Acne Scar Treatment: Choosing the Right Method for Each Type of Scar

📅 Updated 09/04/2026·🏷️ Skin & Rejuvenation·✍️ Editorial team — Dr. Vo Thanh Sang

Have you tried countless serums, sheet masks and microneedling at a spa, only to find the dents on your cheeks still there? That self-conscious feeling every time you catch your reflection under angled light is something many people experience. The truth is that acne scar treatment has no one-size-fits-all formula. Each type of scar has a different structure, and only when you choose the method that matches it does the skin have a real chance to improve noticeably.

This article will help you understand how depressed acne scars are classified and which medical methods are commonly used, so you can have a realistic perspective before making a decision.

What are depressed acne scars and why don't they resolve on their own?

Depressed (atrophic) scars form when the inflammation caused by acne destroys collagen in the dermis. When the skin heals but does not produce enough collagen to fill the gap, the surface sinks inward, creating the pitted scars.

Because the damage lies deep within the skin and involves collagen structure that has already been lost, depressed scars usually do not fill back in over time. Most topical products only help to soothe, moisturize or improve pigmentation; they rarely regenerate the tissue that has been lost. This is why many people treat their skin at home for years and see little change.

Classifying depressed scars: ice pick, boxcar and rolling

Correctly identifying the type of scar is the most important step before discussing any method. According to dermatology literature, depressed scars are generally divided into three main groups:

Ice pick scars: the opening is small and narrow but plunges deep into the skin like a puncture from a sharp point. This is the most difficult type to treat because the base of the scar sits deep down.
Boxcar scars (round or square-based): a wide opening with well-defined edges and a flat base. Often seen on the cheeks and temple area.
Rolling scars: a wide opening with sloping edges, giving the skin surface a wavy appearance. This type is closely related to fibrous bands that tether the base of the scar downward.

In practice, most people with long-standing acne have mixed skin with several scar types at once. That means a treatment plan usually has to combine multiple techniques, and you cannot expect a single method to resolve everything.

Acne scar treatment methods by scar type

Below are common medical methods and the scar types they are typically suited to. The choice and combination must be decided by a specialist physician after a direct examination.

Subcision

The physician uses a specialized needle inserted beneath the skin to cut the fibrous bands that tether the base of the scar downward, releasing the scar base and stimulating the formation of new tissue. This method is usually considered for:

Rolling scars, which are anchored by fibrous bands.
Boxcar scars with adherent edges and base.

Subcision is often combined with laser or microneedling to improve overall effectiveness, rather than being performed in isolation.

Resurfacing laser

Lasers (such as fractional CO2 laser or other fractional laser systems) create controlled zones of injury on the skin to stimulate the body to produce new collagen. Laser is commonly used for:

Boxcar and square-based scars, to soften the edges and lift the base.
Improving overall skin texture, making the surface smoother.

Laser needs to be carried out as a course of several sessions, with recovery time and strict sun protection and aftercare afterward.

Microneedling and needle-free skin renewal (micro-injury)

This technique creates micro-injuries in the skin with needle tips to stimulate collagen regeneration. Microneedling is generally suitable for shallow scars and skin texture that is not too deep, or used in combination with active ingredients that support regeneration. It is also a method that is frequently done incorrectly in places without adequate sterile conditions, which can easily lead to infection or make scarring worse.

TCA CROSS and supportive techniques

For deep ice pick scars, the physician may consider focal acid application (TCA CROSS) to remodel the narrow scar base. In addition, some cases are combined with dermal filler injection or other techniques depending on the specific condition.

Why does acne scar treatment require a specialist physician?

As you have seen, each type of scar requires its own approach and often has to combine multiple techniques. Correctly assessing the type of scar, its depth, the condition of the skin and selecting the appropriate parameters requires properly trained expertise.

A specialist physician builds a personalized protocol instead of applying a fixed course to everyone.
Invasive procedures such as subcision and laser require a sterile environment that meets standards in order to limit complications.
Performing the procedure at a licensed hospital or medical facility is safer than at a spa that lacks the necessary professional conditions.

It must be emphasized that the degree of improvement depends on each person's constitution, scar type and adherence to aftercare. No method can guarantee that the skin will return completely to how it was before the acne.

Medical notes: contraindications and risks/complications

Any depressed-scar treatment method carries potential risks, and there are cases that call for caution or in which treatment should not be performed. Some important notes:

Contraindications or reasons to postpone: active severe inflammatory acne, skin infection in the treatment area, currently taking certain oral acne medications without enough wash-out time, pregnancy, a predisposition to keloid scarring, bleeding disorders or uncontrolled underlying conditions.
Common risks: redness, swelling, peeling and a stinging sensation after the procedure, which gradually subside.
Risks to be aware of: post-inflammatory hyperpigmentation or hypopigmentation (especially in skin prone to darkening), infection if aftercare is not done correctly, and, in rare cases, the possibility of leaving a new scar.
Factors that increase risk: inadequate sun protection, picking off scabs on your own, and having the procedure done somewhere that does not ensure sterility.

For this reason, honestly disclosing your medical history and following the aftercare instructions are essential conditions for limiting complications. Only a physician who examines you in person can assess whether you are suitable for each method.

Aftercare to support results

Much of the outcome depends on the recovery phase. Some basic principles are commonly recommended:

Strict daily sun protection, limiting direct sun exposure.
Moisturize and soothe the skin as instructed; do not add strong actives on your own.
Do not pick, scratch or peel off scabs; keep the area clean as directed.
Attend follow-up appointments on schedule so the physician can monitor and adjust the protocol.

Closing thoughts and an invitation to consult

Acne scar treatment is a journey that requires patience, the right method and the right person performing it. Once you have identified which type of scar you have and have a suitable protocol, the chance of improving your skin becomes far more realistic than scattered experimentation.

If you are unsure which method suits your skin, allow yourself to be examined and advised in person. Dr. Vo Thanh Sang (Dermatology Specialist Level I) will assess your scar type and skin condition and discuss with you a safe approach that fits your individual constitution. You can contact the hotline 079 7479 222 for support in booking an appointment and having your questions answered gently, with no pressure.