How Do I Know What Type of Acne Scars I Have?
Ice Pick, Boxcar, or Rolling?
If you’ve struggled with acne in the past and are now left with lingering marks or indentations, you’re not alone. Acne scars can be frustrating—but identifying the type of scar you have is the first step toward choosing the right treatment.
Not all acne scars are the same. In fact, most fall into three main categories: ice pick, boxcar, and rolling scars. Each has a distinct appearance and responds differently to treatment.
Let’s break them down.
Ice Pick Scars
What They Look Like
Ice pick scars are:
- Narrow (usually less than 2 mm wide)
- Deep
- Sharp-edged
- Appear like tiny holes or punctures in the skin
They often look as if the skin was pierced with a sharp object—hence the name.
Why They Form
These scars typically result from deep, inflamed cystic acne that damages collagen far beneath the surface.
Where They’re Common
- Cheeks
- Around the nose
How to Identify Them at Home
If you stretch your skin and the scar does not flatten or disappear, and it looks like a small deep “pore” that goes straight down, it’s likely an ice pick scar.
Boxcar Scars
What They Look Like
Boxcar scars are:
- Round or oval depressions
- Wider than ice pick scars
- Have well-defined, sharp edges
- May be shallow or deep
They resemble small craters with vertical sides.
Why They Form
Boxcar scars develop when inflammatory acne destroys collagen and the skin cannot fully regenerate, leaving a structural depression.
Where They’re Common
- Lower cheeks
- Temples
- Jawline
How to Identify Them at Home
If the scar:
- Has clear edges
- Looks like a small crater
- Doesn’t completely disappear when stretched
…it’s likely a boxcar scar.
Rolling Scars
What They Look Like
Rolling scars are:
- Wide and shallow
- Have soft, sloping edges
- Create a wave-like or uneven skin texture
They give the skin a “rolling” or undulating appearance.
Why They Form
These scars are caused by fibrous bands forming between the skin and deeper tissues. These bands pull the skin downward, creating surface irregularities.
Where They’re Common
- Cheeks
How to Identify Them at Home
If you gently stretch your skin and the indentation temporarily improves or disappears, it’s most likely a rolling scar.
What About Dark Marks?
It’s important to distinguish scars from post-inflammatory hyperpigmentation (PIH).
If the mark is:
- Flat
- Red, pink, brown, or purple
- Not indented
…it’s likely discoloration, not a true scar. These often fade with time and topical treatments.
Why Identifying Your Scar Type Matters
Different scars require different treatments:
- Ice pick scars often respond best to procedures like TCA CROSS or punch excision.
- Boxcar scars may improve with laser resurfacing or microneedling.
- Rolling scars often respond well to subcision (to release the fibrous bands).
Many patients actually have a combination of scar types, which means treatment plans are usually customized.
When to See a Dermatologist
If:
- You’re unsure what type you have
- You’ve tried over-the-counter treatments without improvement
- Scars are affecting your confidence
A board-certified dermatologist can assess scar depth, skin type, and recommend a personalized treatment strategy.
Final Thoughts
Understanding whether you have ice pick, boxcar, or rolling scars is the foundation of effective acne scar treatment. While all three are forms of atrophic (indented) scarring, their shape, depth, and behavior when stretched can help you tell them apart.
The good news? With modern dermatologic procedures, most acne scars can be significantly improved.
If you’d like, I can also write a companion blog on the best treatments for each acne scar type.
