Run a fingertip slowly across acne-scarred skin and you can often feel the difference before you can name it. Some marks are narrow and deep, like a pin has been pressed in. Others sit in shallow craters with clean edges. A few are broad, soft dips that seem to shift when the light changes. They can look like one problem in the mirror, but under the surface they are not the same thing at all — and that single fact is the reason so many people feel let down by a treatment that worked beautifully for someone else and did very little for them.
Acne scarring is extremely common, and it is not a flaw or a failure of care. It is simply what skin sometimes does after inflammation. But because the scar types are structurally different, they respond to different approaches. Matching the treatment to the scar — rather than to the marketing — is where realistic improvement starts. This is a plain-English guide to the main types and what tends to suit each, written from how we assess scarring at our clinic on St James’s Street in Brighton.
A note before we go further: nothing here is a substitute for having your skin looked at in person. Scar type is best confirmed by a qualified practitioner in good light, because the treatment plan hinges on getting that reading right.
First, not every mark is a scar
One of the most useful things to understand early is that some of what people call “scars” are not scars at all.
After a spot heals, it often leaves behind a flat mark — pink, red or purple on lighter skin, or brown on deeper skin tones. The red-purple kind is post-inflammatory erythema (PIE); the brown kind is post-inflammatory hyperpigmentation (PIH). Both are changes in colour, not changes in the skin’s structure, and many fade on their own over months, often helped along by good sun protection and a considered skincare routine. Treating them as though they were textured scars — with aggressive resurfacing — can be the wrong call, and in deeper skin tones it can even provoke more pigmentation.
True scars are textural: the surface itself has been pulled down (atrophic) or built up (raised). Telling the two situations apart is one of the first things a consultation is for, and it is exactly where a lot of over-the-counter “scar” products quietly disappoint — a theme we explored in our piece on why so many acne scar products fall short.
The three atrophic scar types
Most acne scarring is atrophic — a loss of tissue that leaves an indentation. It is usually sorted into three broad shapes, and most people have a mix rather than a single tidy type.
Ice pick scars
These are narrow, deep and steep-sided, as if a fine tool has punched straight down into the skin. They are often the most stubborn, because their depth reaches far below where surface resurfacing can reach. Broad laser treatments frequently skim over the top of an ice pick scar without addressing the tethered base.
For this reason, ice pick scars are often approached with more focal techniques — for example, chemical reconstruction of the scar base (sometimes called TCA CROSS), or small punch procedures — sometimes alongside resurfacing to blend the surrounding skin. These are precise, practitioner-dependent methods, and they are not suited to every skin type, which is why assessment matters so much here.
Boxcar scars
Boxcars are wider than ice pick scars, with more defined, vertical edges and a flatter floor — think of a shallow, angular crater. Because they have some breadth and a visible edge, they can respond to treatments that soften those edges and encourage the floor to lift.
Fractional resurfacing, including fractional CO2 laser, is one of the approaches often considered for shallower boxcar scarring, because it works on the texture and edges across an area. We go into which scar types tend to respond to that specific technology — and which do not — in our closer look at what CO2 laser actually does for acne scars. Deeper boxcars may need combining with other methods rather than laser alone.
Rolling scars
Rolling scars give skin a gentle, undulating, “wave-like” look. There is usually no sharp edge; instead, fibrous bands beneath the surface tether the skin downward, creating shadows that come and go with the light. Because the problem is largely below the surface, treating only the surface tends to underwhelm.
This is where subcision — a technique that releases those underlying bands — is commonly discussed, often paired with treatments that encourage the skin’s own collagen to fill the released space over time, such as microneedling (collagen induction) or bio-stimulating approaches. Occasionally a small amount of dermal filler is used to support a tethered scar. Again, these are options a practitioner weighs up together, not a fixed prescription.
