Acne Scars: Rolling, Ice Pick, and Boxcar Explained
If you’ve struggled with acne, you’re not alone. And if you’ve been left with scars long after the breakouts faded, you’re definitely not alone either. Acne scars are one of the most common reasons clients come to Bad Skin, our cosmetic studio located inside Sola Salons in downtown Redwood City.
We see clients from all over the Bay Area—San Mateo, Menlo Park, Palo Alto, Mountain View, Belmont, San Carlos, Foster City, Sunnyvale, Santa Clara, Cupertino, San Jose, Fremont, Union City, Hayward, Millbrae, Burlingame, South San Francisco, Los Altos, Daly City, and beyond—who want smooth, clear skin after years of battling acne.
But not all acne scars are created equal. In fact, one of the first steps in effectively treating acne scarring is knowing exactly what type of scars you have.
Let’s break down the three main types: rolling, ice pick, and boxcar scars—and what you can do about them.
🔍 What Causes Acne Scars?
Acne scars form when deep inflammation damages the skin’s tissue. This damage can lead to abnormal healing, where the skin either produces too little collagen (causing indented scars) or too much (causing raised scars).
The depth, location, and frequency of breakouts all play a role—but often, it’s the type of acne (like cystic or nodular) that leads to more severe scarring.
🔹 Rolling Scars
What They Look Like:
Rolling scars appear as broad depressions in the skin with soft, sloping edges. They tend to give the skin a wavy or uneven texture, especially under certain lighting.
What Causes Them:
They result from long-term inflammation that causes damage below the surface, often due to cystic or inflammatory acne.
Best Treatments:
Microneedling: Encourages collagen regeneration and helps smooth texture.
Radiofrequency Microneedling (RF): Combines collagen stimulation with heat for deeper effects.
Subcision: A technique where the tethered bands beneath the scar are released.
Sculptra or filler: May be used to lift deeper rolling scars and improve overall contour.
🔹 Ice Pick Scars
What They Look Like:
Ice pick scars are narrow, deep, and sharply defined pits that look like the skin was pierced with a needle. These can be some of the most challenging scars to treat.
What Causes Them:
They often form after deep cystic breakouts and occur when the skin doesn’t produce enough collagen during healing.
Best Treatments:
TCA Cross: A chemical technique that uses trichloroacetic acid to stimulate collagen in deep scar channels.
Punch excision: A minor surgical procedure where the scar is removed and stitched closed.
Microneedling + PRP: May improve appearance with consistent sessions.
Laser Resurfacing: Can help shallow the depth over time with fractional CO₂ or erbium lasers.
🔹 Boxcar Scars
What They Look Like:
Boxcar scars are broad, defined indentations with sharp vertical edges. They’re wider than ice pick scars but deeper than rolling scars.
What Causes Them:
Like rolling scars, boxcar scars often stem from inflammatory acne, but the healing process leaves behind sharply defined depressions.
Best Treatments:
Fractional laser resurfacing (like UltraClear or CO₂): Helps smooth the surface and stimulate new skin growth.
Microneedling: Especially effective when combined with radiofrequency.
Dermal Fillers: Hyaluronic acid can temporarily lift and smooth the indentation.
Chemical peels: Medium-depth peels like TCA can improve texture when done in a series.
✨ Combination Therapy Is Key
The truth is—most people have a combination of scar types. That’s why the most effective acne scar treatments are usually multi-modal, meaning we use different techniques over time to address all layers of the skin.
At Bad Skin, we customize your treatment plan based on your scar types, skin tone, sensitivity, and goals. Some scars may require deeper collagen stimulation, while others need surface resurfacing.
💬 What About Hyperpigmentation?
Post-acne discoloration (aka hyperpigmentation or red marks) isn’t technically scarring—it’s a temporary pigment change, not a change in skin texture.
Luckily, this is much easier to treat with options like:
Chemical peels
Laser treatments
Microneedling
Topicals like azelaic acid or tranexamic acid
We often treat hyperpigmentation alongside scarring to give you a more even, radiant complexion.
🕒 How Long Until You See Results?
Acne scar revision is a process, not a one-time fix. Expect:
Noticeable changes in 4–6 weeks post-treatment
Cumulative improvement with a series of 3–6 sessions
Even better outcomes when combined with good home care and SPF use
Consistency and patience = smoother, brighter skin.
📍 Why Clients Choose Bad Skin
At Bad Skin, we don’t take a one-size-fits-all approach to acne scarring. Every treatment plan is:
Customized to your skin
Designed to minimize downtime
Focused on real, noticeable results
We’re proud to treat clients from all over the Bay Area—including Redwood City, San Mateo, Palo Alto, Belmont, Mountain View, and more—who are ready to invest in their skin and confidence.
Our studio is located in downtown Redwood City, inside Sola Salons, just across from Philz Coffee. It’s a calm, clean space where you can feel heard, supported, and seen.
