What Is the Best Acne Scar Treatment?
There is no single best acne scar treatment for everyone.
The most appropriate treatment depends on the type of scar, depth, severity, skin type, skin tone and overall condition of the skin.
This is particularly important because acne scars are not all structurally the same.
The main types of depressed acne scars are:
- Ice pick scars
- Boxcar scars
- Rolling scars
There are also raised scars, including hypertrophic scars and keloids. The American Academy of Dermatology explains that different acne-scar types can require different treatments, and that a dermatologist should examine the scars before creating an individual treatment plan.
Maple Clinic’s Acne Scar treatment page similarly divides acne scars into raised and depressed scars, with depressed scars further categorised into ice pick, boxcar and rolling scars. It lists TCA Cross, dermabrasion, RF microneedling, laser therapy, injectables and subcision as potential treatment options.
So the more useful question is: Which acne scar treatment is most appropriate for your specific scar type?
Why Scar Type Matters
Acne scars are caused by changes in the skin’s structure during the healing process.
A deep, narrow ice pick scar does not have the same structure as a broad rolling scar.
A rolling scar may be tethered to deeper tissue, while a boxcar scar can have a wider depression with more defined edges.
Because their underlying structures differ, using exactly the same treatment for every scar may not produce the best outcome.
The American Academy of Dermatology specifically notes that treating acne scars effectively requires identifying the scar type, because different scar types may require different treatments.
The Main Acne Scar Types
Ice Pick Scars
Ice pick scars are narrow and relatively deep depressions. They can look like small holes or punctures in the skin. The American Academy of Dermatology describes them as small but deep scars that extend further into the skin. Because of their narrow structure, treatment often needs to be more targeted.
Boxcar Scars
Boxcar scars are wider depressions with relatively defined edges. They can be shallow or moderately deep, and are more clearly visible because of their borders. The American Academy of Dermatology describes boxcar scars as round or oval depressions that are wider than ice pick scars. The best treatment depends on their depth, edges and whether other scar types are present.
Rolling Scars
Rolling scars are generally wider and shallower and can give the skin a wavy or undulating appearance. The American Academy of Dermatology describes rolling scars as broad, shallow depressions that can create a rolling appearance across the skin. They may also involve fibrous attachments beneath the skin, which can affect treatment selection.
Raised Acne Scars
Not all acne scars are depressed. Raised scars occur when the body produces excessive collagen during healing. They include hypertrophic scars and keloids, which require a different treatment approach from depressed acne scars. Maple Clinic also distinguishes raised scars from depressed scars on its Acne Scar page.
What Is the Best Treatment for Ice Pick Scars?
For ice pick scars, highly targeted treatment is often more relevant than simply resurfacing the entire skin surface.
One treatment Maple Clinic specifically lists for acne scars is TCA Cross. The technique applies trichloroacetic acid directly to individual depressed scars.
Clinical literature also identifies TCA CROSS as particularly useful for ice-pick scars, although treatment protocols and outcomes vary and complications such as post-inflammatory pigmentation can occur.
Depending on the scar and its depth, other approaches may also be considered.
The appropriate choice should therefore be based on the actual scar rather than the treatment name alone.
What Is the Best Treatment for Rolling Scars?
Rolling scars often have a different structural cause from ice pick scars.
Some rolling scars are associated with fibrous strands that tether the scar downward, creating a wavy surface.
This is one reason subcision can be considered.
Subcision involves placing a needle or cannula beneath the scar to release fibrotic strands that tether it to deeper tissue. A review of clinical trials describes subcision as a technique designed to release these tethering bands and elevate atrophic scars.
Maple Clinic lists subcision among its acne-scar treatment options.
Depending on the individual, subcision may be combined with other treatments to improve remaining texture.
What Is the Best Treatment for Boxcar Scars?
Boxcar scars can vary significantly.
A shallow boxcar scar may respond differently from a deeper one.
Potential treatment categories can include:
- Laser resurfacing
- RF microneedling
- Microneedling
- Subcision in selected cases
- Other scar-specific procedures
The American Academy of Dermatology notes that dermatologists choose treatment according to scar type, and that a person may require more than one procedure to achieve the desired improvement.
Maple Clinic lists RF microneedling and laser therapy among its acne-scar treatment options.
What About Shallow Acne Scars?
Shallow scars are generally less structurally severe than deep scars.
Treatment may focus on improving:
- Skin texture
- Collagen production
- Surface smoothness
- Overall appearance
Depending on the scar type, options may include microneedling, RF microneedling, laser therapy, and chemical treatments.
The American Academy of Dermatology notes that microneedling creates controlled punctures that stimulate collagen and elastin production and can diminish the appearance of acne scars.
What About Deep Acne Scars?
Deep scars tend to require more targeted treatment.
For example:
- Deep ice pick scars may require scar-specific techniques rather than only broad resurfacing.
- Deep rolling scars may require release of fibrotic tethering.
- Deep boxcar scars may require a combination of procedures depending on their edges and depth.
