Key Takeaways
Acne scars usually involve changes to the skin’s structure, while post-acne marks are changes in colour that leave the skin surface relatively smooth.
Ice pick, boxcar, rolling, and raised scars develop differently, so we first assess scar depth, shape, tethering, and collagen changes before considering treatment.
Treatment may involve subcision, RF microneedling, pico laser treatment, or chemical peels, depending on whether the main concern is structural scarring, pigmentation or surface texture.
Introduction
Acne may clear, but the reminders can linger. You may be left with dark marks, uneven texture, or indentations that become more noticeable under certain lighting, even when breakouts are no longer a major concern.
The challenge is that not every post-acne change is the same. Different types of acne scars can involve pigmentation, collagen loss, tethered tissue or excess scar formation, so understanding what has changed beneath the skin is an important first step before deciding what may help.
What Are the Different Types of Acne Scars?
1. Ice Pick Scars
Ice pick scars are narrow, deep indented acne scars that can resemble small puncture marks in the skin. They form when inflammation damages collagen deeper within the skin, leaving a sharply defined depression that may look more noticeable under direct or angled lighting.
2. Boxcar Scars
Boxcar scars are broader depressions with more defined edges and may be shallow or deep. They usually develop when collagen is lost during the healing process, causing part of the skin surface to sink and creating a more noticeable change in texture.
3. Rolling Scars
Rolling scars create broad, wave-like depressions that can make the skin look uneven, especially when light falls across it from the side. They usually form when fibrous bands beneath the surface pull the skin down and tether it to deeper tissue.
4. Hypertrophic and Keloid Scars
Hypertrophic and keloid scars are raised rather than indented and may feel firm, itchy or tender. They develop when the skin produces excess collagen during healing. Hypertrophic scars tend to remain within the original acne area, while keloids can extend beyond it.
What About Post-Acne Pigmentation?
Post-acne pigmentation happens when inflammation from a breakout leaves behind excess pigment or lingering redness as the skin heals. This can appear as brown, grey, red or pink marks that remain even after the acne itself has settled.
Strictly speaking, these acne marks are not considered acne scars because they do not involve a permanent change in the skin’s structure. The surface usually stays smooth, although pigmentation can still make the complexion look uneven and may appear alongside true acne scarring.
How We Assess Your Acne Scarring Before Treatment
Before recommending a treatment for different types of acne scars, we assess both what the scars look like and what may be happening beneath the surface. This usually includes:
Visual assessment: We look at whether scars are narrow, broad, rolling, raised or sharply defined, as well as their depth and distribution.
Skin stretching: Gently stretching the skin can show whether certain depressions flatten, which may indicate how strongly the scar is tethered.
Palpation: Feeling the area can help us identify firm or fibrous tissue beneath the skin that may not be obvious visually.
Skin type and tone: We consider your skin tone and how easily it develops post-inflammatory pigmentation, as this can influence treatment choice and energy settings.
Active acne: Our doctors will also determine whether there are any ongoing inflammatory breakouts, as controlling active acne may need to come before acne scar treatment.
Together, these findings help us determine which features of the scarring should be addressed first.
Treatments We Consider for Different Types of Acne Scars
Once we understand whether the main concern is tethering, collagen loss, pigmentation or surface irregularity, we can consider treatments that address that particular change in the skin.
1. Subcision for Rolling or Tethered Scars
For rolling scars, or selected boxcar scars that are visibly tethered, our doctors may consider subcision. This involves passing a fine needle under the scar to release the fibrous bands pulling the skin down, allowing the depressed area to sit more freely.
Bruising, swelling and tenderness can occur after treatment. Once the area has recovered, other treatments may be introduced if there is still uneven texture or loss of skin support.
2. Radiofrequency (RF) Microneedling for Indented Scars and Uneven Texture
For indented acne scars, our doctors may consider RF microneedling to help improve uneven skin structure and texture. Fine needles create controlled micro-injuries at selected depths, while dual-wavelength RF energy is delivered directly within the skin.
This controlled injury prompts the skin to repair and reorganise existing collagen while producing new collagen over time. Shallower settings can focus on surface irregularities, while deeper settings reach areas where the scar has affected the skin’s underlying support. By triggering collagen remodelling within the skin, RF microneedling can help the treated area look smoother and more even over time.
3. Pico Laser for Post-Acne Pigmentation and Mild Texture Changes
If your acne scarring is accompanied by brown or grey post-acne pigmentation, we may also recommend a Pico laser treatment. It delivers pulses in a trillionth of a second, creating a photomechanical effect that fragments the pigment into smaller particles, which are then cleared through the skin’s natural processes.
For textural concerns, certain fractional delivery modes create tiny treatment zones beneath the skin. These controlled micro-injuries prompt the skin to repair itself and reorganise collagen around the treated areas, which can gradually improve uneven texture and shallow scarring.
Our doctors will select the wavelength and delivery mode based on your scar’s depth, your skin tone, and whether there is any risk of post-inflammatory pigmentation.
4. Chemical Peel for Surface Pigmentation and Texture
For post-acne marks, congestion, enlarged pores, or uneven skin, Illumia Medical’s mandelic acid chemical peel may be a suitable option.
Mandelic acid is an alpha hydroxy acid (AHA) with a larger molecular size, so it penetrates the skin more gradually. It works by loosening the bonds between dead surface cells, encouraging them to shed and supporting cell turnover. While not intended to address deeper indented scars directly, this treatment can help address more superficial pigmentation and texture.
Conclusion
Acne scarring rarely follows a single pattern. You may have rolling scars in one area, shallower boxcar scars in another, and lingering pigmentation from more recent breakouts. That is why understanding the different types of acne scars present matters more than simply choosing one treatment for the whole face.
At Illumia Medical, our doctors can draw from a range of treatment categories that address different layers and causes of scarring, from releasing tethered tissue to supporting collagen remodelling and treating residual pigmentation. This allows treatment to be planned by scar pattern and, where appropriate, sequenced over time rather than applying a one-size-fits-all approach.
For more information about our treatments, contact us today.
Frequently Asked Questions
1. Can acne scars fade on their own?
Some post-acne marks may gradually fade as the skin recovers, but true acne scars involve structural changes in the skin and are less likely to disappear completely without treatment. How noticeable they remain depends on the scar type, depth and your skin’s natural healing response.
2. How can I reduce the risk of acne scarring?
The most important step is to manage active acne early, especially deeper or inflamed breakouts. Avoid picking, squeezing or repeatedly touching spots, as this can increase inflammation and tissue damage. Consistent sun protection may also help reduce the darkening of post-acne marks while the skin heals.
3. Why do some people develop acne scars more easily than others?
The risk of scarring can vary depending on how deep or inflamed the acne is, how long it remains active, and how your skin heals. Genetics can also influence collagen production during healing, making some people more prone to developing indented scars from collagen loss or raised scars from excess collagen formation.