Types of Acne Scars, Boxcar, Rolling & Icepick scars

Acne vulgaris is the most prevalent skin condition in the United States, and the American Academy of Dermatology reports that up to 50 million Americans are affected yearly. Researchers estimate that one in five individuals with acne breakouts will develop an acne scar. Acne scars arise when the skin’s natural healing response generates an inappropriate amount of new collagen, either too much or too little, to repair the damage caused by inflammatory acne lesions. Treating acne scars can often be even more difficult than addressing the initial breakouts and, for many, may lead to feelings of self-consciousness or low self-esteem. Consulting with an experienced, board-certified dermatologist like Dr. Green in NYC is the best approach to creating a safe and effective acne scar treatment plan.

The two classifications for acne scars include atrophic and hypertrophic. Atrophic acne scars, also known as rolling, boxcars, and ice-pick scars, are depressions in the skin’s surface that develop when too little collagen is produced. Hypertrophic scars, including keloid scars, are raised scars that form when too much new collagen is produced. While not classified as true acne scars, dark spots known as post-inflammatory hyperpigmentation can also develop after inflammatory acne. No two individuals will develop scars in the same manner, and most patients with acne scars have a mixture of several types of acne scars, requiring a unique combination treatment approach to reduce their appearance successfully. Non-invasive treatment options include traditional and radiofrequency microneedling, subcision with dermal fillers, laser resurfacing, steroid injections, and chemical peels, depending on the acne scars present. When you consult with Dr. Green, she will assess your unique combination of acne scars and customize a treatment plan that leaves you with smooth, beautiful skin that lasts.

Dr. Michele Green is a board-certified cosmetic dermatologist and world-renowned expert in non-invasive treatment options, including lasers, dermal fillers, and chemical peels for acne scar treatment. In her boutique dermatology office in the Upper East Side neighborhood of Manhattan, she utilizes the most cutting-edge techniques and innovative technologies to reduce the appearance of acne scars in patients of all skin types and skin tones, providing long-lasting rejuvenation results. Castle Connolly, New York Magazine, Super Doctors, and The New York Times consistently identify Dr. Green as one of NYC’s best dermatologists for her dedication to her patients and expertise. Whether your acne scar treatment plan includes subcision with dermal fillers, chemical peels, microneedling, specially formulated skincare products, or laser resurfacing, Dr. Green will work with you to create a personalized treatment protocol that aptly addresses your unique concerns and leaves you with a clear, smooth, beautiful complexion that lasts.

What is an acne scar?

Acne scars develop when inflammation associated with an acne lesion causes irreparable damage to the underlying skin tissue. The skin then undergoes a natural wound-healing process to stimulate collagen production and try to repair the damage. Collagen is a protein essential for providing the skin with structure, firmness, and suppleness. Acne scars develop when insufficient or excess collagen production is produced. Atrophic or depressed scars form when too little new collagen is produced, while hypertrophic or raised scars form when too much collagen is produced. Dark spots left behind on the skin from acne lesions are called post-inflammatory hyperpigmentation (PIH). PIH is not an actual acne scar and occurs when the skin cells that produce pigmentation or skin color are overactive during the healing process.

Do all acne breakouts result in acne scars?

Not all acne breakouts will result in scarring. Inflammatory acne is the most likely type of lesion to cause scarring; however, any acne lesion may result in scarring. Nodules and cysts are severe acne lesions accompanied by a significant degree of inflammation. When these breakouts are left untreated, patients will likely develop acne scarring. In addition, picking at and popping pimples can exacerbate the inflammation associated with acne, significantly increasing the likelihood of scarring. It is essential to start treating acne breakouts with a board-certified dermatologist like Dr. Green as soon as they occur, as preventing an acne scar by treating the breakout is often much more straightforward than reducing the appearance of an acne scar after it has formed.

What are the different types of acne scars?

