick (atrophic) | Narrow, deep pits, as if the skin was pierced by a sharp point | Focal chemical peels (such as TCA CROSS), punch excision or grafting |
| Boxcar (atrophic) | Round or oval depressions with sharp, steep edges, like chickenpox scars | Laser resurfacing, microneedling, chemical peels, punch elevation, fillers |
| Rolling (atrophic) | Broad, shallow dips with sloping edges that give skin a wavy look | Subcision, fillers, microneedling, laser resurfacing |
| Hypertrophic (raised) | Firm, raised scar that stays within the original spot | Corticosteroid injections, silicone gel or sheets, laser |
| Keloid (raised) | Raised scar that grows beyond the original spot; common on chest, shoulders, jawline | Corticosteroid injections, other injectables, laser, cryotherapy; specialist care |
Many people have more than one type, which is one reason combination treatment is the norm.
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In-office treatments for depressed scars
According to the American Academy of Dermatology, dermatologists choose among the following, often combining several:
Laser resurfacing
- Ablative lasers (such as carbon dioxide or erbium) remove thin layers of skin and stimulate new collagen. They can give the biggest single-treatment improvement for many atrophic scars, but they involve more downtime and a higher risk of side effects, including pigment changes.
- Non-ablative and fractional lasers heat or treat tiny columns of skin while leaving surrounding tissue intact. There’s less downtime, but several sessions are usually needed.
Microneedling
A device creates many tiny punctures to trigger collagen remodeling. Several FDA-cleared microneedling devices are marketed for acne scars. Microneedling is often combined with radiofrequency energy (RF microneedling). It generally has a lower risk of pigment changes than some lasers, which can make it a common option for darker skin tones in experienced hands. Home rollers are much shallower and aren’t a substitute. Using sharp needles at home risks infection and scarring.
Chemical peels
Peels remove the outer layers of skin to varying depths. Superficial peels, such as salicylic or glycolic acid, mainly help with dark marks and texture. Medium and deeper peels do more for scars but carry more risk. TCA CROSS, which applies high-strength trichloroacetic acid precisely into individual ice pick or narrow boxcar scars, is a focused technique for those types.
Subcision
A needle is inserted under a rolling scar to break the fibrous bands that tether it down, which lets the skin lift. It’s a common, relatively simple procedure for rolling scars, and it’s often combined with fillers or resurfacing.
Punch techniques
For deep ice pick and boxcar scars, a small, cookie-cutter-like tool removes the scar. The wound is then closed (punch excision), filled with a tiny skin graft (punch grafting), or the scar base is raised to the surface (punch elevation). The result is a smaller, flatter scar that other treatments can then smooth.
Dermal fillers
Fillers lift depressed scars, especially rolling scars, from below. The FDA lists approved dermal fillers and their indications. At least one filler is FDA-approved specifically for certain moderate-to-severe atrophic acne scars on the cheeks. Depending on the product, results can be temporary or longer-lasting. The FDA warns that fillers have risks, including rare but serious ones, and should be injected only by a trained, licensed provider.
Treatments for raised scars
Hypertrophic and keloid scars are treated differently from depressed ones. Options include corticosteroid injections into the scar, silicone gel or sheets, certain lasers, cryotherapy and other injectable medicines. Keloids can recur even after treatment, so they’re best managed by a dermatologist experienced with them. If you’re prone to keloids, tell any clinician before a procedure or piercing.
What you can do at home
At-home products can’t remove textured scars, but home care matters in three ways:
- Control active acne. Every inflamed breakout is a potential new scar. The AAD’s advice to treat acne early is the single best scar-prevention step, especially if a family member has acne scars. Our step-by-step acne treatment guide covers how.
- Help marks fade. Daily broad-spectrum sunscreen keeps flat marks from darkening. Topical retinoids (such as adapalene) and azelaic acid can help discoloration fade over time. Niacinamide has some evidence for reducing hyperpigmentation.
- Don’t pick. Squeezing and picking push inflammation deeper and increase scarring.
Prescription retinoid treatments are also being studied for preventing and softening early atrophic scars. For scars that are already established, though, the procedures below remain the main options, and a dermatologist can tell you which fit your scar type.
Timing, isotretinoin and choosing a provider
Acne first. Dermatologists generally aim to get active acne under control before resurfacing scars, since new breakouts create new scars.
Isotretinoin. For years, patients were told to wait 6 to 12 months after isotretinoin before any procedure. Dermatologic surgeons have since revisited that rule for some gentler procedures, while deeper ones such as full-field ablative resurfacing and dermabrasion are still approached with more caution. Your dermatologist will advise on timing for your situation.
Skin tone matters. Some lasers and deeper peels carry a higher risk of dark or light patches on medium and darker skin. Choose a provider with experience treating your skin type.
Choose qualified care. Look for a board-certified dermatologist or a clinician working under one. You can verify certification through the American Board of Dermatology. Ask how many procedures of that type they perform, what results are realistic for your scars, how many sessions you’ll need, and the total cost.
When to see a dermatologist
See a dermatologist if:
- your acne is still active and leaving new scars. Getting effective acne treatment is the priority;
- you have pitted or raised scars you’d like to improve;
- dark marks haven’t faded after several months of sun protection and acne control;
- scars are raised, itchy or growing, which could be hypertrophic or keloid scars.
For help deciding when a visit is needed, see when to see a dermatologist for acne.