A systematic review of acne-scar treatments found evidence for multiple modalities, including subcision, microneedling, fillers and chemical peels, while emphasising that outcomes vary and treatment should be tailored.
Is Laser the Best Treatment for Acne Scars?
Laser therapy can be effective for selected acne scars, but it is not automatically the best option for every scar.
Maple Clinic lists Laser Therapy as one of its acne-scar treatment options and describes it as stimulating collagen and improving texture and tone.
The American Academy of Dermatology also describes laser resurfacing as one method dermatologists use to reduce the appearance of acne scars.
However, laser treatment may be more relevant to certain textural scars than others. A deep tethered rolling scar, for example, may require treatment of the underlying attachment rather than surface resurfacing alone.
Is RF Microneedling Good for Acne Scars?
RF microneedling combines microneedling with radiofrequency energy.
Maple Clinic lists RF microneedling as one of its acne-scar treatment options and describes the treatment as supporting collagen and elastin production.
It may be considered for selected:
- Rolling scars
- Boxcar scars
- Uneven texture
- General acne-scar resurfacing
The suitability depends on the scar morphology and skin condition.
RF microneedling should therefore be viewed as one treatment category within a broader scar-treatment plan rather than a universal answer.
Where Does TCA Cross Fit?
TCA Cross is particularly associated with targeted treatment of depressed scars.
Instead of applying the chemical peel broadly across the face, the technique applies TCA directly into individual scar depressions.
Maple Clinic lists TCA Cross among its acne-scar treatments.
Published reviews have found that TCA CROSS has been used particularly for ice pick and boxcar scars, although treatment technique, concentration and patient factors affect both results and risk.
This makes TCA Cross different from a conventional full-face chemical peel.
Where Does Subcision Fit?
Subcision is particularly relevant when a scar is tethered to underlying tissue.
A needle or blunt cannula is introduced beneath the scar and used to release fibrotic strands.
The purpose is to allow the depressed skin to lift away from the tissue underneath.
Clinical literature identifies subcision as a technique used for rolling acne scars, although outcomes vary and it may be combined with other modalities.
Maple Clinic includes subcision as an acne-scar treatment option.
Where Do Injectables Fit?
Some depressed scars may be suitable for injectable treatments.
Maple Clinic lists injectables among its acne-scar treatment options and explains that substances such as hyaluronic acid, collagen or fat may be used to smooth selected scar depressions.
Injectables may be particularly relevant when:
- A scar is depressed
- Volume loss contributes to the indentation
- The scar has an appropriate shape for correction
However, fillers do not address every scar type. A deep ice pick scar, for example, may require a different technique.
Does Everyone Need More Than One Acne Scar Treatment?
Not necessarily, but combination treatment is common when different scar structures are present.
A patient might have a mix of ice pick scars, rolling scars, boxcar scars, pigmentation, and uneven texture.
One treatment may improve one component but not another.
The American Academy of Dermatology notes that dermatologists may use more than one treatment to achieve better acne-scar improvement.
A 2023 evidence-based review also describes multiple treatment modalities for atrophic acne scarring and notes that there is still a need for better standardisation of treatment protocols.
How Do You Choose the Best Acne Scar Treatment?
A useful decision framework is:
Step 1: Identify the Scar Type
Is it ice pick, boxcar, rolling, or raised?
Step 2: Assess the Depth
A shallow scar and a deep scar may require different treatment strategies.
Step 3: Check for Tethering
If the scar is pulled down by fibrous tissue, subcision may be relevant.
Step 4: Look at Skin Texture
If the main concern is widespread uneven texture, resurfacing or collagen-stimulating treatments may be considered.
Step 5: Consider Skin Tone
The risk of post-inflammatory pigmentation can influence treatment selection and settings.
Step 6: Consider Whether Acne Is Still Active
Acne should generally be controlled before focusing heavily on scar revision. The American Academy of Dermatology recommends treating active acne and preventing new breakouts before or alongside scar treatment.
What Is the Best Acne Scar Treatment for Asian Skin?
There is no single treatment that is best for every Asian patient.
Skin tone matters because some procedures can trigger post-inflammatory hyperpigmentation, especially in patients who are more prone to pigmentation after inflammation or injury.
This does not mean that laser, chemical or energy-based treatments cannot be used.
It means the doctor should consider:
- Skin tone
- Pigmentation history
- Scar type
- Treatment intensity
- Risk of post-inflammatory pigmentation
- Previous treatment response
Treatment should therefore be personalised instead of using the same protocol for everyone.
Can Acne Scars Be Completely Removed?
Complete removal cannot be guaranteed.
The realistic goal is generally to make scars:
- Less visible
- Smoother
- Shallower
- Less noticeable under normal lighting
Maple Clinic states that treatment outcomes are affected by scar severity, scar type, skin type and skin tone, and notes that deeper scars may become less visible rather than disappear completely.
This is particularly important for deep or long-standing acne scars.
How Long Does Acne Scar Treatment Take?
Acne-scar correction is usually a process rather than a single-session procedure.