There are two main categories of acne scars: atrophic and hypertrophic. Atrophic acne scars are the most common type of acne scar. They develop when the skin’s natural wound-healing response produces insufficient new collagen, resulting in depressions or indentations in the skin. Depressions in the skin’s surface characterize these types of acne scars. The three types of atrophic scars are rolling, boxcar, and ice-pick. Hypertrophic scars are thick, firm, raised scars that occur when the skin’s natural wound-healing response produces too much new collagen. They commonly develop in response to a deeper wound. Hypertrophic scars typically affect areas of the body such as the chest, back, shoulders, and jawline. Acne scars can also vary in severity, ranging from macular to mild and moderate to severe. While not classified as an actual acne scar, post-inflammatory hyperpigmentation is often lumped together with acne scars, as these dark marks can be left behind after inflammatory acne lesions.

Rolling scars

Rolling scars are the shallowest atrophic scars that appear wavy, uneven, and rough-looking on the skin’s surface. Rolling scars do not have sharply defined borders but rather sloping edges. These scars get their name due to bands of scar tissue and fibrous tethers developing between the surface of the skin and the underlying subcutaneous tissue. The fibrous bands pull down on the epidermis, creating the rolling, wavy appearance of rolling scars. Rolling scars are typically several millimeters wide and most commonly affect areas of the face, such as the jawline and cheeks.

Boxcar scars

Boxcar scars are atrophic scars with a round or oval-shaped appearance, well-defined edges, and deep vertical sides. These scars often resemble chicken pox scars, as they are usually wider than other atrophic scars. Boxcar scars range from superficial to deep, depending on the amount of skin atrophy caused by the previous inflamed and infected acne lesions.

Ice-pick scars

Ice-pick scars are atrophic scars with deep, narrow, V-shaped indentations on the skin’s surface. Ice-pick scars are typically 2 mm wide or smaller, often resembling enlarged pores. This type of acne scar appears as though the skin was punctured with a sharp tool, such as an ice-pick. Ice-pick scars extend deep into the dermal layers of skin and are often caused by severe inflammation associated with nodular or cystic acne lesions. Due to their deep and narrow nature, ice-pick scars are known to be the most challenging acne scars to treat.

Hypertrophic scars

Normal hypertrophic scars appear as raised, growth-like lumps of scar tissue. They do not extend beyond the original wound and may regress independently. Normal hypertrophic scars can form approximately three times as much new collagen as typically produced during wound healing, creating new collagen fibers that develop in a uniform pattern and raise the lump.

Keloid scars

Keloid scars are a specific type of hypertrophic raised scar that usually grows larger than the initial wound. These scars may continue to grow after healing entirely and will not regress on their own. Keloid scars can produce up to 20 times as much new collagen, and the collagen fibers form in a random arrangement. Keloid scars are a type of raised scar that can be particularly challenging to treat, as removing them can stimulate new collagen production, causing them to recur. Some individuals are more prone to developing keloid scars than others due to a genetic predisposition to keloid scarring. Additionally, patients with darker skin tones are typically more susceptible to developing keloids than those with lighter skin tones. Treatment for keloid scars includes intralesional cortisone injections, silicone gel and sheets, and VBeam laser for associated pigmentation.

What is Post-inflammatory hyperpigmentation?

Post-inflammatory hyperpigmentation (PIH) is not considered true acne scarring as it does not cause irreparable damage to underlying skin tissue or is associated with impaired collagen production. PIH refers to the dark spots that may be left behind after an acne lesion or other inflammatory skin condition (such as a wound or a rash) heals. The color of the dark spots associated with post-inflammatory hyperpigmentation varies, appearing as brown, black, red, pink, or purple patches of skin, depending on the patient’s skin tone. During the natural healing process of the skin, there is potential that skin cells involved with healing the area are also contributing to the overproduction of melanin, leading to areas of concentrated hyperpigmentation. Although this type of hyperpigmentation may fade on its own, it can take a significant amount of time to fade fully without any cosmetic intervention.

How do dermatologists classify the different types of acne scars?

