Acne Scars: Complete Guide to Types, Causes, and Treatment

You may have been told acne scars are permanent and that only a laser clinic can touch them. That is true for some scars and wrong for others. The term "acne scars" covers at least three structurally different kinds of skin damage, plus flat marks that are not scars at all, and each one responds to a different approach. How severe your acne scarring is, mild, moderate or severe, changes the plan too.

This guide walks through what acne scars are, how to tell the types apart, how to grade the severity, what causes them, how to prevent new ones, and what your options are at the clinic and at home. If you are weighing an at-home device, judge it on four things: fine control over the power, reviews you can verify, support you can actually reach, and a money-back guarantee. A pen with one fixed power level hits a shallow scar on thin cheek skin as hard as it would hit a thick skin tag, and that is how a smoother patch turns into a new mark.

What Are Acne Scars?

Acne scars are lasting texture changes left when an inflamed breakout, typically a cyst or deep pustule, damages the dermis: the layer of skin below the surface. When that damage heals, the body either produces too little collagen, leaving a depression in the skin, or too much collagen, leaving a raised area. The medical term is cutaneous scarring secondary to acne vulgaris. In plain English: damaged skin that healed in a way that left a visible texture or color change.

Not every mark left by acne is a scar. Many people confuse post-inflammatory hyperpigmentation, the flat red or brown discoloration that follows a breakout, with an actual acne scar. The distinction matters because the two respond to different treatments. That separation is covered in its own section below.

Acne and acne scarring go together more often than most people expect. According to the American Academy of Dermatology, acne scarring affects an estimated 95% of people who experience moderate to severe acne at some point. Cleveland Clinic puts it another way: about 80% of people between 11 and 30 get acne, and about one in five of them will scar. It is not a sign of poor hygiene or poor skincare. It is a consequence of deep tissue inflammation. Additional clinical context is available via NIH MedlinePlus.

Types of Acne Scars

Atrophic scars, the most common type, are depressions in the skin where tissue was lost during healing. There are three main sub-types, and most people with acne scars have a mix of them, so telling them apart matters for every treatment decision.

Ice Pick Scars

Ice pick scars are narrow, deep, and sharply defined. They look like a small puncture or pinprick hole in the skin, typically less than 2 mm across. They are the most difficult to treat because they extend deep into the dermis and sometimes into the subcutaneous tissue beneath. They occur most often on the cheeks, where sebaceous gland density is high. For a detailed comparison of how ice pick scars differ from the other types, see our type identification guide.

Boxcar Scars

Boxcar scars are wider than ice pick scars, with sharply defined vertical edges and a flat or slightly rounded floor. They look like small rectangular or oval craters on the skin surface, typically 1.5 to 4 mm across. They form when inflammation destroys collagen in a localized area without the sharp-edged depth of an ice pick. Boxcar scars respond well to treatments that stimulate new collagen formation because there is tissue to rebuild.

Rolling Scars

Rolling scars give the skin a wave-like or undulating texture. They are caused by fibrous bands of tissue that form between the dermis and the subcutaneous tissue underneath, tethering the skin surface from below. The result is a scar that looks soft at its edges but creates a broader depression. Rolling scars are often more visible in side-lit or raking light. They tend to respond to treatments that break those fibrous attachments.

Hypertrophic and Keloid Scars

A smaller group of people develop raised scars instead of depressed ones. Hypertrophic scars stay within the original wound boundary and may flatten over time. Keloid scars overgrow the original wound boundary and continue to grow. Both are more common in people with darker skin tones and in areas where the skin is under repeated tension, such as the jaw, shoulders, and chest. Raised scars have a different treatment path than atrophic scars and generally require a dermatologist to manage.

How Severe Is Your Acne Scarring? Mild, Moderate, and Severe

Dermatologists grade acne scarring in four steps, from flat marks to scars you can see from across a room, and the grade tells you how much outside help you need. The four grades, known as the Goodman and Baron scale and laid out by Cleveland Clinic, judge how visible the scars are at a normal conversation distance of about 50 cm, roughly arm's length.

• Macular: flat red, pink or brown marks with no texture change. These are marks, not true scars.
• Mild: shallow scars that makeup covers easily and that are not obvious at conversation distance.
• Moderate acne scarring: scars you notice at conversation distance and that makeup does not easily hide, but that flatten when you stretch the skin between two fingers. Rolling and shallow boxcar scars usually sit here.
• Severe acne scarring: scars that stand out beyond 50 cm and do not flatten when the skin is stretched. This grade usually includes deep ice pick or deep boxcar scars, and sometimes raised scars.

The stretch test is the useful part at home. Place two fingers either side of a scar and gently pull the skin apart. If the dip mostly disappears, the scar is shallow enough for collagen-stimulating treatments to work on, including at-home plasma energy. If it stays sharp and deep, it belongs with a dermatologist. Severe scarring usually needs a dermatologist-led plan, often combining several methods, while any shallow scars in the mix can still be treated at home. Flat macular marks follow the PIH route covered below.

Are Acne Scars Permanent?

