Acne Scars Aren't One Problem — Here's What Actually Works for Each Type

"Acne scars" gets treated as one category, as if a single treatment could fix all of it. It can't — acne scarring actually splits into two opposite mechanisms (too little collagen, or too much), and within the "too little" category, three genuinely different shapes, each responding to different treatment approaches.

Here's how to tell them apart, and what actually matches each one.

The Three Types (Most People Have a Mix, Not Just One)

Rolling scars are broad, wave-like indentations caused by fibrous bands tethering the skin down from beneath — they give skin an uneven, undulating texture rather than sharp-edged pits.

Boxcar scars are wider depressions with sharp, defined edges — think shallow rectangular or oval indentations, distinct from the soft rolling shape.

Icepick scars are narrow, deep pits — the hardest of the three to treat, because they extend deep into the skin rather than sitting near the surface.

Research shows icepick scars are actually the most common of the three, followed by boxcar, then rolling — and most people with acne scarring have a genuine mix of types on the same face, not just one.

Rolling Scars — Where Regenerative Treatment Does Real Work

Rolling scars form from fibrous bands tethering the skin down from beneath — which is exactly why subcision is often the most direct fix: a fine needle is used to release those tethering bands, allowing the depressed skin to lift back toward its normal position. This is frequently paired with microneedling, which stimulates broader collagen remodeling across the treated area rather than targeting one point, and PRP, whose growth factors have been shown in research to produce significantly greater improvement when combined with microneedling than microneedling alone. Together, these three treatments — subcision to release the tethering, microneedling to rebuild collagen broadly, and PRP to enhance that regenerative response — form a well-matched combination specifically for this scar type.

Boxcar Scars — Where Structural Lift and Resurfacing Help

Because boxcar scars are defined depressions with a clear floor and edge, they respond to two different mechanisms depending on depth. Shallower boxcar scars often improve well with microneedling, which resurfaces and rebuilds collagen across the depression over a course of sessions. Deeper boxcar scars benefit more from dermal filler placed carefully into the depression, physically lifting the scar floor to match the surrounding skin level — though because filler is temporary, this is often paired with microneedling or PRP for a more lasting result underneath.

Icepick Scars — The Honest Limitation

This is the type our regenerative treatments genuinely struggle with. Because icepick scars extend narrow and deep, even subcision and microneedling — effective as they are for rolling and boxcar scars — often can't fully reach the base of a true icepick pit. This is a real biological limitation, not a marketing gap. While some improvement is still possible with a combined approach, deep icepick scars typically respond best to more specialized, targeted procedures assessed individually — and a provider who tells you this honestly upfront is more trustworthy than one promising a standard treatment will fully resolve them.

What's Not Actually a Scar (But Gets Called One Anyway)

Flat red or brown marks left after a breakout — post-inflammatory erythema and post-inflammatory hyperpigmentation — aren't scars at all. They're pigment and vascular changes that often fade with time, and they typically respond to a different approach than true atrophic scarring. Rejuran, alongside its regenerative benefits, has also been associated with improved tone and reduced discoloration — making it a reasonable option specifically for this category, separate from the structural scar types above.

Hypertrophic Scars — The Opposite Problem Entirely

Everything above is about atrophic scarring — too little collagen, leaving a depression. Hypertrophic scars (and keloids, a more severe variant) are the mechanical opposite: an excessive, disorganized collagen response that raises the scar above the surrounding skin, rather than sinking below it. This means none of the treatments above actually apply — you're not rebuilding lost collagen, you're calming an overactive healing response.

This is one of the more genuinely surprising findings in current scar research: Botox has real, evidence-backed benefit here. A 2024 systematic review of randomized controlled trials found botulinum toxin type A outperformed both corticosteroid injections and fluorouracil for improving hypertrophic scars and keloids, and separate research found combining corticosteroid with Botox produced better results than corticosteroid alone. The proposed mechanism is mechanical, not just chemical — reducing tension on the surrounding muscle appears to reduce the ongoing stress that keeps driving the scar's overactive healing response.

Because keloids in particular are notoriously prone to recurring even after treatment, more severe cases are often managed with a layered approach — which is why a proper assessment matters as much here as it does for atrophic scarring, rather than assuming one single treatment resolves it.

At Matrix Clinic, Botox is available under our Fine Lines & Wrinkles programme and can be discussed as part of a hypertrophic scar treatment plan during consultation.

The Real Takeaway

Improvement, not complete erasure, is the honest, realistic goal for atrophic acne scarring — well-matched treatment can make scarring substantially less noticeable, but deep icepick and boxcar scars in particular rarely disappear entirely. Anyone promising 100% clearance from a single treatment type isn't giving you an accurate picture. The real starting point isn't picking a trending treatment — it's identifying which scar types you actually have, since most people have more than one.

At Matrix Clinic, acne scarring is assessed individually under our Fine Lines & Wrinkles programme, using PRP, microneedling, subcision, Rejuran, and dermal filler matched to your specific scar pattern.

If you'd like a deeper look at PRP for skin specifically, see our full breakdown here.

Book a consultation here to find out what's actually causing your scarring, and what realistically helps.

This article is for general educational purposes and does not constitute medical advice. Individual results vary. Individual treatment plans should always be discussed with a qualified physician.