02/09/2026
🔹 Types of Atrophic Acne Scars :
1} Boxcar Scars 📦
Shape: Round or oval depressions with sharp, well-defined edges.
Depth: Superficial or deep.
Cause: Loss of collagen following acne inflammation.
Best treatments: Fractional laser, microneedling, TCA CROSS for selected scars, and subcision for deeper lesions.
2} Ice Pick Scars 🧊
Shape: Very narrow, deep, V-shaped pits that extend deeply into the skin.
Appearance: Small but markedly deep openings.
Best treatments: TCA CROSS is particularly useful; punch excision/elevation may be considered for selected deep scars.
3} Rolling Scars 🌊
Shape: Broad, shallow depressions with smooth, undulating edges.
Key feature: The skin looks uneven or wavy, especially when stretched or under oblique lighting.
Cause: Dermal tethering by fibrous bands.
Best treatment: Subcision is the key treatment, often combined with fractional laser, microneedling, or fillers.
⭐ Quick Clinical Differentiation ⭐️
👉🏻Boxcar = sharp edges 📦
👉🏻Ice pick = narrow & deep 🧊
👉🏻Rolling = broad & wavy 🌊 + tethering
🎯🎯Clinical pearl:☠️🔥
☝️If the scar improves significantly when the skin is stretched, think rolling scar 👍🏻
☝️If it remains a sharply demarcated depression, boxcar scar is more likely.