Ice Pick vs Boxcar vs Rolling Acne Scars: What’s the Difference?

If you have acne scars, one of the most important things to understand is that not all acne scars are the same.

Some scars are narrow and deep.

Some are wider with sharp edges.

Others create a wavy or uneven appearance across the skin.

Those differences matter because different scar types often respond better to different treatments.

At Allure Infinite Beauty MedSpa & Salon in Mesa, Arizona, we look at the type and depth of acne scarring before recommending treatment.

The three most common depressed acne scar types are:

• Ice-pick scars
• Boxcar scars
• Rolling scars

What Are Ice-Pick Acne Scars?

Ice-pick scars are narrow, deep scars that extend into the skin.

They often look like:

• Tiny holes
• Deep pinpoints
• Narrow pits
• Small but noticeable indentations

They are called ice-pick scars because they can look like the skin has been punctured with a sharp object.

Why Are Ice-Pick Scars Hard to Treat?

Ice-pick scars extend deeper into the skin than many other scar types.

That means surface-level treatments may not reach the full depth of the scar.

They may require more targeted treatment than broader resurfacing alone.

What Treatments May Help Ice-Pick Scars?

Depending on scar depth and the patient, treatment may involve:

• Targeted scar procedures
• Chemical reconstruction techniques performed by qualified medical providers
• Fractional resurfacing
• Combination treatment

Microneedling or lighter resurfacing alone may not be enough for very deep ice-pick scars.

What Are Boxcar Acne Scars?

Boxcar scars are wider depressions with more defined edges.

They may look:

• Round
• Oval
• Square
• Like shallow craters

They can range from shallow to deep.

What Causes Boxcar Scars?

Boxcar scars develop when inflammation damages collagen and tissue in the skin.

The result is a depressed area with relatively defined borders.

What Treatments May Help Boxcar Scars?

Depending on depth, treatment may include:

• Microneedling
• RF microneedling
• Fractional CO2 laser
• CoolPeel for milder scars
• Combination therapy

Shallow boxcar scars may respond more easily than deeper ones.

What Are Rolling Acne Scars?

Rolling scars create broad, shallow depressions.

Instead of looking like individual pits, they can make the skin look:

• Wavy
• Uneven
• Rippled
• Indented in broader areas

They are often caused by fibrous bands pulling the skin downward.

What Treatments May Help Rolling Scars?

Treatment may include:

• Microneedling
• RF microneedling
• Fractional CO2
• Combination scar treatment

If the scars are strongly tethered, additional procedures may be needed to address the underlying bands.

Ice Pick vs Boxcar vs Rolling Scars at a Glance

Ice-pick scars

Usually:

• Narrow
• Deep
• Pinpoint-like
• Difficult to treat with surface treatments alone

Boxcar scars

Usually:

• Wider
• More defined
• Round or oval
• Shallow or deep

Rolling scars

Usually:

• Broad
• Shallow
• Wavy
• Less sharply defined

Which Acne Scar Type Is Most Common?

Many patients have more than one type.

You may have:

• Rolling scars on the cheeks
• Boxcar scars near the temples
• Ice-pick scars in smaller areas

This is one reason acne scar treatment often requires a combination approach.

Can You Have Acne Marks and Scars Together?

Yes.

You may also have:

• Brown pigmentation
• Red marks
• Enlarged pores
• Active acne
• Uneven tone

These are separate concerns that may require different treatments.

Which Acne Scar Is Easiest to Treat?

There is no universal answer.

However, shallow rolling and boxcar scars may respond more predictably to collagen-stimulating treatments.

Deep ice-pick scars can be more challenging because of their depth.

Which Acne Scar Is Hardest to Treat?

Deep ice-pick scars are often among the more difficult scars to improve with standard resurfacing.

That does not mean they cannot improve.

It simply means they may need a more specialized approach.

Can Microneedling Help Rolling Scars?

Yes.

Microneedling can be useful for rolling scars because it stimulates collagen remodeling.

It may help improve:

• Shallow depressions
• Uneven texture
• Overall skin smoothness

Can Microneedling Help Boxcar Scars?

Yes, especially shallow boxcar scars.

Deeper scars may need stronger treatment.

Can Microneedling Help Ice-Pick Scars?

