Acne Scars 101: Types and What Can Change Texture
Which Treatment
Acne scars · 101
If acne has left your skin uneven, you've probably seen words like "icepick," "boxcar" and "rolling" and wondered which one you have. It matters, because different scar types respond to different approaches, and some need a dermatologist rather than a facial studio.
Here's a plain-language guide to the main types, how to tell a mark from a scar, what research says can change texture, and how we approach it at our Henderson studio. One honest note up front: scars are individual, and nobody can promise how yours will respond. That's why we always start with a consult.
Not sure what you're looking at?
01Marks vs. scars: color vs. texture
Not every spot left behind by a breakout is a scar. Flat dark or red marks are changes in color. The American Academy of Dermatology (AAD) notes that when an acne scar first appears you may see an indent or a raised area along with some discoloration, and it covers post-inflammatory hyperpigmentation (PIH), the dark marks acne can leave, separately from scars.
A quick way to think about it: if you run a fingertip over the area and it's flat, you're likely looking at a mark. If it dips below the surface or rises above it, that's texture, and that's what this post is about.
02The main types of acne scars
According to the AAD, most people who develop acne scars get depressed (sunken) scars. Dermatology reviews sort those into three main types:
- Icepick scars. Narrow, deep and sharply defined, often described as a "V" shape. A widely cited review in the medical literature describes them as extending deep into the skin, which is why they're hard to reach with surface treatments.
- Boxcar scars. Round or oval depressions with sharp, vertical edges, wider at the surface than icepick scars and more like a "U" shape. They can be shallow or deep.
- Rolling scars. Broader dips with sloped edges that give the skin a wavy, undulating look ("M" shape). They happen when bands of tissue under the skin tether the surface down.
Less often, acne leaves raised scars (hypertrophic or keloid scars). Those are a dermatologist's territory.
Many people have more than one type at once, which is one reason a one-size plan rarely makes sense.
03What can change texture
Here's what the research and dermatology sources describe. None of these is a promise for your skin.
Microneedling. The AAD lists microneedling among dermatologist treatments for depressed acne scars and notes it is safe for all skin tones. Cleveland Clinic explains that because microneedling goes deeper than microdermabrasion, it may work better for concerns beneath the surface, such as acne scars, and that most people need multiple treatments spaced weeks apart. The AAD also notes it's often combined with other treatments.
At Beyond, microneedling starts at $350 per treatment. Most people see some redness for a few days afterward, and we ask you to skip exfoliants, retinoids, saunas and hard workouts for a few days. We plan any series around your skin at the consult, not in advance.
Chemical peels. The AAD notes that a chemical peel helps the body produce more collagen and elastin and lists peels among treatments for depressed scars. A narrative review in JMIR Dermatology describes peels as flexible and lower cost, while warning that stronger peels carry a risk of dark marks, especially in darker skin. Our chemical peels start at $200, with 0–3 days of downtime, and we choose the peel type after assessing your skin.
Procell microchanneling. For guests who want a gentler starting point for texture, we also offer Procell, starting at $450. Our post on Procell vs microneedling compares the two.
04Why scar type matters
The 2024 ASAP consensus paper on acne scar management puts it simply: classifying the scar type is crucial because it shapes which options make sense. It notes that icepick scars are difficult to treat with conventional resurfacing, that rolling scars need treatment beneath the skin because of the tethering, and that shallow boxcar scars respond better to resurfacing than deep ones.
In practice, that means two people with "acne scars" may need very different plans, and some scars won't change much with studio treatments at all.
05When a dermatologist is the right call
We'll tell you if we think you'd do better with a physician. That includes deep icepick scars, raised or keloid scars, and scars that may need procedures like subcision or punch techniques, which medical reviews describe for rolling and icepick scars. The same goes for anyone who still has active, inflamed acne: treating the acne comes first, and the JMIR review notes that early, effective acne treatment is the main way to prevent or limit scarring.
06How we start: a consult
Our Licensed Advanced Estheticians look at your scar types, your skin tone and your history before suggesting anything. We'll explain what we think can change your texture, what probably won't, and whether a referral makes more sense. Daily broad-spectrum sunscreen is part of every plan in Las Vegas sun.
Start with a Free Skin Analysis, online from your phone, no visit needed. Or book now, or call (702) 408-6891.
07FAQ
What are the different types of acne scars?
Most acne scars are depressed. Dermatology reviews group them into icepick scars (narrow and deep), boxcar scars (round or oval with sharp edges) and rolling scars (broad, wavy dips). Less often, acne leaves raised scars.
Can microneedling help acne scars?
The American Academy of Dermatology lists microneedling among treatments for depressed acne scars, and Cleveland Clinic notes it may help concerns beneath the surface. How your scars respond depends on their type and depth, so we start with a consult.
How is a treatment plan for acne scars decided?
We look at your scar types, skin tone and history first. Cleveland Clinic notes most people need multiple microneedling treatments spaced weeks apart, and we plan any series around your skin at the consult.
Are dark marks after acne the same as scars?
No. Flat dark or red marks are changes in color, while scars change the texture of the skin. They are treated differently, so it helps to know which one you have.
This article is for general education and isn't medical advice. If you're pregnant, on acne medication such as a retinoid, have a skin condition or any medical concern, ask your provider before starting a new treatment.
Eliana Roldan is a Licensed Advanced Esthetician & Co‑owner of Beyond Skin & Body Care in Henderson. She reviews Skin Journal posts before they're published.
About Eliana →ReferencesSources
- AAD: Acne scars: www.aad.org/public/diseases/acne/derm-treat/scars
- AAD: Acne scar treatment: www.aad.org/public/diseases/acne/derm-treat/scars/treatment
- Cleveland Clinic: Microneedling: my.clevelandclinic.org/health/treatments/23113-microneedling
- Fabbrocini et al., Acne Scars: Pathogenesis, Classification and Treatment: pmc.ncbi.nlm.nih.gov/articles/PMC2958495/
- ASAP 2024: Practical Aspects of Acne Scar Management: pmc.ncbi.nlm.nih.gov/articles/PMC11003649/
- JMIR Dermatology: Atrophic Postacne Scar Treatment: derma.jmir.org/2024/1/e49954/