It depends on the type and depth. Ice pick scars, being the deepest, are the most persistent without intervention. Superficial boxcar and rolling scars improve significantly with the right treatment because the dermis can regenerate collagen when stimulated. Hypertrophic scars often soften on their own over 12 to 18 months. Keloid scars do not resolve without treatment.

Post-inflammatory hyperpigmentation, the flat red or brown marks that look like scars, is not a true scar. PIH is melanin overproduction in response to inflammation and fades on its own in 3 to 12 months for most people, faster with consistent SPF use and certain topical ingredients. If you would rather not wait, a flat dark mark can also be treated directly at home. True atrophic scarring does not fade on its own because the collagen architecture underneath the surface has changed structurally, not just in color.

For a focused answer to this question, see Do Acne Scars Fade on Their Own?

Acne Scars vs Post-Inflammatory Hyperpigmentation: What Is the Difference?

A true acne scar changes the texture of the skin, while PIH only changes its color, and that one difference decides which treatment is worth your time and money.

↔ Swipe the table sideways to see the full comparison.

The quick test: run your finger across the mark in low light. If it is flat and only a color difference, you are looking at PIH. If there is a depression or elevation, you have a scar. Most people in their 30s and 40s dealing with "acne scars" have a mix of both, and knowing which is which tells you where to focus. Flat dark marks and dark spots are what the OcuraLife 6-in-1 DPN Dark Spot Removal Pen is built for, while texture scars follow the plasma route covered further down. This distinction also separates acne scarring from other face-texture conditions like sebaceous hyperplasia, where the lesion is a raised oil gland rather than a depressed scar.

What Causes Acne Scars?

The underlying cause is always deep inflammation, but not every breakout leaves a scar. These are the factors that raise the risk:

Lesion Depth and Severity

Superficial whiteheads and blackheads almost never scar because they sit at the surface. Cystic acne, nodular acne, and deep pustules reach into the dermis and damage the collagen framework. The deeper the inflammation, the higher the scar risk. This is why hormonal cystic acne, which tends to be nodular and concentrated on the chin, jaw, and cheeks, leaves more scarring than teen whiteheads.

Delayed or Disrupted Healing

Picking, squeezing, or manipulating a lesion extends the inflammatory window, introduces bacteria into a deeper plane of the skin, and almost always worsens the scar outcome. The fingernail introduces contamination and pushes infected content deeper into the dermis. If you have a habit of picking, the scar outcome will be worse than if you leave lesions alone.

Acne Scars on Darker Skin Tones

People with medium to deeper skin tones are more susceptible to post-inflammatory hyperpigmentation AND to hypertrophic or keloid scarring. The melanocyte response to inflammation is more robust. This means PIH marks are darker, last longer, and can be triggered by less severe acne. It also means treatment choices matter more: certain laser settings and chemical peel concentrations that are safe for lighter skin tones carry a higher risk of hyperpigmentation or hypopigmentation in darker tones. Any at-home treatment in this group should start at the lowest intensity settings.

Genetic Predisposition and Smoking

Some people consistently scar more from comparable acne severity than others. The tendency to produce excess or insufficient collagen in response to tissue damage is partly genetic. If a parent or sibling has significant acne scarring, your own risk is elevated. Smoking adds to it: research summarized by DermNet suggests smoking raises the risk of more severe acne scarring.

How to Prevent Acne Scars

The most reliable way to prevent acne scars is to get active acne under control early, because scarring follows deep inflammation that is left to run. DermNet puts it plainly: timely, appropriate treatment during the active phase reduces both how often scars form and how severe they are.

• Treat breakouts early. See a dermatologist for cystic or nodular acne, the deep kind most likely to scar, rather than waiting it out.
• Hands off. Do not pick, squeeze or pop, for the reasons covered above.
• Wear SPF every day. Sun darkens fresh PIH marks and makes them last longer.
• Do not smoke. It is linked to more severe scarring.

Prevention protects the skin you have now. The rest of this guide covers the scars that have already formed.

How Do Dermatologists Treat Acne Scars?

Clinical treatment depends entirely on scar type, and no single method treats every type equally. A dermatologist will typically assess the mix of scar types present before recommending a treatment plan.

For Ice Pick Scars

TCA cross (trichloroacetic acid applied at very high concentration directly into the ice pick channel) is the most effective in-office approach. It stimulates collagen growth inside the channel. Punch excision, where the scar is surgically removed and the edges sutured, is used for very deep or wide ice pick scars. Multiple sessions are standard.

For Boxcar and Rolling Scars

Microneedling (radiofrequency or standard) and resurfacing lasers (ablative CO2, erbium) are the primary approaches. Both trigger a collagen-production response by controlled wounding of the dermis. Chemical peels and dermabrasion are other resurfacing options. Subcision, where a needle is inserted under the skin to break fibrous tethering bands, is particularly effective for rolling scars. Dermal fillers can temporarily lift boxcar and rolling scars, though this does not change the underlying structure.

