Acne Scar Types: Ice Pick, Rolling and Boxcar Scars, and Which Treatment Works for Each
If you have tried creams, facials and home remedies and your acne scars are still there, the problem is usually not effort. It is that different scars need different treatments. A deep, narrow ice pick scar and a soft, wave-like rolling scar are built differently under the skin, so a treatment that works beautifully for one can do very little for the other.
This guide explains the main types of acne scars, how to tell them apart, and which treatments our doctors at Dr Jane Clinic in Petaling Jaya use for each.
Why your scar type matters
Acne scars form when deep inflammation damages the collagen in your skin. As the skin heals, it either produces too little collagen, leaving a dent (atrophic scars), or too much, leaving a raised bump (hypertrophic scars). Most acne scars on the face are atrophic, and they fall into three main shapes. Matching the treatment to the shape is what makes the difference between small and significant improvement.
The 3 main types of acne scars
Ice pick scars
Ice pick scars are narrow, deep and look like small punctures or open pores, often on the cheeks. They are usually less than 2mm wide but can extend deep into the skin, which is why lasers and microneedling alone often cannot reach the bottom of them.
What works best: punch excision, where the doctor removes the scar with a tiny round instrument and closes it so it heals as a fine, flat line. This is usually followed by resurfacing to blend the skin texture.
Boxcar scars
Boxcar scars are wider, with sharp, steep edges and a flatter base, like a small crater. Shallow boxcar scars respond well to resurfacing; deeper ones usually need a stronger approach or a combination.
What works best: fractional CO2 laser for deeper boxcar scars, and Pico laser for shallow scars with uneven tone. You can read how the two compare in our guide to Pico vs CO2 laser for acne scars.
Rolling scars
Rolling scars have soft, sloping edges and give the skin a wavy, uneven look, especially under side lighting. They happen when bands of scar tissue under the skin pull the surface down.
What works best: SkinPen microneedling to remodel collagen gradually, and dermal fillers to lift sunken areas for a smoother surface straight away.
Red and brown marks are not scars
Many people call any mark left behind by acne a scar, but flat marks are a different problem with a different fix. Red or pink marks (post-inflammatory erythema) come from dilated blood vessels and respond to vascular laser. Brown marks (post-inflammatory hyperpigmentation) are excess pigment and respond to Pico laser and good sun protection. Treating these early stops them from lingering for months.
Quick guide: scar type and matching treatment
Ice pick scars: punch excision, then resurfacing
Deep boxcar scars: fractional CO2 laser
Shallow boxcar scars and uneven tone: Pico laser
Rolling scars: SkinPen microneedling and dermal fillers
Red marks: vascular laser
Brown marks: Pico laser and daily sunscreen
Most people have a mix of scars
In practice, very few patients have only one type. A typical face might have a few ice pick scars on the cheeks, some boxcar scars on the temples and rolling texture along the jaw. That is why the best results usually come from a combined plan, for example punch excision for the deepest scars first, followed by a series of CO2 laser or microneedling sessions, with filler for any areas that need lifting.
How many sessions, and what downtime to expect
Most patients need 3 to 6 sessions, spaced a few weeks apart
Pico laser and microneedling: mild redness for 1 to 2 days
Fractional CO2 laser: around 5 to 7 days of redness and peeling
Punch excision: around 1 to 2 weeks for the small wounds to heal
Fillers: minimal downtime, with possible mild swelling
Collagen keeps remodelling for months after treatment, so scars often continue to soften well after your last session.
Clear active acne first
If you are still breaking out, new inflammation can create new scars while you treat the old ones. Getting active acne under control comes first. If you are not sure what is driving your breakouts, our guide to hormonal, cystic and fungal acne and our acne treatment page are good places to start.
Realistic expectations
Acne scars can be improved significantly, but complete removal is rare. A good goal is smoother skin that catches less light and needs less makeup. Be cautious of anyone promising that one session will erase deep scars.
Frequently asked questions
Can acne scars go away on their own?
Red and brown marks often fade with time and sun protection. True textural scars, such as ice pick, boxcar and rolling scars, do not go away on their own because the collagen structure has changed.
Which is the best treatment for acne scars?
There is no single best treatment. The best results come from matching each scar type to the right method, which is why an in-person assessment matters.
Is acne scar treatment painful?
Numbing cream is used for lasers and microneedling, and local anaesthetic for punch excision, so most patients find treatment very tolerable.
Get your scars assessed
At Dr Jane Clinic, our doctors examine your scars under proper lighting, identify each type, and build a plan that fits your skin and your downtime. Learn more on our acne scar treatment page, book a consultation online, or WhatsApp us. We are at Tropicana Avenue, Petaling Jaya.
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