“What’s the best treatment for acne scars?” is a common question, but it assumes acne scarring is one thing. It isn’t. A scar left by a deep cystic breakout looks and behaves differently at the tissue level than a shallow, saucer-shaped depression or a flat brown mark left behind after a pimple heals. Each of those needs a different approach, and a treatment that works well on one type can do very little for another.
The more useful starting point is matching the treatment to the physical structure of the scar rather than chasing whichever option is trending. This post breaks down the four categories of post-acne scarring, what makes each one structurally distinct, and which modalities have the clearest evidence behind them for each. That distinction matters for anyone in Las Vegas researching acne scar treatment, since Las Vegas’s sun exposure and desert air can make textural scarring and lingering discoloration more noticeable year-round.
Four Main Types of Acne Scarring and Their Treatment Needs
Most acne scarring falls into a category called atrophic scarring, meaning the skin loses tissue during healing and sits lower than the surrounding surface. (Raised, tissue-excess scarring, called hypertrophic or keloid scarring, is far less common from acne and is treated differently than what’s covered here.) Atrophic scarring breaks down into three structural sub-types, plus a fourth category that isn’t textural at all.
Ice pick scars
Narrow, sharply defined tracts, typically under 2 millimeters wide, that extend deep into the dermis or even the layer beneath it. They tend to look like small punctures rather than broad depressions and are the most common type of atrophic acne scarring.
Boxcar scars
Wider than ice pick scars, with sharp vertical edges and a flatter base, giving them a somewhat rectangular shape when viewed up close. They sit shallower in the skin than ice pick scars, which matters for how they respond to treatment.
Rolling scars
Broad, sloped depressions caused by fibrous bands beneath the skin’s surface that tether the skin to deeper tissue, pulling it down and creating an undulating, wave-like texture across the treated area.
Post-inflammatory hyperpigmentation and erythema
Flat discoloration left behind after an inflamed acne lesion heals, not a textural change in the skin at all. Post-inflammatory hyperpigmentation (brown or tan marks from excess melanin production) and post-inflammatory erythema (pink or red marks from persistent dilated blood vessels) are frequently mistaken for scarring, but neither responds to the treatments that address texture.
A patient can have more than one of these categories at once, which is one reason a generic “acne scar treatment” recommendation often falls short of expectations.
Treatment Approaches for Deep Ice Pick Scars
Because ice pick scars extend so deep and are so narrow, surface-level treatments like standard microneedling or resurfacing alone frequently can’t reach the base of the tract, which limits how much improvement they can deliver on their own.
The treatment with the most consistent support in dermatology literature for this scar type is a technique called TCA CROSS (chemical reconstruction of skin scars). A provider applies a high concentration of trichloroacetic acid precisely to the floor of each individual scar, which triggers a focused, localized inflammatory response and encourages the body to rebuild collagen from the bottom of the tract upward. Clinical research on this technique has reported meaningful depth reduction after a series of sessions spaced over several months, though the degree of improvement depends on the scar’s original depth, the patient’s skin, and the number of sessions completed.
For very deep, narrow tracts, a provider may recommend punch excision, a minor surgical technique that removes the scar tissue directly, sometimes as a first step before resurfacing is used to blend the treated area with surrounding skin.
Ice pick scars generally require more sessions and more patience than other scar types. Individual results vary, and no provider can guarantee a specific level of improvement or a fixed number of sessions before results become visible.
Treatment Options for Boxcar and Rolling Acne Scars
Boxcar and rolling scars share a treatment toolkit, but the right combination depends on the specific scar.
Boxcar scars, being shallower with a defined edge, tend to respond well to fractional laser resurfacing, which works by removing controlled layers of skin and stimulating new collagen production in the treated area. Deeper boxcar scars sometimes benefit from subcision first, a technique that uses a fine needle or cannula beneath the skin to release any fibrous tethering, followed by resurfacing or a dermal filler to help lift and smooth the scar floor.
Rolling scars are caused by fibrous bands pulling the skin down from beneath, so the more direct approach is subcision, which severs those bands and allows the depressed skin to release upward. Patients sometimes notice initial improvement after their first one or two sessions, though the fuller effect tends to develop over the following months as the treated tissue settles.