For Raised Scars

Intralesional corticosteroid injections flatten hypertrophic scars over time. Silicone sheeting is recommended for maintenance. Keloid management requires specialist care and often a combination of corticosteroids, silicone, and laser. Clinical treatments for acne scarring typically start at $200 to $400 per session for microneedling and reach $800 to $2,000+ per session for ablative laser resurfacing. Multiple sessions are almost always required.

Can You Remove Acne Scars at Home?

Yes, for shallow scars and flat dark marks, with realistic expectations. Superficial boxcar and rolling scars respond to treatments that stimulate collagen production in the dermal layer, and plasma energy works by the same mechanism as electrocautery-based clinical treatments. At-home plasma pen use targets the surface of the scar bed and triggers a localized healing response, which stimulates new collagen formation as the treated skin renews.

The OcuraLife 6-in-1 Skin Imperfection Removal Pen uses plasma energy delivered at 9 power settings, allowing you to calibrate the intensity to the depth and sensitivity of the scar location. The device is designed for at-home use on benign skin changes including acne scars, within the bounds of reasonable scar depth and accessibility. The same collagen-renewal mechanism applies to related texture conditions like stretch marks.

The flat brown or dark marks a pimple leaves behind are a separate job with a separate tool: the 6-in-1 DPN Dark Spot Removal Pen treats flat dark marks and dark spots one at a time, once the breakout has fully healed.

For a step-by-step at-home treatment protocol, see How to Fade Acne Scars at Home and Can You Remove Acne Scars at Home? For a head-to-head comparison of plasma pen, microneedling, and TCA for acne scars, see Plasma Pen vs Microneedling vs TCA for Acne Scars.

Important scope: very deep ice pick scars, raised hypertrophic or keloid scars, and scars on the lid rim, lash line or waterline are not for at-home plasma treatment. When in doubt about scar type or depth, a dermatologist assessment is the right first step.

What to Expect: The Treatment Timeline

At-home plasma pen treatment follows a predictable healing sequence for each treated spot, from about 5 minutes of treatment to a fully settled spot within weeks.

Day 0: Treatment (Approximately 5 Minutes Per Spot)

The plasma tip is held close to the scar surface without contact. A small arc delivers plasma energy directly to the spot. A tiny protective scab begins to form immediately. Keep the area clean and dry after treatment.

Day 3 to Day 7: The Scab Falls Off

A small scab forms and falls off between day 3 and day 7. The spot is usually gone within 1 to 3 weeks. Do not pick or scrub the scab while it is in place, because the skin is rebuilding underneath. Healing Patches can shield the spot from friction and accidental picking during this window.

After the Scab: Collagen Keeps Working

The collagen stimulation continues beneath the surface for weeks after the visible scab is gone. SPF 50 is essential during this period, as newly treated skin burns more easily and unprotected sun exposure can trigger PIH in the healing zone. Deeper or older scars may benefit from a second session once the first healing cycle is complete, typically 4 to 6 weeks later.

When Should You See a Doctor Instead?

Shallow, settled acne scars can be treated at home, and a dermatologist visit comes first only in a handful of clear cases.

See Mayo Clinic's acne overview and the American Academy of Dermatology for clinical guidance on when inflammatory acne itself requires a dermatologist visit. Uncontrolled active acne should be addressed before scar treatment begins.

"The most important first step is identifying which type of acne scar you have, because the identification tells you which treatments are appropriate and which to skip entirely."

FAQ

Frequently asked questions

Here are answers to the questions people ask most about acne scars, how severe acne scarring gets, and at-home treatment.

↓ Tap each question to reveal the answer.

The Bottom Line

Acne scars are common, manageable, and not a life sentence. The most important first step is identifying which type you have and how severe your acne scarring is, because that tells you which treatments are appropriate. Flat PIH marks fade with time and SPF, or can be treated directly with a dark spot pen. Ice pick scars and severe scarring are best addressed clinically. Superficial boxcar and rolling scars respond well to collagen-stimulating treatments, including at-home plasma energy.

If you have shallow atrophic scarring and want to treat it at home, the OcuraLife 6-in-1 Skin Imperfection Removal Pen uses plasma energy to stimulate the collagen-renewal response that gradually improves the texture of treated scars, and it comes with a 90-day money-back guarantee. The guides below walk through doing it correctly.

Related guides in this cluster

This is the hub guide for acne scars in the OcuraLife Skin Conditions library. Go deeper with:

• How to Fade Acne Scars at Home (the treatment protocol)
• Boxcar vs Ice Pick vs Rolling Acne Scars: How to Identify Yours (type identification)
• Plasma Pen vs Microneedling vs TCA for Acne Scars: The Comparison (method comparison)
• Do Acne Scars Fade on Their Own? The Honest Answer (resolution Q&A)
• Best At-Home Acne Scars Removal (at-home options ranked)

Rated 4.87 out of 5 from 425+ verified reviews. See real customer reviews, photos, and before-and-afters →

The OcuraLife Plasma Pen is a cosmetic device for benign, surface-level spots and is not a substitute for medical advice or diagnosis. If a spot is changing or you are unsure, check with a qualified professional.