One system for evaluating the severity of acne scars is by using grades 1, 2, 3, and 4, which represent macular, mild, moderate, and severe acne scars, respectively. A grade 1 macular acne scar is a flat, smooth scar that doesn’t have texture but does have notable post-inflammatory hyperpigmentation. A grade 2 mild acne scar is only observable at a distance of less than 50 cm and can be covered with makeup. A grade 3 moderate acne scar is visible at a distance greater than 50 cm and can’t be covered with makeup. Manually stretching the skin can flatten a grade 3 scar. A grade 4 severe acne scar is evident from a distance and can not be easily covered. Manually stretching the skin will not flatten a grade 4 scar. No two patients will develop acne scars in the same manner, and most patients have a mixture of multiple grades and types of acne scars. An experienced board-certified dermatologist, such as Dr. Michele Green in NYC, has the expertise to treat acne scars in varying severities to improve their overall appearance and provide a smoother, clearer skin texture.

What kind of acne scars won’t go away?

Unfortunately, most acne scars are permanent and will not disappear without intervention. While dark spots associated with post-inflammatory hyperpigmentation have the potential to fade on their own over time, atrophic and hypertrophic scars are usually permanent. Acne scars frequently cause feelings of self-consciousness and low self-esteem, and the presence of acne scars can be a painful reminder of past breakouts. However, the appearance of acne scars can be significantly improved. Expert board-certified dermatologist Dr. Michele Green has over 25 years of experience providing some of the world’s most discerning individuals with the best personalized non-invasive acne scar treatment plans. By implementing a customized acne scar treatment plan unique to you and the types of acne scars you have, Dr. Green can significantly diminish the appearance of your scars and provide you with a smooth, clear, beautiful complexion that lasts. 

What are the best acne scar treatment options? 

Many safe and effective non-invasive treatment options for acne scars are available, including resurfacing lasers, subcision with dermal fillers, chemical peels, and microneedling. Since there are many types of acne scars and a given individual may present with more than one type, effective treatment of acne scars typically requires a combination approach. Internationally renowned board-certified dermatologist Dr. Michele Green is an acne and acne scar treatment expert in New York City. Dr. Green takes a holistic approach to acne scar treatment, customizing each patient’s treatment plan to include the best cosmetic procedures and specially formulated skincare products to achieve and maintain a smooth, healthy complexion.

Subcision with Dermal Fillers

Subcision is a minimally invasive cosmetic procedure for treating atrophic acne scars, mainly rolling and boxcar scars. During subcision, Dr. Green uses a sterile needle to break apart the scar tissue that tethers the top layer of the skin to its underlying layers. Dr. Green takes an innovative approach to subcision as an acne scar treatment by injecting dermal fillers into the depressions as she breaks up the scar tissue underneath. The dermal fillers restore volume to the areas affected by the depressed acne scars, which can not be achieved with the same effect as a subcision alone. Combining these two treatment options results in optimal results and a long-lasting, smooth complexion.

Dr. Green often uses Juvederm and Restylane, two hyaluronic acid fillers, to immediately restore volume to depressed acne scars. Depending on the exact filler used, Juvederm or Restylane results can last six to twelve months after a single treatment. Sculptra is a unique dermal filler product composed of poly-L-lactic acid that induces new collagen production in the skin. After an initial series of treatments, Sculptra results can last up to two years.

Fraxel Laser Treatment

The Fraxel Dual laser is a non-ablative, non-invasive cosmetic procedure that can improve the appearance of acne scars, fine lines, wrinkles, uneven skin texture and tone, sun damage, and discoloration. Dr. Green refers to Fraxel Dual as the “magic eraser” due to its unique ability to tackle many skin concerns, including acne scars. Fraxel can be operated at a 1550nm wavelength setting to treat textural irregularities, fine lines, and wrinkles or at a 1927nm wavelength setting to treat sun damage and pigmentation. Fraxel utilizes a fractional laser technology that allows the device to create precise, controlled microscopic wounds in the skin’s dermis. The natural wound-healing process is then stimulated, leading to the production of new collagen. When Fraxel is performed with the 1550nm wavelength setting, the result is a clear, smooth, even-textured complexion that lasts. Little to no downtime is required with Fraxel, as the laser only treats a fraction of the skin at a time while leaving the surrounding skin unaffected. Patients interested in reducing the overall appearance of their acne scars should expect to have a series of three to five Fraxel laser therapy sessions spread one month apart to achieve optimal cosmetic results. 

eMatrix Sublative Resurfacing Laser

The eMatrix sublative resurfacing laser is a non-invasive therapy that minimizes acne scars, fine lines and wrinkles, enlarged pores, and stretch marks. This laser resurfacing treatment uses bipolar radiofrequency energy to heat the dermis and stimulate new collagen production. Increased collagen levels in the skin will work to smooth out depressed acne scars and create a smoother, more even skin texture. As the epidermis is left untouched, there is little downtime associated with treatment, with patients typically experiencing mild redness that dissipates independently within 48 hours of treatment. The eMatrix laser is beloved by all as it is safe and effective for patients of all skin types and tones, including darker skin tones. Four to six treatments spaced one month apart are typically required to achieve the ideal cosmetic results.