Microneedling, with or without a PRP (platelet-rich plasma) add-on, is also well-supported for rolling scars because it works by stimulating collagen remodeling across a broader treated area rather than needing to reach deep tissue directly. A meta-analysis pooling more than a dozen studies and hundreds of patients found that adding PRP to microneedling produced significantly greater improvement in acne scarring than microneedling alone, without a meaningful increase in side effects. Readers weighing that specific decision can find a fuller breakdown in our comparison of microneedling with and without PRP. Microneedling also comes in a radiofrequency-assisted version aimed primarily at skin laxity rather than scar texture; the difference is covered in our RF microneedling vs. traditional microneedling comparison.
Many patients present with a mix of boxcar and rolling scarring, or all three atrophic types together, which is why combination protocols, such as subcision paired with resurfacing or TCA CROSS paired with microneedling, tend to produce more consistent results than a single technique used alone.
Treatment Options for Post-Inflammatory Hyperpigmentation and Erythema
Post-inflammatory hyperpigmentation and post-inflammatory erythema are not texture problems, so texture-focused treatments like subcision or dermal filler do very little for them. Treating discoloration requires a different mechanism altogether.
For hyperpigmentation, chemical peels containing glycolic or lactic acid are commonly used because these acids help inhibit the enzyme responsible for excess melanin production. Pigment-targeting laser devices are another option. Patients with more melanin-rich skin benefit from a provider who selects gentler, more conservative protocols for this category specifically, since overly aggressive pigment treatments can occasionally trigger more discoloration rather than resolving it. A closer look at how peels address this specific concern is available in our guide to chemical peels for hyperpigmentation.
For erythema, the persistent redness comes from dilated blood vessels rather than pigment, so it responds to vascular-targeting approaches instead of the pigment-focused treatments used for hyperpigmentation. Because the underlying cause is different, a treatment plan built around pigment correction typically won’t resolve residual redness, and vice versa.
Distinguishing between these two categories, and distinguishing both from textural scarring, is part of what a proper skin assessment is for.
The Importance of an Accurate Acne Scar Diagnosis
Because ice pick, boxcar, rolling, and pigment-based scarring often look similar to an untrained eye and frequently overlap in the same patient, a skin analysis by a licensed provider is the starting point for any post-acne scarring plan. A board-certified provider examines the scar pattern, skin type, and history of breakouts before recommending a specific modality or combination of modalities. For more on what that evaluation involves, see our overview of a professional skin analysis.
At Blue Point Medical Spa, the Acne Bootcamp program is designed for patients working through both active breakouts and the scarring left behind by past ones, since ongoing acne and old scarring are often addressed together rather than as separate problems. Patients still managing active breakouts may also want to review the difference between cystic and hormonal acne treatment approaches, since scar prevention starts with getting active acne under control, and readers exploring options more broadly can start with our guide to adult acne treatment in Las Vegas.
Individual results vary based on scar depth, skin type, treatment history, and how consistently a patient completes a recommended series. No provider can guarantee a specific outcome or timeline, and most scar-revision protocols involve multiple sessions spaced over several months rather than a single visit.
FAQ
Can different types of acne scars be treated at the same time?
Yes. Many patients have a combination of ice pick, boxcar, rolling, and pigment-related marks. A provider may recommend a combination treatment plan, such as subcision with resurfacing, TCA CROSS with microneedling, or pigment-focused treatments alongside texture correction, depending on the scar pattern and skin type.
How many sessions are usually needed for acne scar treatment?
The number of sessions depends on the type and depth of the scars, the treatment selected, the patient’s skin, and how the tissue responds over time. Most acne scar treatment plans involve multiple sessions spaced over several months rather than a single appointment. Individual results vary.
Can acne scars be completely removed?
Acne scar treatments are designed to improve the depth, texture, and appearance of scarring, but complete removal cannot be guaranteed. Some scars respond more noticeably than others, and combination treatments are often needed when several scar types are present. A licensed provider can set realistic expectations after evaluating the skin in person.
Conclusion
Acne scars do not all respond to the same treatment. Ice pick scars, boxcar scars, rolling scars, hyperpigmentation, and erythema each involve different changes in the skin, which is why an accurate diagnosis is essential before choosing a treatment.
The most effective plan may include one approach or a combination of treatments, such as TCA CROSS, subcision, microneedling, PRP, laser resurfacing, chemical peels, or pigment-focused care. Matching the treatment to the scar type helps avoid wasted time, unnecessary procedures, and unrealistic expectations.
At Blue Point Medical Spa, a licensed provider can evaluate your scar pattern, skin type, treatment history, and current breakouts to create a personalized plan focused on meaningful, gradual improvement.
Schedule an appointment with Blue Point Medical Spa to receive a professional acne scar assessment and learn which treatment options are best suited to your skin.
