- Deep scars (Ice Pick): Best treated with chemical reconstruction (TCA CROSS) or deep ablative lasers.
- Tethered scars (Rolling): Require subcision to release fibrous bands beneath the skin.
- Wide scars (Boxcar): Respond best to resurfacing (Lasers) and collagen induction (RF Microneedling).
- Pigmentation (PIE/PIH): Not true scars; treated with pigment-specific lasers and creams.
Acne scars vary in depth, structure, and how they form beneath the skin. These biological differences dictate exactly how your skin will respond to treatment.
A laser that works wonders on a shallow boxcar scar may not affect a deep ice-pick scar. In this guide, we provide a dermatologist-backed breakdown to help you identify your scar type and match it with the effective medical solution.
How Do Acne Scars Form?
When acne causes inflammation deep in the pore, it damages the surrounding tissue. The scar that remains is essentially the result of how your body handled that repair job:
Depressed Scars: If the body produces too little collagen during healing, the skin collapses, creating an indentation.
Raised Scars: If the body produces too much collagen, the tissue builds up, forming a bump (Hypertrophic or Keloid).
How to Match Your Acne Scars to the Right Treatment
When it comes to acne scars, the treatment only works as well as the match. Using a method that doesn’t address how your scar formed can lead to slow progress or uneven results.
Step 1: Identify Your Acne Scar
Before booking a treatment, look closely at your skin in a well-lit mirror. You likely have a combination of different types.
Pay attention to:
- Whether the scar looks indented or raised
- How deep or shallow it appears
- Whether the concern is texture, colour, or both
These details can help you narrow down which treatments are likely to be effective and which may offer limited improvement to your acne scars.
Acne scars are generally grouped based on how collagen behaves during healing. Broadly, they fall into two main categories: depressed scars caused by collagen loss, and raised scars caused by excess collagen. Some marks left by acne aren’t true scars at all, but colour changes that fade differently.
The 3 Main Types of Atrophic (Depressed) Scars
| Scar Type | Appearance | Underlying Cause |
| Ice Pick Scars | Deep, narrow punctures (V-shape) < 2mm wide. Resembles a large pore. | Deep inflammation is destroying the pore wall. |
| Boxcar Scars | Round or oval depressions with sharp, vertical edges (U-shape). | Collagen destruction in a specific area. |
| Rolling Scars | Wave-like, uneven texture. No sharp edges. | Fibrous bands tether the skin to deeper tissues. |
Pigmentation (Not True Scars)
- PIE (Post-Inflammatory Erythema): Red or pink marks caused by dilated blood vessels. Common in lighter skin tones.
- PIH (Post-Inflammatory Hyperpigmentation): Brown or dark spots caused by excess melanin production. Common in darker Asian skin tones.
Note: If you cannot distinguish your scar type, it is best to consult a professional. Misidentifying a scar often leads to wasted money on ineffective treatments.
Book a skin assessment with DermAlly to identify your acne scar type and receive a personalised removal plan.
Step 2: Treatments We Recommend For Your Acne Scar Type
At DermAlly, we believe in a “targeted” approach. We do not use a “one-laser-fits-all” method.
A. For Ice Pick Scars
These are notoriously difficult to treat because they are deeper than most standard lasers can reach effectively.
- Gold Standard: TCA CROSS (Chemical Reconstruction of Skin Scars). This involves depositing high-concentration trichloroacetic acid precisely into the base of the scar. This stimulates intense collagen production to "lift" the floor of the scar.
- Alternative: Fractional CO2 Laser (high power) can help, but often requires more sessions than TCA CROSS for this specific scar type.
B. For Rolling Scars
Lasers often fail here because the skin is physically “tied down” by bands of scar tissue.
- Gold Standard: Subcision. A doctor inserts a special needle or cannula beneath the skin to physically cut and release the fibrous bands. Once released, the skin snaps back up, smoothing the surface.
- Adjunct: Dermal Fillers or Salmon DNA Healer are often injected immediately after subcision to act as a "spacer," preventing the bands from re-tethering while boosting collagen.