VBeam Pulsed Dye Laser Treatment

The VBeam laser is considered the gold standard treatment for targeting skin redness, including that associated with acne inflammation. This laser operates on a wavelength of light that is selectively absorbed by skin cells with red pigment. The light is converted into energy and destroys the red pigment while leaving the surrounding structures of the skin unaffected. The VBeam laser is highly effective in treating post-inflammatory hyperpigmentation and red-pigmented acne scars. There is zero downtime involved with V-Beam treatment, meaning you can resume regular daily activities immediately after the procedure. As a bonus, the VBeam utilizes patented dynamic cooling technology to cool the skin directly before and after each laser pulse, maximizing patient comfort. Typically, patients undergo a series of four to six treatment sessions spaced one month apart to achieve the best cosmetic results.

Trichloroacetic acid (TCA) Chemical Peels

Trichloroacetic acid (TCA) peels are among the most common chemical peels for acne scars. TCA peels work to exfoliate the skin, sloughing off dead skin cells to bring healthy, bright, smooth cells to the skin’s surface. These chemical peels can also stimulate the generation of new collagen to smooth out acne scars and create a more even skin texture. TCA peels are available in various strengths and are especially effective against acne scars, hyperpigmentation, and acne. TCA peels require multiple treatment sessions to see effective cosmetic results. TCA peels are better suited to patients with fair to light skin tones, as patients with medium to dark skin tones are at higher risk for experiencing hypo- or hyperpigmentation as a side effect.

TCA Cross

In a method known as TCA cross, a very high concentration of TCA is placed directly into an atrophic scar. The TCA produces a “frost,” an immediate whitening of the area that encourages peeling over several days. TCA cross is best suited for treating medium to deep ice-pick scars. Following this procedure, strict sun avoidance and adamant use of sunscreen are essential to avoid hyperpigmentation of the treatment area. Having your TCA cross performed by a board-certified dermatologist is crucial, as an inappropriate technique or selection of TCA strength can result in hyperpigmentation, hypopigmentation, or scarring.

Mesopeels

Mesopeels are specially designed chemical peels used to treat hyperpigmentation. These peels contain lightening agents such as tranexamic acid, kojic acid, and azelaic acid to gently chemo-exfoliate the skin and slough off dead, pigmented skin cells. Mesopeels can also inhibit and control melanocyte activity, reducing melanin or pigment production. No downtime is required with Mesopeel treatment, and patients can look forward to an improved and more even skin tone with each treatment. Additionally, patients of all skin tones, including darker skin tones, can benefit from Mesopeel treatment without the risk of hyperpigmentation. Like other chemical peels, multiple treatment sessions are needed to obtain the best cosmetic results.

Microneedling collagen induction therapy

Microneedling, or collagen induction therapy, is a non-invasive cosmetic procedure to improve the skin’s tone and texture. A microneedling treatment entails the application of ultra-fine needles to the surface of the skin to create controlled skin injury. This process stimulates the generation of new elastin and collagen within the skin as it heals itself. This treatment can be highly beneficial for patients seeking to reduce the appearance of textural irregularities in the skin from atrophic acne scars and fine lines, wrinkles, enlarged pores, and pigmentation. Patients typically undergo a series of three or more treatment sessions for acne scar treatment.

