Boxcar Acne Scars: What They Are and Treatment Options

Boxcar acne scars are broad, depressed scars with sharply defined edges, caused by collagen loss across a wider area of skin after inflammatory acne. Because the damage sits in the dermis, creams cannot lift the depression.

Treatment usually aims to stimulate collagen and resurface the edges — commonly with CO₂ laser, RF microneedling, or a combination. Shallow boxcar scars tend to improve more readily than deep ones, and suitability depends on an in-person assessment.

Boxcar scars are a type of atrophic (depressed) acne scar. They are named for their box-like profile: a flat base and steep, well-defined walls, similar in appearance to the scars sometimes left by chickenpox.

They are wider than ice pick scars and more sharply edged than rolling scars. This defined shape is a useful clue at assessment, because it points to collagen loss in a contained area rather than tethering from below.

Boxcar scars typically appear as round or oval depressions, most often on the cheeks and temples. The edges are crisp enough that the scar can cast a small shadow in angled light, which is why texture often looks worse under overhead lighting.

They range from shallow dips that catch the light to deeper craters with steep walls. Many people notice them most when applying makeup, as product can settle into the defined edges.

Boxcar scars develop when inflammatory acne destroys collagen across a wider patch of the dermis. As the area heals, the lost collagen is not fully replaced, so the skin surface collapses into a depression with defined edges.

The wider the zone of collagen loss and the deeper it reaches, the more pronounced the boxcar scar tends to be. This is why deeper inflammatory lesions are more likely to leave boxcar scars than mild surface spots.

Boxcar scars are not all the same, and depth strongly influences what treatment may help and how much improvement is realistic.

Shallow boxcar scars sit closer to the surface and often respond well to resurfacing and collagen-stimulating treatments. Deep boxcar scars reach further into the dermis and frequently need a combination approach over several sessions.

Topical products work mainly on the epidermis — the outermost layer of skin. Boxcar scars are a structural change in the dermis, which sits below the reach of creams and serums.

Good skincare still has a role: it can improve overall skin quality, support the barrier, and help with post-inflammatory marks. But it cannot rebuild the lost collagen that creates the depression, so it rarely changes the boxcar shape itself.

Because boxcar scars have defined edges and sit in the dermis, treatment usually aims to stimulate new collagen and resurface the edges so the depression looks softer. Several treatments may be considered, often in combination.

The right choice depends on scar depth, skin tone, downtime tolerance and any other concerns — which is why a doctor assessment comes before any plan.

CO₂ laser is often considered for boxcar scars because their defined edges respond well to fractional resurfacing. The laser creates microscopic columns of controlled injury, prompting the skin to rebuild collagen and soften the steep walls of the scar.

It involves several days of redness and peeling, and careful planning is needed for darker skin tones to reduce the risk of post-inflammatory pigmentation. Multiple sessions are usually planned rather than a single treatment.

RF microneedling delivers radiofrequency energy into the dermis through fine needles. Because most of the energy lands at depth rather than across the surface, it tends to be gentler on the upper skin and is often a friendlier starting point for a broad range of skin tones.

For boxcar scars it works by stimulating collagen in the floor and walls of the depression. It is frequently combined with other treatments across a planned sequence to address both depth and surface texture.

Deeper boxcar scars, or a mix of scar types, often respond best to a combination of treatments sequenced over months rather than a single device. One treatment may rebuild collagen at depth while another refines the surface.

Combination plans are tailored to the assessment. The aim is gradual, realistic improvement — softening the appearance of scars rather than removing them entirely.

If boxcar scars have stayed unchanged for months after acne settled and skincare has not improved the texture, a scar assessment is a reasonable next step. A doctor can confirm scar depth, discuss suitability, and explain what improvement is realistic for your skin.