Rolling Acne Scars: Why They Form Beneath the Skin

Rolling acne scars are shallow, wave-like depressions caused by fibrous bands that tether the underside of the skin to deeper tissue. These bands pull the surface down, creating an undulating texture.

Because the cause sits beneath the surface, lasers and creams alone often disappoint. Treatment usually begins by releasing the tethering — commonly with subcision — then adds collagen-stimulating treatments. Suitability is confirmed by a doctor assessment in Johor Bahru.

Rolling scars are a type of atrophic acne scar that gives the skin a gently undulating, hill-and-valley appearance. Unlike boxcar or ice pick scars, their edges are soft and sloping rather than sharply defined.

They are usually wider than they are deep and are most often seen on the cheeks. In flat, even lighting they can be hard to spot, but they become obvious under angled light when the surface ripples.

The wave-like texture of rolling scars comes from the surface being pulled down unevenly. Where a fibrous band anchors the skin, the surface dips; the skin between anchors sits higher, creating the rolling effect.

This is why the texture often looks like a soft, rolling landscape rather than discrete craters. It also explains why the scars seem to shift in appearance depending on facial expression and lighting.

During healing from inflammatory acne, bands of fibrous tissue can form between the underside of the skin and the deeper layers below. These bands act like tiny anchors, physically holding the surface down.

Tethering is the defining feature of rolling scars. The visible depression is not just a loss of collagen at the surface — it is the surface being actively pulled downward by tissue underneath.

Resurfacing lasers work on the surface and upper skin. They can improve skin quality and texture, but they do not cut the fibrous bands anchoring a rolling scar from below.

If the tether is left intact, the surface keeps being pulled back down — which is why people sometimes feel surface treatments alone under-deliver on rolling scars. Addressing the structural cause first usually makes later surface work more effective.

Subcision is a small in-clinic procedure performed under local anaesthesia. A fine instrument is passed under the skin to break the fibrous bands tethering the scar down, allowing the surface to lift toward its natural level.

Releasing the bands also triggers a healing response that can stimulate some collagen in the area. Because it targets the structural cause rather than the surface, subcision is often the first treatment considered for rolling scars.

DrPlus assesses whether subcision is appropriate based on scar type and skin condition — it is generally not performed during active acne flares.

Releasing the tether is often step one. Many plans add a collagen-stimulating treatment such as RF microneedling a few weeks later, so the lifted skin has structural support holding it up. CO₂ laser may be considered later for any remaining surface texture.

The sequence matters: each treatment is spaced to let the skin recover and respond before the next. Combination plans are tailored to the individual rather than applied as a fixed formula.

After subcision, mild swelling and bruising are common in the first few days and usually settle within about a week. Some tenderness or firmness in the treated area can follow as it heals — this is part of the normal response.

Recovery from added collagen treatments varies: RF microneedling typically involves one to three days of mild redness. Your doctor will give aftercare guidance tailored to the treatments in your plan. Results develop gradually over months as collagen remodels.

Because rolling scars are structural, an in-person assessment is the only reliable way to confirm whether tethering is present and whether subcision is appropriate. At DrPlus in Johor Bahru, the consultation maps the scar mix and explains how treatments would be sequenced.

You will leave with a clear plan and realistic expectations — and no pressure to proceed on the day.