Acne scars are one of the most common longer-term skin concerns dermatologists address, and effective treatment depends heavily on which type of scarring you actually have. Many patients try the same approach for years without improvement simply because they never had the scar type correctly identified.
The Main Types of Acne Scars
According to the American Academy of Dermatology, acne scars generally fall into a few categories: icepick scars (narrow, deep pits that look like small puncture marks), boxcar scars (broader depressions with defined, angular edges), rolling scars (shallow, wave-like depressions caused by fibrous bands tethering the skin below), and post-inflammatory discoloration (red or brown marks that aren't true scars but often get lumped in with them since they follow the same breakouts).
Why the Distinction Matters
Textural scars (icepick, boxcar, rolling) involve actual tissue damage and collagen changes, while discoloration is purely pigment-based and resolves differently — often on its own over several months, or faster with topical brightening agents and sun protection. Treating the wrong type with the wrong tool wastes time and money, which is why an accurate diagnosis up front matters more with acne scarring than with almost any other skin concern.
How to Tell Your Scar Types Apart
Icepick scars are the deepest and narrowest, often visible as small dark pits, particularly on the cheeks and forehead. Boxcar scars have more defined, box-like edges and vary in depth. Rolling scars create a wave-like, undulating texture across broader areas of skin rather than discrete pits, and are often more noticeable in certain lighting. Many patients have a combination of two or more types, which is why a treatment plan often needs to address multiple textures rather than a single scar type.
Treatment Options
RF Microneedling: Combines microneedling with radiofrequency energy to remodel scar tissue and stimulate new collagen from within — often the most effective option for rolling and boxcar scars, since it works on the fibrous bands and collagen structure beneath the visible depression.
Laser Resurfacing: Resurfaces the skin's surface layer to smooth texture and stimulate collagen, well suited to broader textural irregularity and some boxcar scarring, particularly when combined with treatment for accompanying discoloration.
Icepick scars, being the deepest and narrowest, are sometimes addressed with more targeted techniques such as punch excision in combination with resurfacing, since their depth and shape make them less responsive to surface-level treatment alone.
How Many Sessions Will You Need?
Most patients see gradual improvement over a series of sessions spaced weeks apart, as collagen remodeling continues for months after each treatment. A typical treatment course often involves three to six sessions, though this varies significantly based on scar depth, type, and how your skin responds. Because collagen remodeling is a gradual biological process, results continue to improve for months after the last session in a series.
Can Acne Scars Be Completely Removed?
Most acne scar treatments produce meaningful improvement rather than complete elimination, particularly for deeper icepick and boxcar scars. Setting realistic expectations at the outset — significant improvement in texture and visibility rather than a perfectly smooth surface — helps patients feel satisfied with results that are genuinely successful by clinical standards.
Frequently Asked Questions
Can acne scars be treated while I still have active breakouts?
Generally, active acne should be brought under control first, since ongoing breakouts can create new scarring during the same period you're treating old scars.
Is RF microneedling painful?
Most patients tolerate it well with topical numbing cream applied beforehand; discomfort is generally mild to moderate.
How long between sessions is ideal?
Sessions are typically spaced several weeks apart to allow adequate healing and collagen remodeling between treatments.
Will my scars come back after treatment?
No — the improvement to existing scar tissue is permanent, though new scarring can form from future breakouts if acne isn't controlled.
What's the difference between treating scars and treating dark marks from acne?
Dark marks (post-inflammatory hyperpigmentation) are pigment-based and often fade with topical treatment and time, while true scars involve textural change and generally need RF microneedling or resurfacing.
Get a Personalized Scar Treatment Plan
Dr. Karp will identify your specific scar type and recommend the most effective approach. Learn more about RF Microneedling and Laser Resurfacing in NYC.