Many patients in Dr. Green’s office wonder, “Does microneedling help acne scars?” The answer is yes! Through increased collagen production and skin cell renewal, microneedling can smooth the skin and improve skin texture and tone. Another incredible feature of microneedling is that the microchannels created in the skin can increase the absorption of topical serums. Dr. Green often suggests that her patients take advantage of this by adding platelet-rich plasma (PRP) to their microneedling treatments. PRP contains a tremendous supply of epidermal growth factors and proteins that can further enhance the skin rejuvenating effects of microneedling. PRP is derived from the patient’s blood, making it 100% safe to add to the microneedling procedure. In addition to PRP, patients experiencing post-inflammatory hyperpigmentation can benefit from adding a specially formulated depigmentation serum to eliminate pigmentation and create a more even skin tone.

Vivace Radiofrequency Microneedling

Vivace is an innovative cosmetic procedure that combines two popular forms of skin rejuvenation therapy- radiofrequency technology and microneedling- to improve atrophic acne scars, skin tone, elasticity, and texture. Vivace treatment simultaneously utilizes microneedling to create micro-injuries in the epidermis with tiny needles and radiofrequency to heat the dermis gently. This combination approach maximizes new collagen production in multiple layers of skin, providing optimal rejuvenation without downtime. RF Microneedling is commonly used to treat acne scars, fine lines, large pores, stretch marks, hyperpigmentation, sun damage, and mild skin laxity. Vivace RF microneedling is a safe and effective cosmetic treatment option for patients of all skin tones and skin types, including individuals with sensitive skin types and darker skin tones, who are more susceptible to developing side effects of skin irritation and hyperpigmentation. Like regular microneedling, three or more treatment sessions are often best for optimal cosmetic results.

Microdermabrasion for acne scars

Microdermabrasion is a non-invasive procedure that gently removes the top layer of dead and damaged skin cells to reveal a fresher, healthier-looking complexion underneath. It can utilize a micro-crystal spray or a diamond-tipped handpiece to exfoliate the epidermis, stimulate collagen production, and address uneven skin tone and texture. Microdermabrasion is best used for treating mild textural atrophic acne scars, and multiple treatments are required to achieve the best results.

Dermabrasion for acne scars

Dermabrasion is a more aggressive version of microdermabrasion that involves completely removing the superficial layers of the skin to trigger the growth of new, healthy skin cells and collagen underneath. Typically, it is performed by a physician using a handheld device to “sand” away the epidermis and upper layer of the dermis using a high-speed rotating wheel layered with wire brushes. Dermabrasion requires local or general anesthesia and approximately two weeks of downtime. Dermabrasion results are more dramatic than microdermabrasion, although there is a greater risk of unwanted side effects, such as infection, permanent changes in skin color, and scarring.

Cortisone injections for treating hypertrophic acne scars

Intralesional cortisone injections are one of the best treatment options for reducing the appearance of hypertrophic acne scars. These steroid injections are highly effective for flattening raised scars and keloids and shrinking active acne lesions and cysts. Generally, a series of injections are needed to flatten hypertrophic scars successfully. For keloid scarring, patients can expect up to 50-80% of their keloid scars to respond to cortisone injection treatment. Dr. Green recommends intralesional cortisone injections over cryotherapy for hypertrophic and keloid scars due to their decreased risk of unwanted side effects after treatment.

Cryotherapy for hypertrophic scarring

Cryotherapy is a non-invasive procedure that entails the controlled application of extreme cold to a hypertrophic scar to destroy it. Typically, liquid nitrogen is used to freeze hypertrophic or keloid scars upon contact to reduce the size. Scabbing and blistering can be shared after the procedure, and proper wound care should be performed to minimize adverse side effects. Cryotherapy is not recommended for patients of darker skin tones due to the high risk of scarring, hyperpigmentation, or hypopigmentation post-treatment. Additionally, patients with a family history or predisposition to keloid scarring should not undergo cryotherapy, as the procedure can potentially cause new keloids to form.

Punch excision for deep ice-pick scars.

Punch excision involves performing a small excision of the scar using a punch biopsy tool. After the scar is surgically removed, the wound is sutured or glued together and allowed to heal. Punch grafting involves taking a skin graft from behind the ear and using it to close the defect in the skin. This procedure is usually reserved for profound and more extensive scars and should only be performed by a board-certified professional.

What is the best skincare routine to complement acne scar treatments?

