Dispatch · December 17, 2025 · 7 min · By Quentin Asare
Acne scarring: what can and cannot be fixed
Boxcar, rolling, ice-pick, the scar type decides the treatment.
Once acne settles, the marks it leaves split into two categories that are often confused. Post-inflammatory marks, the flat red or brown spots, are not scars at all; they fade over months and respond to pigment care and sunscreen. True scars are textural changes in the skin's surface, and those need procedural treatment.
Scar shape dictates the tool. Rolling scars, with their soft undulating edges, respond to subcision and energy devices that stimulate collagen. Boxcar scars, with sharper walls, do well with fractional lasers and microneedling. Narrow, deep ice-pick scars often need a focal technique like TCA CROSS rather than resurfacing.
No single device clears every scar, and most patients need a combination across several sessions. Setting that expectation early, meaningful improvement, not erasure, is the difference between a satisfied patient and a disappointed one. A dermatologist's exam to map the scar types is the necessary first step before any laser is chosen.
Related reading: Why your acne came back in your 30s and Retinoids: the backbone of acne care.