0455 859 548
For a lot of people, the acne itself clears up long before the marks it left behind do. If you’re still looking at scarring years after your breakouts settled, you’re not alone, and it’s a genuinely frustrating thing to live with. The first thing worth understanding is that not all acne scars are the same. The treatment that works beautifully for one type can do very little for another, or in some cases isn’t the right tool for the job at all. This article walks through the main types of acne scarring in plain language, so you have a clearer picture of what you’re actually dealing with before you look at treatment.
Why Scar Type Matters
The depth, shape, and underlying cause of a scar all influence which treatments are likely to make a visible difference. Sending every acne scar patient straight to CO2 laser, for example, isn’t always the right call. Some scars respond far better to RF microneedling, subcision, chemical peels, or a combination of these approaches. This is why Dr Scott maps each patient’s scarring individually at consultation rather than applying the same protocol to everyone who walks through the door.
Atrophic (Depressed) Scars: The Most Common Category
When most people picture acne scarring, this is what they’re picturing. Atrophic scars sit below the surrounding skin, simply because the skin lost more collagen during inflammation than it managed to rebuild. There are three main subtypes here, and knowing which one you’ve got makes a real difference to how it’s treated.
Ice pick scars are deep, narrow, and often described as looking like small pores or pinpricks. They penetrate quite far into the dermis, which makes them the hardest of the three to treat, and they tend to show up most often on the cheeks. TCA CROSS, a targeted chemical peel technique, is a common option for this scar type.
Boxcar scars are broader, box-shaped depressions with sharply defined vertical edges. They sit closer to the surface than ice pick scars, which generally makes them more responsive to treatment. Fractional CO2 laser, RF microneedling, and subcision can all be effective here.
Rolling scars create a wavy, uneven texture across broader areas of skin, with sloping rather than sharp edges. This happens because fibrous bands form under the skin and tether it down from beneath. Subcision, which releases those bands, tends to be a key part of treating this scar type, often paired with CO2 laser or RF microneedling to smooth the surface afterwards.
Hypertrophic and Keloid Scars
Not every acne scar sits below the skin. Some people’s skin responds to healing by producing too much collagen, which creates a raised rather than depressed scar. This is less common with acne scarring than the atrophic types above, but it does happen, particularly on the chest, shoulders, and back.
Hypertrophic scars are raised, firm, and pink or red in colour, but they stay within the boundary of the original mark. These can sometimes flatten on their own over time, and intralesional injections or laser treatment may help speed that process along.
Keloid scars are a different matter. They grow beyond the boundary of the original mark and can keep growing over time. They’re more common in darker skin tones and need specialist management rather than standard scar treatment. If Dr Scott identifies keloid scarring during an assessment, he’ll advise you on the most appropriate next steps.
Post-Inflammatory Hyperpigmentation: Often Mistaken for a Scar, But It Isn’t One
Flat red, brown or grey marks left behind after a breakout often get mistaken for scarring, but in a lot of cases that’s not what’s happening. This is post-inflammatory hyperpigmentation, or PIH: a pigmentation response rather than an actual change in the skin’s structure, and one of the categories patients ask about most.
PIH often fades on its own over 6 to 12 months, though this can feel like a long time to wait when it’s on your face. Treatments such as IPL, ClearLift laser, chemical peels, and topical brightening agents can help speed up clearance. The approach for PIH looks quite different to the approach for structural scarring, which is exactly why correctly identifying what you’re dealing with matters so much before starting treatment.
Can You Have More Than One Scar Type?
Yes, and honestly, most people with noticeable acne scarring do. It’s common to have boxcar scars on one area of the face, rolling scars on another, and some lingering pigmentation layered on top. This is a big part of why a single treatment applied across the board rarely gives the best result. A well-planned approach from Dr Scott may combine CO2 laser, RF microneedling, subcision, and targeted pigmentation treatment, depending on exactly what your individual scar map looks like.
Why Choose Dr Scott for Acne Scar Treatment in Brisbane
Acne scarring is rarely a one-treatment problem, which is exactly why having a doctor who offers the full range of modalities, rather than just one, makes a genuine difference to your results.
Dr Scott Horsburgh holds an MBBS from the University of Queensland, is a Fellow of the Royal Australian College of General Practice (FRACGP), and brings over 20 years of experience across clinical and aesthetic medicine. He is AHPRA registered (MED0000954670) and is also Head of Derma Medical Australia, training other cosmetic practitioners around the country.
At his Brisbane clinic, Dr Scott offers CO2 laser, Morpheus8 RF microneedling, skin needling, chemical peels, and combination treatment approaches for acne scarring. Rather than applying a fixed protocol, he maps each patient’s scarring individually and builds a plan around what’s actually there. All treatments are performed personally by Dr Scott at Lila Aesthetics, 1/33 Lytton Rd, East Brisbane QLD 4169.
You can see more of his work on Instagram and LinkedIn.
FAQs
What are the different types of acne scars?
Broadly speaking, there’s ice pick scars (deep, narrow pits), boxcar scars (broader depressions with defined edges), rolling scars (a wavy, uneven texture), hypertrophic or keloid scars (raised), and post-inflammatory hyperpigmentation (flat discolouration). Treatment usually needs to be matched to the specific type.
How do I know what type of acne scar I have?
As a rough guide, ice pick scars look like deep, narrow pits, boxcar scars are wider with sharp edges, and rolling scars give the skin a wavy, uneven texture. That said, it’s worth having a doctor assess your scarring in person, since scar types are often mixed and treatment depends on getting this right.
Can all acne scar types be treated?
Most atrophic scars can be improved with the right combination of treatments, although completely removing them isn’t usually realistic. How much improvement you can expect depends on the scar type, its depth, your skin type, and the approach used.
What is post-inflammatory hyperpigmentation and is it the same as a scar?
No. Post-inflammatory hyperpigmentation (PIH) is flat discolouration left after acne heals, and it’s a pigmentation response rather than a structural scar. Unlike true scarring, PIH often fades on its own but can be treated with lasers, chemical peels, or topical agents to speed things up.
Ready to Understand Your Scarring Better?
If you’ve been trying to work out what you’re dealing with, or you’ve tried treatments before without much change, a consultation with Dr Scott can give you real clarity. He’ll assess your scarring in person and talk you through a plan that actually matches what’s there.
Book a Consultation with Dr Scott
Further Reading about Acne Scar Treatment with Dr Scott:
- Read Dr Scott’s acne scar treatment service page
- Read Dr Scott’s CO2 laser page
- Read Dr Scott’s Morpheus8 RF microneedling page
- Read Dr Scott’s ClearLift laser treatment page
Medical References:
This article is general information only and doesn’t replace personalised medical advice. Results from acne scar treatment vary between individuals, and complete removal of scarring is not typically achievable. Dr Scott Horsburgh, AHPRA MED0000954670, assesses each patient’s scarring individually during consultation before recommending a treatment plan.
