The 5 types of acne scars — and what treats each

First: is it a scar or a mark?

Most of what patients call "acne scars" are actually flat brown or dark marks — post-inflammatory hyperpigmentation. These carry no texture change: run a finger over them and the skin feels smooth. They fade over months and respond to pigment-directed treatment and strict sun protection, not to scar procedures.

A true scar is a change in texture — a dip or a bump you can feel, and one that shows in low-angle light. This distinction is the first thing we establish in an assessment, because scar tools do nothing for pigment and pigment creams do nothing for texture. Getting it wrong wastes both money and months.

Ice pick scars

Narrow, deep pits — as if the skin was punctured by a needle. They are usually smaller than 2mm across but extend deep, which is why they are the hardest type to improve with surface-level treatment alone.

Honest framing: ice pick scars respond least to any single modality. Focal techniques targeting each pit individually tend to do more than treating the whole face uniformly, and expectations should be set at softening, not disappearance.

Boxcar scars

Broader depressions with defined, sharp edges — like a small crater with walls. They can be shallow or deep, most often on the cheeks and temples.

Shallow boxcar scars are among the better responders to collagen-remodelling treatments such as microneedling, because building new collagen in the base visibly lifts the depression. Deeper boxcars improve more gradually over a longer course.

Rolling scars

Wave-like undulations across an area of skin, caused by fibrous bands tethering the skin down from underneath. They have soft, sloping edges, and they look dramatically worse in side-lighting — which is why patients often notice them in car mirrors and lift lighting.

Rolling scars are usually the most satisfying type to treat: releasing the tethering and stimulating collagen lets the surface sit more evenly. Microneedling courses are typically the starting point.

Raised scars: hypertrophic and keloid

Hypertrophic scars are raised but stay within the original spot's boundary; keloids grow beyond it and can keep growing. Both are more common on the jawline, chest, shoulders and back, and more common in Indian skin than in lighter skin types.

A keloid tendency changes the entire plan. Aggressive resurfacing on keloid-prone skin can trigger new scarring worse than the original — so raised scars are managed medically first, and any energy-based treatment is chosen conservatively. If you have ever had a keloid, say so at assessment; it is one of the most important facts in your history.

Matching the treatment to the type

Rolling and shallow boxcar scars: collagen-induction approaches such as microneedling, usually as a course of sessions. Surface texture and the pigment component: chemical peels alongside. Ice pick scars: focal techniques and honest expectations. Raised scars: medical management before anything resurfacing.

Two rules hold regardless of type. Active acne must be controlled first — treating scars while new breakouts continue means new scars form as fast as old ones soften. And realistic outcomes are measured in visible improvement over a course of sessions, not erasure; any clinic promising scar-free skin is describing something no treatment achieves.

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