C. For Boxcar Scars
Because these scars have sharp edges but are not as deep as ice pick scars, they respond well to resurfacing.
- Treatments: RF Gold Microneedling (Radiofrequency) or Fractional CO2 Lasers. These devices create controlled micro-injuries that force the skin to remodel the edges of the scar, making them softer and less visible.
D. For Hypertrophic & Keloid Scars
Raised scars require a more cautious and controlled approach, as the goal is to soften scar tissue and limit further overgrowth rather than stimulate additional collagen.
Treatment plans may include steroid injections, sometimes combined with laser-based or RF-based treatments, selected carefully based on scar behaviour and skin response.
E. For PIE (Red Marks)
When redness is the main concern, treatment focuses on improving skin tone rather than changing skin texture. We often recommend Yellow Laser or Gold Toning to help reduce persistent redness.
F. For PIH (Brown Marks)
For pigmentation-related marks, treatment focuses on reducing excess pigment while supporting healthy skin turnover.
At DermAlly, we may recommend Pico Laser, chemical peels, or non-ablative laser treatments, depending on your skin tone and sensitivity. Sessions are spaced to allow the skin to recover while gradually improving overall tone.
Step 3: Combination Therapy (“Sandwich” Method)
Many people have more than one type of acne scar at the same time. When this happens, treating just one aspect may lead to uneven results.
In these cases, we often recommend combination therapy, in which multiple treatments are planned together to address texture, depth, tethering, and pigmentation across different areas of the skin.
Get Expert Guidance for Your Skin
Acne scars, as you have seen, vary in so many ways. Similarly, treatment results can vary from person to person. Matching the right approach to your scar type helps set realistic expectations and improves how your skin responds over time.
At DermAlly, acne scar treatments are guided by dermatologists, with plans tailored to your scar pattern and skin condition. Book a consultation today.
Frequently Asked Questions (FAQ)
Can acne scars be removed completely?
While the term “removal” is commonly used, medically, we aim for significant improvement rather than total perfection. With the right combination of treatments, many patients see a substantial reduction in scar visibility, making them barely noticeable.
Is there downtime after laser or microneedling treatments?
Yes, most scar treatments involve some recovery time. Depending on the intensity of the laser or the depth of the microneedling, you may experience redness or mild swelling for a few days. Sessions are spaced out to allow your skin sufficient time to recover and remodel collagen between appointments.
Is Subcision painful?
Subcision is typically performed under local anaesthesia to minimise discomfort. You may feel some pressure or a “tugging” sensation as the fibrous bands tethering the skin are released.
How can I prevent acne scars from forming in the first place?
The most important step is to treat acne early. Severe, prolonged inflammation increases the likelihood of scarring. Additionally, avoid picking or squeezing spots, as this worsens inflammation and damages the surrounding tissue, leading to deeper scars.
How many sessions do I need?
Collagen remodelling is a biological process that takes time. Most patients require a series of sessions to achieve optimal results. Your specific plan will depend on the depth of your scar and how your skin responds to the first few treatments.
Are these treatments safe for darker or sensitive skin?
Yes, but the device settings must be chosen carefully. For example, when treating pigmentation (PIH) in darker skin tones, we use specific non-ablative lasers or Pico lasers to avoid overheating the skin, which can cause rebound pigmentation.
Why do I have different types of scars on my face?
It is very common to have “mixed scarring.” Acne can damage the skin at varying depths in different areas, leading to a mix of ice pick, boxcar, and rolling scars. This is why we often recommend combination therapy rather than a single treatment method.
Our articles are written and reviewed by Dr. Coni Liu (MRCS, FAMS) and Dr. Heng Jun Khee (MRCP, FAMS), Ministry of Health-accredited Consultant Dermatologists at DermAlly.
Both are Fellows of the Academy of Medicine (Dermatology) and previously served as Consultants at the National Skin Centre (NSC), bringing extensive experience in medical, surgical, and aesthetic dermatology. They are committed to making expert-led skin education accessible, practical, and clear, helping patients look and feel their best through evidence-based care rooted in science and compassion.
