Acne Scars: How They Form and the Best Treatments for Each Type

Clearing active acne is one challenge. Dealing with the scars it leaves behind is another. Acne scars rank among the most frustrating skin concerns dermatologists treat, partly because they come in several distinct types, and what works well for one type may do little for another. Understanding how your scars formed and what category they fall into shapes every treatment decision that follows.

How Acne Scars Form

When an acne lesion, particularly a deep or inflamed one, damages the surrounding skin tissue, the body attempts to repair the area by producing collagen. That repair process doesn’t always replicate the original skin structure perfectly.

• Too little collagen produces depressed scars, where the skin surface sits lower than the surrounding tissue
• Too much collagen produces raised scars, where excess tissue builds above the skin surface
• Pigment changes without textural disruption produce post-inflammatory hyperpigmentation (PIH), the flat dark marks many people mistake for scars

PIH typically fades on its own over months, though treatments can accelerate that process. True acne scars, both depressed and raised, involve structural changes to the skin that require more targeted intervention.

Types of Depressed (Atrophic) Scars

Most acne scarring falls into the atrophic category. Dermatologists further divide these into three types, each with distinct characteristics:

• Ice pick scars: Deep, narrow, sharply defined columns that extend into the skin. They resemble enlarged pores or small punctures and are among the most difficult scar types to treat.
• Boxcar scars: Broad, flat-bottomed depressions with defined vertical edges. They tend to appear on the cheeks and temples and create a pitted, uneven texture.
• Rolling scars: Shallow but wide depressions with sloping edges that create a wave-like texture. They often result from tethering, where fibrous bands of tissue pull the skin surface downward from below.

Types of Raised (Hypertrophic and Keloidal) Scars

Less common with acne than atrophic scars, raised scars develop when the body overproduces collagen during healing. Hypertrophic scars stay within the boundary of the original lesion, while keloids extend beyond it. Both feel firm to the touch and can be itchy or sensitive. People with darker skin tones face a higher risk of keloidal scarring.

Treatment Options by Scar Type

No single treatment addresses every scar type, and most patients benefit from a combination approach. Here’s how the main options match up:

UltraClear Laser

The UltraClear cold ablative laser resurfacing delivers precise energy to the skin, stimulating collagen remodeling and improving both texture and tone. It works particularly well for boxcar and rolling scars, smoothing depressed areas and evening out the skin’s overall surface. 

UltraClear’s customizable intensity allows treatment across a range of skin tones with a lower risk of post-inflammatory hyperpigmentation than older ablative lasers, making it a strong option for patients who might not have been good candidates for laser resurfacing in the past.

VBeam Vascular Laser

The VBeam laser works differently from UltraClear. The energy from this laser is absorbed by the pigments found inside blood vessels, making it an excellent option for targeting reddened areas of scarring. Results take several weeks to develop, but are typically long-lasting with good acne management in the future. 

Fillers

Injectable fillers offer an effective approach for isolated, depressed scars, particularly boxcar scars with well-defined edges. 

Your dermatologist injects a small amount of filler beneath the scar to lift the depression to the level of the surrounding skin. Results appear immediately and can last from several months to over a year, depending on the filler used. Fillers work best for discrete scars rather than widespread texture issues.

Subcision

Subcision specifically targets rolling scars caused by fibrous tethering beneath the skin. Using a fine needle inserted beneath the scar, your dermatologist manually releases the fibrous bands that are pulling the skin surface downward. 

Once freed, the depressed area rises naturally, and the minor controlled injury stimulates new collagen production to support the correction. Subcision pairs well with laser treatments or microneedling for more comprehensive results.

Building the Right Plan

Most patients with significant acne scarring benefit from a combination of treatments rather than a single modality. 

A dermatologist might recommend subcision to release tethered rolling scars, UltraClear to resurface overall texture, and chemical peels to address remaining pigmentation. The right sequence and combination depend on your specific scar types, skin tone, and how your skin responds to treatment over time. 

The dermatologists at Krauss Dermatology will evaluate your scarring in detail and build a plan designed to deliver real, lasting improvement. Schedule a consultation to get started.

Take the Next Step

If you have further questions about treating acne scars, we encourage you to schedule a consultation at Krauss Dermatology. Call us at (781) 247-5593 or fill out our online contact form. We look forward to taking care of you.