A proper skincare routine is essential to maintaining and enhancing the results of acne scar treatments. Targeted skincare products can also treat textural irregularities and pigmentation left behind from old acne lesions. Dr. Green’s proprietary skincare line, MGSKINLABs, was specially formulated with active ingredients to treat a wide range of skin concerns, from acne scars and post-inflammatory hyperpigmentation to fine lines and wrinkles. Dr. Green can help you create a unique skincare routine suited for your skin type, tone, and specific concerns to rejuvenate the skin and create a smooth, healthy complexion.

Retinol and retinoids are the most effective topical products for treating acne scars. These products are derived from vitamin A and work to stimulate new collagen production and accelerate skin cell turnover rate. Retinol and retinoids gently exfoliate the skin, removing dead, pigmented skin cells from the skin’s surface to create a clearer, smoother skin complexion. Retinol can be found over the counter in various creams and serums. The Essential Antioxidant Infusion from MGSKINLABs contains retinol and essential vitamins and nutrients to rejuvenate the skin. Patients with severe acne scars may benefit from tretinoin or Retin-A, retinoids higher in strength than retinol that can only be obtained through a prescription by a board-certified dermatologist. Proper sun protection should be practiced with retinol and retinoid usage, as these products increase the skin’s sensitivity to the sun.

Patients experiencing post-inflammatory hyperpigmentation can benefit from prescription hydroquinone. Hydroquinone is a skin-bleaching ingredient that lightens hyperpigmentation. It can be prescribed in varying strengths depending on the patient’s skin tone and the severity of the pigmentation. Like retinol and retinoids, hydroquinone is a photosensitizing agent and should only be used with sunscreen and proper sun protection.

Vitamin C is a powerful antioxidant that offers a wide range of benefits to the skin, including reduced pigmentation, increased skin cell renewal, and improved texture. MGSKINLAB’s Vita-C serum contains highly potent vitamin C to rejuvenate the skin and protect it from oxidative stress and free radical damage. The Skin Brightening Cream from MGSKINLABs is another excellent product for gently reducing pigmentation and post-inflammatory hyperpigmentation. The Vita-C serum and the Skin Brightening Cream do not contain hydroquinone, allowing patients to use it twice daily and in the sun without any risk of irritation.

Sunscreen is the most crucial skincare product in any skincare routine. Sunscreen works to protect the skin from harmful UV rays, which can damage collagen fibers and result in a worsened appearance of acne scars and other skin concerns. It is imperative to apply sunscreen after lasers or chemical peels and when using retinol, retinoids, or hydroquinone to prevent adverse side effects. A broad-spectrum sunscreen with an SPF of 50 protects against UVA and UVB rays. The Hydrating SPF 50 from MGSKINLABs contains zinc oxide to create a barrier against the sun’s rays and hyaluronic acid to keep the skin hydrated and supple.

eMatrix for Acne Scars – 2 weeks

FAQs about the different types of acne scars

What type of acne leaves the most scars?

Any acne lesion can leave acne scars, depending on the inflammation associated with the breakout and the propensity of an individual to scar. However, some breakouts are more likely than others to cause acne scarring. Inflammatory acne breakouts that present as cysts, pustules, or nodules are more likely to leave behind scars than non-inflammatory acne, such as blackheads or whiteheads. Cystic and nodular lesions penetrate greater depths of skin tissue, causing irreparable damage to underlying layers. Untreated acne can result in significant acne scarring, which can be even more challenging to treat than the initial breakouts themselves. When a breakout occurs, the best way to prevent and treat acne scars is by consulting an experienced board-certified dermatologist like Dr. Michele Green.

Which type of acne scar is the most common?

The most common type of acne scar that patients experience is atrophic scarring. Atrophic scars occur when inflammation causes irreparable damage to underlying skin tissue, resulting in insufficient collagen production during healing. Atrophic scarring can also result in volume loss, either in the depression or diffuse hollowing and volume loss across an area.

How do I know what kind of acne scar I have?

