How To Heal Acne Scars Based On Your Scar Type?

Acne scars are not all the same, and treating them effectively depends on identifying which type you have. Icepick scars, boxcar scars, rolling scars, and raised scars each require different approaches. Matching treatment to scar type is the only way to see real improvement.

What Are the Different Types of Acne Scars?

Acne scars form when inflammation damages the skin’s collagen during the healing process. Some scars develop from too little collagen, leaving depressions. Others form from too much collagen, creating raised tissue. Knowing which category your scars fall into is the first step.

Depressed scars are called atrophic scars. These include icepick, boxcar, and rolling scars. Raised scars are called hypertrophic or keloid scars. Each type responds best to different treatments.

How To Heal Acne Scars Based On Your Scar Type

Treatment success depends on matching the procedure to the scar structure. A treatment that works well for boxcar scars may do little for icepick scars. Here is what the evidence currently supports for each scar type.

Icepick Scars

Icepick scars are narrow, deep holes in the skin that look like small puncture marks. They extend into the dermis and are the hardest to treat with surface-level procedures alone.

The most effective treatments target the depth of the scar. Punch excision is a common procedure where a doctor removes the scar individually and closes the wound with a small stitch. TCA cross is another option. A high-concentration trichloroacetic acid solution is applied directly into each scar, stimulating collagen formation to raise the base of the depression over several treatments.

Microneedling and laser resurfacing may help but are generally less effective for deep icepick scars compared to excision or TCA cross. Some clinicians combine treatments for better results.

Boxcar Scars

Boxcar scars are broad, round or oval depressions with sharp, defined edges. They resemble chickenpox scars. Because the edges are steep, treatments that smooth the surface tend to work best.

Laser resurfacing is commonly used. Fractional CO2 or erbium lasers remove thin layers of skin and stimulate collagen remodeling in the deeper layers. Multiple sessions are typically needed. Microneedling with radiofrequency is another option that delivers heat deeper into the skin while preserving the surface.

For deeper boxcar scars, dermal fillers can temporarily raise the depression to match the surrounding skin. This does not fix the scar itself but improves appearance for 6 to 18 months depending on the filler used.

Rolling Scars

Rolling scars have a wavy, undulating appearance with sloping edges. They are caused by fibrous bands of tissue pulling the skin downward, creating a rolling surface.

The primary treatment for rolling scars is subcision. A needle is inserted under the skin to break the fibrous bands, releasing the tension that causes the depression. This allows the skin to lift and smooth out. Subcision is often combined with microneedling, laser treatment, or fillers for optimal results.

Without releasing these fibrous bands, surface treatments alone are unlikely to significantly improve rolling scars.

Hypertrophic and Keloid Scars

Raised scars occur when the body produces too much collagen during healing. Hypertrophic scars stay within the original wound area. Keloid scars extend beyond the original wound.

First-line treatment is corticosteroid injections. These reduce inflammation and flatten the scar over several sessions. Silicone gels or sheets are sometimes used alongside injections. Laser therapy, particularly pulsed-dye laser, can reduce redness and thickness.

Cryotherapy is an option for smaller raised scars. Surgical removal is possible for large keloids, but the scar may recur. Most clinicians recommend follow-up treatments like steroid injections after surgery to reduce recurrence risk.

How Do Dermatologists Diagnose Scar Type?

A dermatologist can usually identify scar types during a visual exam. They look at the shape, depth, and edges of each scar. In some cases, they may lightly stretch the skin to better see the contours of rolling scars versus boxcar scars.

Some clinics use 3D imaging or skin surface analysis tools to measure scar depth and track improvement over time. This is not always necessary for treatment planning but can help document progress.

Which Treatments Have the Strongest Evidence?

The evidence varies by treatment and scar type. Some procedures have solid clinical data behind them. Others are used based on clinical experience and smaller studies.

Subcision for rolling scars and punch excision for icepick scars are well-established procedures supported by decades of clinical use. Fractional laser resurfacing has strong evidence for atrophic scars generally, though results depend on the device, settings, and number of sessions.

TCA cross for icepick scars is supported by multiple studies showing improvement with minimal downtime. Corticosteroid injections for hypertrophic scars are considered standard care and are widely supported by clinical guidelines.

Treatments like platelet-rich plasma PRP combined with microneedling are less established. Some studies suggest benefit for atrophic scars, but no large randomized trials have confirmed superiority over microneedling alone. Be cautious of clinics that present PRP as a guaranteed solution.

What Is the Timeline for Seeing Results?

Most treatments require multiple sessions spaced weeks apart. Laser resurfacing typically needs 3 to 6 sessions. Microneedling often requires 4 to 6 sessions. Subcision may need 1 to 3 sessions depending on the severity of the rolling scars.

Improvement is gradual. Some procedures cause initial redness or swelling that takes weeks to resolve. The final result from collagen remodeling can take 3 to 6 months after the last session because the body needs time to build new tissue.

No treatment completely erases acne scars. Most people can expect 30 to 70 percent improvement in appearance depending on scar type, severity, and the treatment used.

Can Over-the-Counter Products Help Acne Scars?

Most over-the-counter products cannot change the structure of mature scars. Creams and serums work mainly on the outermost layer of skin. They cannot rebuild deep collagen loss or break down raised scar tissue.

Silicone gels and sheets are the exception. They have clinical evidence for preventing and improving raised scars. Silicone creates an optimal hydration environment that helps soften and flatten hypertrophic scars over weeks to months.

For atrophic scars, topical retinoids may help by stimulating collagen production and improving skin texture. But the effect is modest compared to in-office procedures. Other ingredients like vitamin C and niacinamide can improve skin tone and brightness around scars but do not change the scar structure itself.

What Should You Avoid When Treating Acne Scars?

Avoid treatments that claim to cure scars overnight. No single session or cream can eliminate acne scars. Be skeptical of marketing language that says “melt away scars” or “erase imperfections completely.”

Do not attempt aggressive home treatments like derma rollers bought online at unknown quality. Using the wrong needle depth or unsanitary tools can cause infections, more scarring, or pigment changes.

Avoid sun exposure on healing scars. UV radiation can cause hyperpigmentation that makes scars look worse. Sunscreen is essential during and after treatment.

Do not fall for the myth that toothpaste, lemon juice, or baking soda can heal scars. These products irritate skin and can worsen inflammation. No clinical evidence supports their use for scars.

How Much Do Acne Scar Treatments Cost?

Cost varies widely depending on your location, provider, and the treatment type. Laser resurfacing typically costs several hundred to a few thousand dollars per session. Microneedling is usually less expensive but still requires multiple sessions. Subcision and punch excision are billed per scar or per session.

Most acne scar treatments are considered cosmetic and not covered by insurance. Check with your provider and insurance company before starting treatment. Some clinics offer payment plans.

Do Acne Scars Fade on Their Own Over Time?

Some improvement can occur naturally over months to years as the skin remodels collagen. But this process is slow and incomplete for moderate to severe scars.

Redness and dark marks called post-inflammatory hyperpigmentation often fade significantly on their own. These are not true scars. True atrophic or hypertrophic scars involve permanent tissue changes and do not fully resolve without treatment.