The timeline depends on:
- Scar type
- Treatment method
- Number of sessions
- Healing response
- Whether combination treatment is needed
Maple Clinic notes that more significant acne scars can take months to improve and states that treatment results can vary significantly based on scar type and severity.
Collagen remodelling can also continue after treatment, so immediate post-treatment appearance does not necessarily represent the final result.
What If You Still Have Active Acne?
Active acne should be addressed before focusing entirely on scar correction.
The American Academy of Dermatology notes that treating active acne and preventing new breakouts is important because continued inflammation can lead to additional acne scars.
A treatment plan may therefore involve:
Active acne → control the acne → Acne scars → select scar-specific treatment
This helps prevent repeated inflammation from creating new scars while the existing scars are being treated.
Can Skincare Remove Acne Scars?
Skincare can be useful for mild concerns and for supporting the skin, but deep structural acne scars generally require professional treatment.
The American Academy of Dermatology notes that topical retinoids or salicylic acid may make mild acne scarring less noticeable.
However, skincare cannot replicate procedures that release tethering, resurface deeper scars, stimulate substantial collagen remodelling, or restore lost volume.
For deeper scars, a professional assessment is therefore more appropriate.
Acne Scar Treatment by Scar Type
| Acne Scar Type | Treatment Approaches That May Be Considered |
|---|---|
| Ice pick | TCA Cross, targeted scar procedures, selected resurfacing approaches |
| Rolling | Subcision, RF microneedling, resurfacing, combination approaches |
| Boxcar | Laser resurfacing, RF microneedling, selected scar procedures |
| Raised / hypertrophic / keloid | Different scar-management approaches; not the same as depressed-scar treatment |
These are general categories rather than prescriptions for an individual patient. Scar morphology and skin type need to be assessed before selecting a procedure. The American Academy of Dermatology and published reviews both emphasise that acne-scar treatment should be individualised according to scar type.
Which Treatment Is Best for Multiple Scar Types?
If you have a mixture of scars, a combination plan may be more appropriate than choosing one procedure for the entire face.
For example:
Ice pick + rolling scars: targeted treatment for ice pick scars + subcision for tethering.
Rolling + boxcar scars: subcision and collagen-remodelling / resurfacing approaches may be considered.
Acne scars + pigmentation: scar treatment and pigment management may need to be addressed separately.
A multimodal approach is supported by the broader acne-scar literature because different scar morphologies have different structural causes.
Conclusion
The best acne scar treatment depends on the scar itself.
Ice pick scars, boxcar scars, rolling scars and raised scars have different structures, so a treatment that works well for one type may not be the best choice for another. The American Academy of Dermatology recommends assessing scar type and other patient factors before developing an individual treatment plan.
For ice pick scars, targeted approaches such as TCA Cross may be considered. For rolling scars, subcision can be relevant when fibrous tethering is present. For boxcar scars, resurfacing and collagen-remodelling approaches may be considered depending on their depth. Maple Clinic currently offers TCA Cross, RF microneedling, laser therapy, injectables and subcision within its Acne Scar treatment options.
The most effective treatment plan may involve more than one procedure, especially when multiple scar types are present.
For patients considering acne scar treatment in Malaysia, the first step is to identify your scar type and understand what is structurally causing it before choosing a procedure.
Explore Maple Clinic’s Acne Scar Treatment to learn more about the available treatment options and discuss which approach may be suitable for your scars.
Frequently Asked Questions
What is the best acne scar treatment?
There is no universal best treatment. The appropriate option depends primarily on scar type, depth, skin tone, severity and whether the scars are tethered or associated with other skin concerns.
What is the best treatment for ice pick scars?
TCA Cross is one treatment commonly used for ice pick scars. Other targeted procedures may also be considered depending on scar depth and skin characteristics.
What is the best treatment for rolling acne scars?
Subcision may be particularly relevant when rolling scars are tethered by fibrous strands beneath the skin. Other treatments may be added to improve remaining texture.
What is the best treatment for boxcar scars?
Treatment depends on whether the boxcar scars are shallow or deep. Laser resurfacing, RF microneedling and other scar-specific procedures may be considered.
Can acne scars be completely removed?
Complete removal cannot be guaranteed, particularly for deep scars. Treatment generally aims to make scars less noticeable and improve skin texture. Maple Clinic notes that outcomes vary according to scar type and severity.
Is laser the best treatment for acne scars?
Not necessarily. Laser can be useful for selected scars, but it may not address tethered rolling scars or deep narrow scars as directly as other procedures. Treatment should be based on scar morphology.
Can RF microneedling treat acne scars?
Yes. RF microneedling is one of Maple Clinic’s listed acne-scar treatment options and can stimulate collagen and elastin production.
Can TCA Cross treat all acne scars?
No. TCA Cross is particularly associated with depressed scars such as ice pick scars, but treatment suitability depends on the scar structure and skin characteristics.
Can subcision treat ice pick scars?
Subcision is generally more relevant to scars with tethering, particularly rolling scars. Ice pick scars often require a more targeted approach.
Should active acne be treated before acne scars?
Generally, active acne should be controlled to reduce ongoing inflammation and prevent new scars from developing.