Not one condition. Icepick, boxcar and rolling scars have different architecture and respond to different things — which is why a single device rarely resolves a mixed face.
Book an assessment →There are three main types of depressed acne scars and one raised group. Ice pick scars are narrow and deep, boxcar scars are wider with steep walls and a flat floor, and rolling scars are broad waves tethered from below; hypertrophic and keloid scars are raised. Flat red or brown marks are not scars. Each type needs a different tool, as set out in acne scar treatment in Singapore.
Acne scars are grouped by shape, because shape reflects how deep the damage went and what is holding the scar down. Most people have two or three types side by side.
| Type | Shape | Typical width | Stretch test | Main page |
|---|---|---|---|---|
| Ice pick | Narrow V-shaped shaft, deep | Under about 2 mm | Stays visible | Ice pick scars |
| Boxcar | Steep walls, flat floor; shallow or deep | About 1.5–4 mm | Stays visible | Boxcar scars |
| Rolling | Broad, soft-edged wave, tethered from below | Often 4–5 mm or wider | Softens or flattens | Rolling scars and subcision |
| Hypertrophic | Firm raised scar within the original spot | Varies | Not applicable | Raised scars |
| Keloid | Raised scar growing beyond the original spot | Varies; can enlarge | Not applicable | Keloid scars |
| Red or brown marks | Flat; colour only, not a scar | Any | No change in contour | PIE vs PIH |
Narrow and deep, like a puncture that runs into the dermis and sometimes down to the fat. They usually follow deep cysts and nodules, and from a distance look like large open pores. Because the opening is so narrow, little of the scar is exposed to the surface, which is why they are treated from the inside. See ice pick scar treatment.
Round or oval dips with steep, almost vertical walls and a flat floor. Shallow boxcar scars sit within about half a millimetre of the surface; deep ones go further. They form where inflammation destroyed collagen over a wider area than an ice pick scar. The sharp edge throws the shadow you see in side light. See boxcar scars treatment.
Broad, shallow, soft-edged dips that give the cheek a wavy look. Fibrous bands join the underside of the skin to deeper tissue and pull it down, so they soften when the skin is stretched. Their cause sits below the surface, which is why release comes before resurfacing; see rolling acne scars and subcision.
Raised scars form when healing lays down too much collagen. Hypertrophic scars stay within the boundary of the original spot and may soften over a year or two; keloids grow beyond it, can itch or hurt and do not settle by themselves. Both are more common on the jaw, chest, shoulders and upper back, and keloids are more frequent in Asian and darker skin.
Mixed scarring, with several types in the same area, is the rule rather than the exception. Less common forms include soft, skin-coloured papular scars on the chin and back, bridges and tunnels where skin heals over a tract, and small atrophic patches that look slightly thinned rather than pitted. They are named at assessment because they can need a different approach.
These checks give a first idea. A doctor’s assessment also measures depth, checks for tethering and separates scars from enlarged pores and marks, which is where most self-diagnosis goes wrong.
Doctors often describe severity with a qualitative global grading system that rates the whole face by how visible the scarring is at a normal social distance. It helps plan treatment and judge progress consistently.
| Grade | Description | What it usually means for a plan |
|---|---|---|
| 1: Macular | Flat red or brown marks; no change in contour | Mark treatment rather than scar treatment |
| 2: Mild | Shallow scars visible up close, easily covered by make-up or facial hair | Resurfacing or RF microneedling; a short course |
| 3: Moderate | Scars obvious at social distance, not easily covered, flatten with stretching | Combination: subcision and resurfacing |
| 4: Severe | Scars obvious at social distance, do not flatten with stretching | All steps, often including TCA CROSS and volume support, over a longer course |
If acne is still active, treating it is the most effective scar prevention; see acne treatment in Singapore. In Asian skin, the same inflammation also tends to leave longer-lasting brown marks, explained in PIE vs PIH: red vs brown acne marks.
Icepick scars are narrow and deep; boxcar scars are wider with sharply defined walls; rolling scars are shallow undulations tethered from below by fibrous bands.
Tethering is the distinction that changes the plan. A rolling scar is held down by a band; resurfacing the surface above it does very little. Release and resurfacing are not substitutes.
Scar type distribution, depth, tethering, active acne, Fitzpatrick type and prior treatment history.
Mixed presentations generally need combined approaches sequenced over time — release for tethering, resurfacing for texture, and pigment work where marks dominate.
Active inflammatory acne is controlled before scar work begins. Treating scars while new lesions form produces new scars.
The assessment grades each area of the face by scar type and depth, checks for tethering, records skin type and any active acne, and notes earlier treatments. Most people have a mixture, so the plan is built in layers rather than around a single device.
Tethered rolling scars are released first, by subcision. Boxcar and textured areas are resurfaced with the DEKA Tetra Pro CO2 laser (SCAR3) or fractional laser; deep icepick scars may need focal treatment. For mixed, deeper scarring these steps are combined in IN Eternity's 4D Scar Reconstruction protocol. The full range of options is set out on acne scar treatment in Singapore.
Scar treatment is gradual. Collagen keeps remodelling for months after each session, so sessions are usually spaced four to eight weeks apart and progress is judged against photographs taken in the same light. Resurfacing sessions bring several days of redness and fine crusting; release and focal treatments may bruise.
In Asian skin the main risk is temporary darkening after treatment, which is reduced by sun protection in the weeks around each session, conservative settings and adequate intervals. The realistic aim is scars that are shallower and catch less light, not skin that has never been scarred.
“A rolling scar is held down from below. Resurfacing the top of it, however many times, will not release the band.”
Not one condition. Icepick, boxcar and rolling scars have different architecture and respond to different things — which is why a single device rarely resolves a mixed face.
Tethering is the distinction that changes the plan. A rolling scar is held down by a band; resurfacing the surface above it does very little. Release and resurfacing are not substitutes.
Scar type distribution, depth, tethering, active acne, Fitzpatrick type and prior treatment history.
Active inflammatory acne is controlled before scar work begins. Treating scars while new lesions form produces new scars.
Scars can usually be made shallower and less noticeable, but complete removal is not realistic. The amount of change depends on scar type, depth, skin type and how many sessions are done.
Shallow boxcar scars and general texture often respond to resurfacing laser. Rolling scars usually need release first, and deep icepick scars often need focal treatment, so laser alone rarely covers a mixed face.
The three main depressed types are ice pick (narrow and deep), boxcar (wider with steep walls and a flat floor) and rolling (broad waves tethered from below). Raised scars are hypertrophic or keloid. Flat red or brown marks are not scars.
Deep ice pick scars, deep boxcar scars with a tethered floor and keloids usually need the most steps. Mixed scarring is also more involved, because each type needs its own tool. Shallow rolling scars and texture tend to respond more readily.
These sources describe mechanisms and general evidence. They are not a promise of any individual result; suitability is decided at an in-person assessment.
Every assessment at IN Eternity Clinic is carried out personally by Medical Director Dr Sin Yong at 9 Scotts Road, #12-01 Pacific Plaza. If the honest answer is that treatment should wait, you will be told that.
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