An acne scar falls into one of two categories: hypertrophic or atrophic acne scars. Hypertrophic scars are thick raised scars that develop when too much new collagen is produced during wound healing. Atrophic scars include ice-pick, boxcar, and rolling scars, and they develop when insufficient collagen is made during the wound-healing process. Dermatologists can identify an acne scar by observing the characteristics of the skin after a pimple has healed. The best way to understand which types of acne scars you have and how to treat them properly is by consulting an experienced board-certified dermatologist, such as Dr. Michele Green, in New York City. Dr. Green is a world-renowned dermatologist with over two and a half decades of experience providing the best non-invasive acne scar treatments for all types of acne scars. When you consult Dr. Green at her private dermatology office in Manhattan’s Upper East Side neighborhood, she will assess your acne scars and create a customized acne scar treatment plan that best suits your unique needs and aesthetic goals.

Which acne scar type is easiest to treat?

Rolling scars are the type of acne scars that are considered the easiest to reduce in appearance. Rolling scars are relatively shallow and soft, so they typically respond well to many kinds of treatments. Rolling scars tend to form in response to long-term acne breakouts rather than deep, infected cystic acne lesions. Many patients have some unique combination of different kinds of acne scars, and successfully reducing the appearance of acne scars requires a combination treatment approach and a series of sessions with an experienced, board-certified dermatologist, such as Dr. Michele Green in NYC. Rolling scars are often treated with laser resurfacing, traditional and radiofrequency microneedling, and subcision with dermal fillers.

What is the most challenging acne scar to treat?

Many patients in Dr. Green’s office ask, “Which acne scar is hard to remove?” The most complex type of acne scar to treat is the ice-pick scar. Ice-pick scars are a type of atrophic acne scar. Ice-pick scars are deep, narrow, v-shaped scars that develop when the skin does not produce enough new collagen during the natural wound healing process following a breakout. Ice-pick scars are most likely to develop from cystic acne. The unique characteristics defining an ice-pick scar make it the most difficult to treat. Successfully reducing the appearance of ice-pick scars requires a combination treatment approach and a series of sessions with an experienced, board-certified dermatologist, such as Dr. Michele Green in NYC. Some of the most popular ice-pick acne scar treatment options include laser treatments and chemical peels. In severe cases, punch excision or punch grafting may be recommended.

Are there any home remedies for acne scars?

Acne scars are formed from irreparable damage to underlying skin tissue. Home remedies are often ineffective in treating acne scars, as they cannot penetrate deep into the skin to affect collagen production. The most effective treatment for acne scars is typically a combination of non-invasive cosmetic procedures and specially formulated skincare products. It is always recommended to consult with a board-certified dermatologist, such as Dr. Michele Green in NYC, for acne scar treatment. Whether depressions or raised growth-like lesions, reducing the appearance of textural acne scars safely and effectively requires professional treatment from an experienced board-certified dermatologist, such as Dr. Michele Green in NYC.

What do depressed acne scars look like?

Depressed or atrophic scars look like small indentations on the skin’s surface. There are three different ways in which depressed acne scars can appear. Some depressed acne scars are rolling scars, appearing as shallow indentations with wavy, undefined borders and sloping edges. Boxcar scars are broad, rectangular-shaped depressions with well-defined boundaries. Ice-pick scars are the last type of depressed acne scars and appear as deep, narrow V-shaped indentations in the skin.

What scars do permanent pimples look like?

Permanent pimple scars can appear as depressions or thick, raised, growth-like lesions on the skin’s surface. No acne scar appears the same, and patients often have many acne scar types. While these permanent scars will not go away on their own, treatment by a board-certified dermatologist like Dr. Green can expedite the healing process and quickly result in a clear, even-toned complexion. 

What are the worst types of acne scars?

No one type of acne scar is the worst, as both atrophic and hypertrophic acne scars produce irreparable, permanent damage to underlying skin tissue. However, the answer is typically ice-pick scars when asking which acne scars are most challenging to remove. Ice-pick scars are V-shaped depressions in the skin’s surface that develop due to insufficient collagen production. Their deep, narrow nature can make them more resistant to superficial lasers and chemical peels and incredibly hard to treat. Punch excision or punch grafting may be recommended for severe, deep, ice-pick scars. Expert board-certified dermatologist Dr. Michele Green has over 25 years of experience treating ice-pick scars and other types of acne scars and will create an acne scar treatment plan to help you achieve smooth, more evenly textured skin.

