J Medical Aesthetics · Blog
Types of Acne Scars: What They Are, Why They Form, and What Can Be Done
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Acne scars are one of the most misunderstood skin concerns we see at J Medical Aesthetics. Patients arrive having lived with textural changes, pitting, or uneven skin tone for years, often having tried numerous skincare products with limited results, and later discover that not only are there distinct types of acne scars, but that each type responds to a different approach.
Knowing which acne scars types you have is more than academic curiosity. It is the essential first step in determining which treatments are actually suited to your presentation, and setting realistic expectations about what improvement looks like and how long it takes.
Why Acne Scars Form
When an acne lesion becomes significantly inflamed, the surrounding tissue is damaged. The skin’s repair process responds by producing collagen to heal the wound. If that collagen production is disrupted, through the severity of the lesion, repeated picking or squeezing, delayed treatment, or genetic predisposition, the skin is left with a permanent structural change.
Two distinct outcomes are possible:
- Too little collagen produced – the repaired area is depressed or pitted, sitting below the surrounding skin surface. This produces atrophic scarring, which is the most common acne scars type in clinical practice.
- Too much collagen produced – the repaired area is raised above the surrounding skin surface. This produces hypertrophic or keloid scarring, more common on the body than the face.
The majority of facial acne scarring is atrophic. Within this category, there are three distinct types of acne scars, each with a different structure, depth, and responses to treatment.
The Three Main Types of Acne Scars
Ice Pick Scars
Ice pick scars are narrow, deep, and sharply defined, they resemble a small puncture mark in the skin’s surface, as though made by a fine pointed instrument. They extend deep into the dermis, sometimes reaching the subcutaneous layer, which makes them the most structurally challenging of all acne scar types to address.
They form most commonly on the cheeks and are typically the result of deep, inflamed cystic acne lesions where the follicle wall has been severely damaged. The narrow opening at the surface belies the depth of the tract below.
Because of their depth and narrow diameter, ice pick scars do not respond well to surface-level resurfacing treatments. The most clinically effective approach is a deep chemical peel technique, in which a high-concentration trichloroacetic acid solution is applied precisely into the scar tract using a fine applicator. This creates a controlled inflammatory response within the scar that stimulates collagen production and gradually raises the depth of the scar over a series of sessions.
Our chemical peels in Melbourne include this technique as part of tailored acne scar treatment plans.
Boxcar Scars
Boxcar scars are wider than ice pick scars, with clearly defined, sharply punched-out vertical edges and a flat base. They resemble the indentations left by a cylindrical stamp (round or oval in shape), ranging from shallow to moderately deep. They appear most commonly on the cheeks and temples.
They form when an acne lesion destroys the collagen in a defined area, leaving a depression with relatively well-defined walls. Unlike ice pick scars, which taper to a point deep in the skin, boxcar scars have a broader, more accessible base, making them more responsive to treatments that stimulate collagen production across the floor of the scar.
Shallow to moderate boxcar scars typically respond well to fractional laser resurfacing, microneedling with mesotherapy, and radiofrequency-based treatments. Deeper boxcar scars may require a combination approach.
Laser treatment for scars at J Medical Aesthetics uses a 1540nm Erbium Glass fractional laser to stimulate collagen remodelling within the dermis, effective for both boxcar and rolling scar presentations.
Rolling Scars
Rolling scars produce a wave-like, undulating texture across the skin surface, a gentle rise and fall that creates the appearance of uneven, lumpy skin rather than distinct individual depressions. They tend to appear in clusters and are often most visible in angled or raking light, or when the skin is pulled taut.
They form when fibrous bands of tissue develop between the skin’s surface and the deeper subcutaneous tissue beneath, tethering the surface downward at irregular intervals. The visible rolling effect is the skin surface being pulled unevenly by these underlying bands.
Rolling scars are often the most visually significant of all acne scar types in terms of their impact on overall skin texture. They respond well to treatments that break down the fibrous tethering bands (a technique called subcision) and to collagen-stimulating treatments, including Alma Opus RF Plasma, which is used at J Medical Aesthetics for moderate to severe scarring. When combined with microneedling and biostimulator support, rolling scars can show meaningful improvement over a structured treatment course.
Other Acne Scar Types Worth Knowing
Beyond the three primary atrophic acne scar types, two additional categories deserve mention:
Post-Inflammatory Hyperpigmentation (PIH)
Technically not a scar but frequently confused with one. PIH is a darkening of the skin at the site of a healed acne lesion, caused by excess melanin production during the inflammatory process. It is flat, not textural, and fades over time, though this can take 6–18 months without treatment. Chemical peels, targeted mesotherapy, and laser treatments can significantly accelerate the fading process.
Hypertrophic and Keloid Scars
Raised scars caused by excess collagen production during healing. Hypertrophic scars remain within the original wound boundary; keloids extend beyond it. Both are more common on the chest, back, and shoulders than on the face, and require a different treatment approach to atrophic scarring.
Why Identifying Your Acne Scar Type Matters
One of the most common mistakes patients understandably make is seeking a single treatment solution for all of their scarring without first identifying which acne scar types are present. A course of fractional laser that produces excellent results for boxcar scars will do little for deep ice pick scars. A deep chemical peel that is highly effective for ice pick scars is not the appropriate primary approach for rolling scars.
This is why the assessment that precedes treatment at J Medical Aesthetics is the foundation of the entire treatment plan. Identifying the types of acne scars present, their depth and distribution, as well as how the surrounding skin is likely to respond, determines whether a plan delivers real improvement or falls short.
At your consultation, your practitioner will assess your scarring in detail, including whether active acne is still occurring, since managing ongoing breakouts is an important part of preventing new scarring while existing scars are being treated.
What to Expect from Acne Scar Treatment
Acne scar treatment is a process, not an event. The skin’s collagen remodelling cycle is slow, meaningful improvement takes months, and most patients require multiple sessions regardless of the treatment modality used.
What has changed significantly is the range of precision tools available to address the different types of acne scars effectively. At J Medical Aesthetics, the combination of acne scar treatment in Melbourne options means that a truly bespoke treatment plan can be designed around your specific scar presentation, rather than a single modality applied uniformly.
The timeline for improvement varies by scar type and depth. Shallow rolling and boxcar scars often respond noticeably within a 4–6 session course. Deeper ice pick scars require patience and a longer protocol. Your practitioner will give you a realistic, honest picture of what is achievable for your specific presentation.
The Prevention Conversation
For younger patients still experiencing active breakouts, preventing scarring from forming in the first place is the best acne scar treatment.
Managing active acne early and effectively, with appropriate skincare, topical treatments, and professional acne treatment options where indicated, reduces the risk of scarring. Avoid picking or squeezing lesions, as this dramatically increases the risk of permanent structural change.
If you are already noticing early textural changes or post-inflammatory marks, seeking a professional assessment sooner rather than later gives you the best chance of addressing concerns before they become established.
Your next step
Start with a Consultation at J Medical Aesthetics
Whether you are living with established acne scarring or beginning to notice textural changes, the best place to start is a clinical assessment by someone who can accurately identify the types of acne scars present and recommend a treatment pathway designed around your specific skin.
At J Medical Aesthetics, our consultations involve in-depth assessments, where we take the time to understand your skin history, identify your scar types and distribution, and personalise your treatment plan to what your skin actually needs.
Your skin’s transformation starts with a conversation. Book a consultation at our clinic today.
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