Types of Acne Scars: Ice Pick, Boxcar, Rolling and Pitted Scars

Atrophic acne scars are depressions in the skin left after deeper or inflammatory acne lesions heal. During healing, the body sometimes loses collagen or fails to replace it evenly — leaving the surface lower than the surrounding skin.

Unlike post-inflammatory pigment marks (which are usually flat and discoloured), atrophic scars involve a structural change to the skin. That structural piece is why surface skincare alone usually cannot resolve them.

Atrophic scars are commonly classified into four shapes — ice pick, boxcar, rolling and pitted scars — because the shape gives clues about what is going on beneath the surface, and therefore what kinds of treatment may actually help.

Most people have a mix of more than one scar type, which is one reason combination treatment is so common. Identifying the dominant pattern guides which treatment is considered first.

Ice pick scars are narrow, deep channels that extend down into the dermis or deeper, resembling a small puncture wound. They often form after cystic acne and are among the most challenging atrophic scars because broad-area resurfacing cannot reach the bottom of the scar.

Treatment usually involves targeted approaches that work depth-first rather than surface-first. Combination protocols — where deep scars are addressed individually and surface work is added later — are common.

Boxcar scars are wider, shallower depressions with sharply defined edges — similar in shape to chickenpox scars. They result from inflammation that destroys a wider area of collagen in the upper or middle dermis.

Because the depression has a defined edge, surface-resurfacing treatments and collagen-stimulating approaches can usefully soften both the depth and the edge over a sequence of sessions.

Rolling scars give the skin a wave-like, undulating texture. They are not just on the surface — they are caused by fibrous bands tethering the skin downward to deeper tissue.

Because the issue is structural, surface treatments alone are limited. Many rolling-scar plans begin with releasing the tethering, then layer in collagen-stimulating treatments to lift and smooth the surface.

The term 'pitted' is sometimes used loosely to describe deeper ice-pick or boxcar scars. It is also used informally for flat post-inflammatory marks (red or brown) left after acne — these are pigment changes rather than true scars and usually behave differently.

Distinguishing structural scars from pigmentation marks is important because the treatment pathway is different. A consultation is the most reliable way to separate the two.

Scar shape is a clue about depth and structure. A wide, shallow scar with a defined edge usually responds well to a different treatment than a narrow, deep channel — and a tethered rolling scar may need to be released structurally before any surface work makes a difference.

There is rarely a single device that addresses every scar type adequately. This is why combination treatment is common, and why an in-person assessment matters before any plan is built.

Depending on scar type, skin condition and personal goals, your doctor may consider treatments such as CO₂ laser, subcision, RF microneedling and chemical peels — usually in combination over a planned sequence rather than as standalone fixes.

Each treatment has different mechanisms, recovery times and suitability ranges. The right combination depends on your assessment.

A scar assessment is useful once active acne is under control. Treating scars while breakouts are still active can sometimes irritate the skin and is not always the right starting point — your doctor will advise on timing.

Bring photos taken in natural light if you can; this helps when comparing changes after treatment. A consultation is consultation-only — you do not need to commit to any treatment on the day.