Are acne scars unattractive?

Many patients wonder, “Are acne scars a turnoff or unattractive?” The answer is no! Acne scars should not define anyone’s appearance, although they can induce frustration and self-consciousness. While acne scarring creates permanent skin tissue damage, its appearance can be significantly reduced and improved with various cosmetic procedures, including laser therapies, chemical peels, traditional and radiofrequency microneedling, and subcision with dermal fillers.

What fades acne scars?

Dark acne scars, also known as post-inflammatory hyperpigmentation, develop from excess melanin production and accumulation where previous inflammatory acne lesions once were. While these pigmented marks can be unsightly, they are not true acne scars and often disappear independently with time. However, it can take considerable time for the pigmentation to lighten without intervention. To treat post-inflammatory hyperpigmentation, Dr. Green frequently utilizes a combination of chemical peels, microneedling with depigmentation serum, and targeted skin-lightening products to treat post-inflammatory hyperpigmentation and create a clear, even-toned complexion.

Does salicylic acid remove acne scars?

Yes! Salicylic acid is a beta hydroxy acid that gently exfoliates the skin, removing dead skin cells to allow healthy new skin cells to come to the skin’s surface. Salicylic acid can penetrate pores to break apart sebum and other impurities. With frequent use, salicylic acid can soften acne scars and reduce pigmentation for a more even skin texture and tone. Salicylic acid can be found in various cleansers, creams, and serums.

Can you 100% remove acne scars?

Unfortunately, it is not possible to 100% remove acne scars. Acne scars develop when the inflammation from acne lesions damages the underlying skin tissue. While post-inflammatory hyperpigmentation can fade over time, atrophic and hypertrophic scars are typically permanent. It is possible, however, to reduce the appearance of hypertrophic and atrophic acne scars with various cosmetic treatment options available at Dr. Michele Green’s private boutique dermatology office in Manhattan’s Upper East Side neighborhood. Dr. Green is a board-certified dermatologist with over 25 years of experience providing some of the world’s most discerning individuals with the best personalized non-invasive acne scar treatment plans. When you consult with Dr. Green for acne scar treatment, she will collect a thorough medical history, review any previous cosmetic treatments you may have had for scars, and physically assess the treatment area to determine which combination of treatment options will provide you with a clear, smooth, healthy complexion that lasts.

How do you get started with removing acne scars today?

Acne scars can be challenging to treat and, for many, may induce feelings of self-consciousness or low self-esteem. Various acne scars exist, including atrophic or depressed and hypertrophic or raised scars. Post-inflammatory hyperpigmentation can also develop as a result of inflammatory acne lesions. Most patients with acne scars have several types, requiring a unique combination treatment approach to reduce their appearance successfully. Popular acne scar treatment options include resurfacing lasers, microneedling, subcision with dermal fillers, and chemical peels due to their ability to reduce the appearance of acne scars with little to no downtime or side effects. With so many treatment options available, knowing which ones suit your acne scars, skin type, and tone can be challenging. An expert in cosmetic dermatology, such as Dr. Green in NYC, can work with you to create a customized acne scar treatment plan to address your scars and provide a healthy, smooth, clear, beautiful complexion that lasts.

Dr. Michele Green in New York City is an internationally renowned board-certified cosmetic dermatologist with over two and a half decades of experience, providing some of the most discerning individuals worldwide with the best non-invasive treatment options for acne scars and other skin concerns. Dr. Green takes a holistic approach and embraces a less-is-more philosophy regarding facial rejuvenation, providing natural-looking and long-lasting cosmetic results by customizing each patient’s treatment plan according to their specific skin condition, needs, and aesthetic goals. She is consistently recognized as one of NYC’s best dermatologists by Castle Connolly, Super Doctors, New York Magazine, and The New York Times for her dedication to her patients and expertise. When you consult with Dr. Green at her private dermatology office in Manhattan’s Upper East Side neighborhood, she will work with you to create a customized acne scar treatment plan best suited to your skin type, skin tone, and the types of acne scars present. To start treating your acne scars, call 212-535-3088 or contact us online to schedule a consultation with Dr. Green.