It may provide some improvement in surrounding texture, but it is often not enough for deep ice-pick scars by itself.

Can RF Microneedling Help Rolling Scars?

Yes.

RF microneedling may be particularly useful for:

• Rolling scars
• Deeper textural irregularities
• Boxcar scars
• Pore appearance

The added radiofrequency energy allows deeper tissue remodeling.

Can RF Microneedling Help Boxcar Scars?

Yes.

Shallow to moderate boxcar scars may respond well.

Deeper scars may still require combination treatment.

Can RF Microneedling Help Ice-Pick Scars?

It may improve overall texture but may not fully address very deep ice-pick scars.

Can CO2 Laser Help Acne Scars?

Yes.

Fractional CO2 resurfacing can be useful for:

• Rolling scars
• Boxcar scars
• Uneven texture
• Overall scar blending

Treatment depth can be adjusted based on the severity of scarring.

Is CO2 Better for Boxcar or Rolling Scars?

It can be useful for both.

Results depend on:

• Scar depth
• Skin type
• Treatment intensity
• Number of treatments
• Healing response

Can CoolPeel Help Acne Scars?

CoolPeel may be helpful for:

• Mild rolling scars
• Shallow boxcar scars
• Overall texture
• Pores

It is generally lighter than deeper fractional CO2.

Why Combination Treatment Often Works Best

Acne scarring is rarely one simple problem.

A patient may have:

• Rolling scars
• Boxcar scars
• Pigmentation
• Enlarged pores
• Redness

One treatment may not address everything equally well.

A treatment plan might use:

• RF microneedling for deeper remodeling
• CO2 for resurfacing
• Chemical peels for pigmentation
• Professional skincare for maintenance

Should You Treat Active Acne Before Scars?

Usually, yes.

If you are still developing deep inflammatory acne, new scars may continue forming.

The typical priority is:

1. Control active acne
2. Improve skin barrier health
3. Treat pigmentation
4. Treat scars
5. Maintain results

How Many Treatments Will You Need?

There is no universal number.

The number depends on:

• Scar type
• Scar depth
• Skin tone
• Treatment intensity
• Combination approach
• Individual healing response

Some scars respond after a few treatments.

Others take longer.

Can Acne Scars Be Completely Removed?

Usually not.

The goal is improvement.

Scars may become:

• Shallower
• Smoother
• Less noticeable
• Better blended with surrounding skin

Complete removal should not be guaranteed.

How Do We Identify Your Scar Type?

A skin evaluation helps determine:

• Scar shape
• Scar depth
• Scar distribution
• Skin tone
• Pigmentation
• Active acne
• Overall texture

That assessment guides the treatment plan.

Acne Scar Treatment at Allure Infinite Beauty in Mesa

At Allure Infinite Beauty MedSpa & Salon in Mesa, Arizona, we do not treat all acne scars the same way.

Depending on your scar type, we may recommend:

• SkinPen microneedling
• Virtue RF microneedling
• CoolPeel
• Fractional CO2 resurfacing
• Chemical peels
• Professional skincare
• Combination treatment

The goal is to match the treatment to the scar.

Frequently Asked Questions

What are the three main types of acne scars?

Ice-pick, boxcar, and rolling scars.

Which acne scars are deepest?

Ice-pick scars are usually the deepest.

Which scars look wavy?

Rolling scars create a broad, wavy texture.

Which scars have defined edges?

Boxcar scars usually have more sharply defined borders.

Does microneedling help rolling scars?

Yes, it can be very useful for rolling scars.

Does RF microneedling help boxcar scars?

Yes, especially shallow to moderate boxcar scars.

Can CO2 laser improve acne scars?

Yes, especially rolling and boxcar scars.

Can CoolPeel help acne scars?

It may help milder texture and shallow scarring.

Can one person have multiple scar types?

Yes, very commonly.

Which acne scar treatment is best?

The best treatment depends on scar type, depth, skin tone, and treatment goals.

Why Knowing Your Scar Type Matters

Acne scar treatment should not start with:

“Which treatment is most popular?”

It should start with:

“What kind of scar do I actually have?”

At Allure Infinite Beauty MedSpa & Salon in Mesa, Arizona, identifying the scar type is the first step toward choosing the right treatment strategy.

Different scars need different solutions.