Acne may eventually clear, but the changes it leaves behind can last much longer. Some people are left with red or brown marks, while others develop indentations, uneven texture, or raised scars.
Although these concerns are often grouped together as “acne scars,” they aren’t all the same, and the type you have plays an important role in determining which treatments are most likely to help.
Understanding the different types of acne scars can help you distinguish true scarring from temporary post-acne marks and understand why treatments such as microneedling, RF microneedling, chemical peels, IPL, and laser resurfacing are used for different concerns.
Acne Scars vs. Acne Marks: What’s the Difference?
One of the most important distinctions is whether you’re dealing with a true scar or discoloration left behind after acne.
Acne scars involve a change in the skin’s texture or structure. They may appear as depressions, pits, uneven areas, or raised tissue.
Post-acne marks are flat areas of discoloration that remain after a blemish heals. The two most common types are post-inflammatory erythema (PIE), which appears red or pink, and post-inflammatory hyperpigmentation (PIH), which appears brown or darker than the surrounding skin.
Unlike true textural scars, these marks can gradually fade over time, although treatment may help improve them more quickly.
It’s also possible to have both acne scars and post-acne discoloration at the same time.
Why Does Acne Cause Scarring?
Acne scars can develop when inflammation damages tissue beneath the surface of the skin.
During the healing process, the body produces collagen to repair the damaged area. If too little collagen is produced, a depression can remain in the skin. If too much collagen develops, a raised scar can form.
The risk of scarring tends to be greater with deeper inflammatory acne, including nodules and cysts. Picking or squeezing blemishes can also increase inflammation and tissue damage.
What are the Different Types of Acne Scars?
There are several types of scarring from acne. Each has a distinct appearance and cause.
Ice Pick Scars
Ice pick scars are deep, narrow depressions that can look as though the skin has been punctured with a small sharp object.
Because these scars extend deeper into the skin, they can be particularly challenging to improve with superficial treatments alone.
Ice pick scars typically have:
- Deep, narrow openings
- Defined edges
- A pitted appearance
- Greater depth than width
Treatment depends on the depth and number of scars and may require approaches specifically designed for deeper focal scarring.
Boxcar Scars
Boxcar scars are round or oval depressions with relatively defined edges. Unlike the narrow opening of an ice pick scar, boxcar scars are generally wider.
They can range from shallow to deep and may create a crater-like appearance in the skin.
Boxcar scars typically have:
- Round or oval depressions
- Defined edges
- A wider appearance than ice pick scars
- Shallow or deep variations
Treatments that stimulate collagen remodeling, including microneedling, RF microneedling, and laser resurfacing, may be considered depending on scar depth and skin type.
Rolling Scars
Rolling scars create broad, shallow depressions that give the skin an uneven or wave-like appearance.
They can develop when fibrous tissue beneath the skin pulls the surface downward, creating tethered areas.
Rolling scars typically have:
- Broad depressions
- Soft or sloping edges
- A wave-like appearance
- Changes that become more noticeable under directional lighting
Because tethering beneath the skin can contribute to rolling scars, treatment may differ from the approach used for other types of acne scarring.
Hypertrophic and Keloid Acne Scars
Not all acne scars are depressed.
Hypertrophic and keloid scars occur when excess collagen is produced during healing, causing tissue to rise above the surrounding skin.
Hypertrophic scars remain within the boundaries of the original injury, while keloids can grow beyond the original area.
These scars are more commonly seen on areas such as the chest, shoulders, back, and jawline and require a different treatment approach from depressed acne scars.
What Are Red Marks After Acne?
Flat red or pink marks remaining after acne are usually post-inflammatory erythema (PIE) rather than true scars.
PIE develops from changes to small blood vessels associated with inflammation and can be especially noticeable in lighter skin tones.
These marks often fade gradually, but persistent redness may respond to treatments that target vascular redness.
Importantly, treatments designed primarily to rebuild collagen and improve deep acne scars aren’t necessarily the best treatments for PIE.
What Are the Dark Spots Left After Pimples?
Brown, gray, or darker areas that remain after a blemish heals are generally known as post-inflammatory hyperpigmentation (PIH).
Inflammation can stimulate excess melanin production, leaving an area darker than the surrounding skin. PIH is particularly common in medium and deeper skin tones.
Although PIH isn’t a true scar, discoloration can persist for months.
Treatment may include appropriate topical skincare, sun protection, chemical peels, and carefully selected energy-based treatments depending on skin type.