Raised scars are a different situation
Not all acne scars sit below the surface. Some people develop hypertrophic or keloid scars — raised, firmer tissue where the healing response has overshot. These behave very differently from atrophic scars and, importantly, resurfacing lasers and needling are generally not the first thought here; the wrong treatment can aggravate them. Raised scarring is usually managed with quite separate approaches and needs careful, individual assessment, particularly if you have a history of keloids.
Why one treatment rarely does everything
By now the pattern is probably clear: because most people carry a mixture of ice pick, boxcar and rolling scars — sometimes with pigmentation layered on top — a single treatment used in isolation is rarely the whole answer. In practice, scar work is often sequenced and combined: releasing tethered scars, then encouraging collagen, then refining texture and finally addressing residual colour, spread across sessions with healing time in between.
That is also why honest expectation-setting matters more here than almost anywhere in aesthetics. Well-chosen treatment is designed to soften and improve the appearance of scarring — to make it catch the light less and read as smoother skin — not to erase it completely. Individual results vary a great deal depending on scar type, skin type, how long the scarring has been present and how skin heals. Any clinic promising a total fix is overselling.
The part people skip: risk and downtime
Acne scar treatments are medical procedures, and they carry real considerations. Resurfacing and needling involve a recovery period — redness, swelling, flaking or a sunburn-like feel for several days, depending on the intensity. There is a risk of post-inflammatory pigmentation, and that risk is higher in deeper skin tones (Fitzpatrick types IV–VI), which is one reason a blanket “one laser fits all” approach is a red flag. As with any procedure that breaks the skin, there is a small risk of infection or delayed healing. Sun protection afterwards is not optional; fresh skin pigments easily, and Brighton’s bright coastal light is stronger than many people assume even out of high summer.
A responsible practitioner will talk you through these risks, ask about your medical history and any tendency to pigment or scar, and — crucially — make sure your acne itself is settled first. Treating scars while active breakouts continue tends to be frustrating and can create new marks. The treatments discussed here are for adults; if you are under 18, or your acne is still active, the right first step is usually your GP or a dermatologist rather than scar treatment.
How a scar assessment actually works
If you are considering doing something about acne scarring, the single most useful step is a proper assessment rather than booking a specific treatment off the back of a name you have read about.
In a consultation, we look at the skin in good light, often stretching it gently to see which scars are tethered and which are shallow, and we take note of your skin tone and healing history. From there, the conversation is about matching approach to scar type, being clear about how many sessions a realistic plan might involve, what the downtime looks like around your life, and — just as importantly — where expectations need to be tempered. Sometimes the honest answer is that a particular scar type will improve modestly rather than dramatically, and it is far better to hear that beforehand. You can read more about the options we offer on our acne scar treatments page.
When choosing where to go, it is reasonable to check that your practitioner is registered with a recognised body such as the Joint Council for Cosmetic Practitioners, and to ask directly about their experience with your particular skin tone and scar type.
Frequently asked questions
Can acne scars be removed completely?
Realistically, no treatment erases scarring entirely. The aim is meaningful improvement — smoother texture and scars that are less noticeable. How much improvement is possible depends heavily on the scar type and your skin, which is why an in-person assessment comes first.
How do I know which scar type I have?
Most people have a combination, and it is genuinely hard to judge your own skin in a bathroom mirror. A practitioner assessing the skin in proper light — and feeling how the scars behave when the skin is stretched — is the reliable way to tell ice pick from boxcar from rolling, and to separate true scarring from pigmentation.
Are the red or brown marks scars too?
Often they are not. Flat red-purple or brown marks left after spots are usually changes in colour (PIE or PIH) rather than textured scars, and many fade over time. They are approached differently from atrophic scarring, so it is worth having them identified rather than treated as though they were dents.
Is there any downtime?
It depends on the treatment. Surface-refining approaches can mean several days of redness, swelling or flaking; more focal techniques carry their own recovery and side effects. Your practitioner should map the realistic downtime to your plan before you commit to anything.
If acne scarring is something you would like to understand and address properly — matched to the type you actually have rather than a one-size-fits-all fix — you are welcome to book a consultation with Fabian at our Brighton clinic to talk it through in person.