Acne Scars: Choose the Treatment by Scar Type
Ice-pick, rolling and boxcar scars are not the same problem. This guide shows how to think about treatment in the right order instead of chasing a different device every month.
Guides · 8 min read · August 22, 2026
Start with the scar type, not the device
The most common mistake is treating every acne scar as one condition. Shape, depth and whether the scar is tethered underneath determine what needs release, resurfacing or a more targeted technique.
That is why the same treatment can be excellent for one person and disappointing for another even when both simply say they have acne scars.
The quick map
- Ice-pick: narrow and deep; often needs targeted approaches such as TCA CROSS, with selected scars sometimes suited to minor surgical techniques.
- Rolling: tethering under the skin is often the key issue, so subcision may matter more than starting with laser.
- Boxcar: depth and edge definition matter; shallow scars may respond to resurfacing while deeper ones often need a combined plan.
- Post-acne pigmentation is not an indented scar and should be treated as a different problem.
If you do not know the scar type, do not start by choosing the machine. Diagnosis comes before technology.
Why combination treatment is common
Most faces contain more than one scar type. Tethered scars may need release, superficial texture may need resurfacing, and pigmentation often needs its own treatment path.
A strong plan is not about stacking the largest number of procedures into one session. It is about fixing the main limiting factor first, then refining the surface.
When should you expect results?
Scar improvement is usually gradual. The realistic goal is meaningful improvement rather than perfectly erasing every mark. Session count and spacing depend on scar type, depth, skin tone, active acne and the technique used.
Medical references
Medical review
This guide was written and medically reviewed by Dr. Yousef Abo Zarad, a German board-certified specialist in Dermatology and Venereology.