Which Treatments Work for Acne Scars?
There isn’t one “best” acne scar treatment because different types of scarring respond to different approaches.
A person with shallow boxcar scars may require a very different treatment plan from someone with deep ice pick scars, rolling scars, or primarily post-acne discoloration.
Microneedling
Microneedling creates controlled micro-injuries that stimulate the skin’s natural healing response and collagen production.
It may help improve overall texture and certain types of atrophic acne scars over a series of treatments.
Because collagen remodeling takes time, improvement develops gradually rather than immediately.
RF Microneedling
RF microneedling combines microneedles with radiofrequency energy delivered beneath the skin.
The combination creates controlled injury while heating deeper tissue to stimulate collagen remodeling. It may be recommended when more substantial textural improvement or skin remodeling is desired.
Laser Skin Resurfacing
Laser skin resurfacing uses controlled laser energy to remodel damaged skin and stimulate collagen production.
Depending on the technology and treatment depth, resurfacing may improve acne scars, uneven texture, and other signs of skin damage.
More intensive resurfacing can produce greater downtime, so the appropriate treatment depends on scar type, skin tone, treatment goals, and tolerance for recovery.
Chemical Peels
Chemical peels remove controlled layers of damaged surface skin and encourage cellular renewal.
They can be particularly useful for post-acne pigmentation, uneven tone, and superficial texture. The type and strength of peel should be selected according to the individual’s skin type and concerns.
Deep textural acne scars generally require treatments that reach deeper than a superficial peel alone.
IPL and Light-Based Treatments
For patients whose primary concern is lingering redness or pigmentation rather than depressed scars, IPL and other light-based treatments may be considered.
These treatments target pigment or vascular redness rather than physically filling or rebuilding a deep acne scar.
This is why correctly distinguishing acne scars from acne marks matters before choosing treatment.
PRP and Regenerative Treatments
Platelet-rich plasma (PRP) may be combined with procedures such as microneedling in some treatment plans.
PRP uses a concentrated portion of the patient’s own blood containing platelets and growth factors and may be used to support the healing and regenerative response following treatment.
Why Combination Treatments Are Often Used for Acne Scars
Many people don’t have just one type of acne scar.
For example, the same person might have rolling scars on the cheeks, several deeper boxcar scars, red post-acne marks, and areas of hyperpigmentation.
Trying to treat all of those concerns with one procedure may produce limited results.
Instead, an individualized acne-scar plan may combine treatments that address different components of the problem—for example, collagen remodeling for depressed scars and pigment- or redness-targeting treatments for discoloration.
Treatment can also be staged over time rather than performing everything at once.
Can Skincare Get Rid of Acne Scars?
Skincare can play an important role in managing acne, improving discoloration, supporting the skin barrier, and preventing new scars from developing.
However, topical skincare generally cannot completely correct established depressions caused by structural collagen loss.
This is an important distinction when setting expectations.
Someone with post-inflammatory hyperpigmentation may see substantial improvement with appropriate topical products and sun protection, while someone with deep ice pick or rolling scars will usually require a different approach.
How Long Does It Take to Improve Acne Scars?
Acne scar treatment is usually a gradual process.
Procedures that stimulate collagen rely on the body’s natural remodeling process, which continues for weeks or months following treatment. Multiple sessions may be recommended depending on the severity and type of scarring.
The goal isn’t necessarily to completely erase every scar. A more realistic goal is often to improve texture, reduce scar visibility, even skin tone, and make scars less noticeable.
When Should You See a Professional About Acne Scars?
Consider a professional skin evaluation if:
- Acne scars aren’t improving
- You have significant changes in skin texture
- You aren’t sure whether you have scars, PIE, or PIH
- Over-the-counter products haven’t improved your concerns
- You have several different types of acne scars
- You’re considering laser, RF microneedling, or other professional procedures
Correctly identifying the type and depth of scarring is an important first step toward choosing an appropriate treatment.
Acne Scar Treatments in Park Ridge, IL
At CN Medical Aesthetics & Wellness, acne-scar treatment begins with evaluating the type of acne scarring, skin tone, current acne activity, and treatment goals.
Depending on your concerns, a customized treatment plan may incorporate microneedling, RF microneedling, chemical peels, laser or light-based treatments, and other approaches designed to improve skin texture and tone.
Learn more about our acne scar treatments in Park Ridge, IL and schedule a consultation to determine which treatment options may be appropriate for your skin.