Atrophic Scarring: Causes, Types & Treatment Options

Atrophic scars—also known as rolling, boxcar, and ice-pick scars—are indentations in the skin that form when the body fails to produce enough collagen during healing. These depressions most commonly result from inflammatory acne, such as cystic or nodular acne. However, chickenpox, mole removals, deep cuts, surgical incisions, and skin infections can also leave behind atrophic scarring. Because atrophic scars represent permanent changes to the skin’s underlying structure, treating them is often more challenging than managing the original acne or injury. This reality can leave many patients self-conscious about their complexion. Fortunately, board-certified dermatologist Dr. Michele Green in NYC has spent over twenty-five years helping men and women worldwide restore smoother skin texture with advanced, non-invasive treatments for atrophic scars.

The most effective non-invasive treatments for atrophic scars include laser resurfacing, subcision with dermal fillers, microneedling, microdermabrasion, and chemical peels. Each of these procedures works by stimulating new collagen production or restoring lost volume in indented scars, gradually smoothing the skin’s surface. Most involve little downtime or risk of side effects. Targeted skincare products, including retinols and vitamin C, can further enhance and help maintain these results over time. Because most patients present with a combination of rolling, boxcar, and ice pick scars, an individualized atrophic scar treatment plan is essential, which is exactly what Dr. Green designs for every patient who visits her Upper East Side dermatology practice.

Dr. Michele Green is a board-certified cosmetic dermatologist and a recognized expert in non-invasive treatments for atrophic scars, including lasers, dermal fillers, and chemical peels. Based in her boutique dermatology practice on Manhattan’s Upper East Side, she uses the latest techniques and advanced technologies to diminish atrophic scars across all skin types and tones, delivering natural, long-lasting rejuvenation. Her dedication and expertise have earned her recognition from Castle Connolly, New York Magazine, Super Doctors, and The New York Times as one of NYC’s top dermatologists. Whether your treatment plan involves subcision with dermal fillers, chemical peels, microneedling, laser resurfacing, or a customized skincare regimen, Dr. Green will work closely with you to create a personalized approach that targets your scars and reveals a smooth, clear, and beautiful complexion.

What is atrophic scarring?

An atrophic scar is an indented, depressed skin lesion that heals below the normal epidermal layer, leaving visible depressions in the skin. Any trauma can cause atrophic scarring, but it most commonly results from cystic acne breakouts and chickenpox. After trauma or injury, the skin responds by producing collagen fibers to repair the wound and smooth the skin; if too little collagen is produced during healing, an atrophic scar can form. Atrophic scarring indicates permanent damage to the skin and will not resolve without treatment. Patients can undergo non-invasive cosmetic procedures such as chemical peels, dermal fillers, and laser resurfacing to stimulate collagen production, smooth skin texture, and reduce the appearance of atrophic scars. Dr. Michele Green is a board-certified dermatologist in New York City with over twenty-five years of experience treating patients with the most innovative procedures for atrophic scar treatment. When you consult with her, she will help you understand the treatment or combination of treatments that will effectively minimize your scars for clear, smooth skin that lasts.

What does atrophic scarring look like?

Atrophic scars appear as depressions or indentations in the skin. The three types of atrophic scars include:

• Rolling scars — These shallow, uneven indentations look wave-like, seemingly “rolling” across the skin’s surface.
• Boxcar scars — These scars are round or oval, with well-defined edges, deep vertical sides, and relatively flat bottoms.
• Ice-pick scars — These scars are the hardest to treat because of their depth and narrow V-shape.

Research estimates that rolling scars account for 15-25%, boxcar scars for 20-30%, and ice-pick scars for 60-70% of total atrophic scars (J Am Acad Dermatol doi: 10.1067).

What causes atrophic scars?

The main cause of atrophic scars is untreated acne vulgaris. Severe acne lesions, including cystic and nodular acne, are often associated with atrophic scarring because of the inflammation they provoke. Picking, squeezing, or popping acne lesions and cysts can cause further skin trauma and worsen inflammation, increasing the risk of atrophic scarring. A chickenpox infection can also lead to atrophic scars: a chickenpox lesion can cause blistering, which often heals with inadequate collagen production, leaving indentations. Unlike atrophic scars from acne, those from chickenpox typically lack the top skin layer and may not respond as well to treatment as acne-related atrophic scars. Additionally, atrophic scars can form after mole removal, deep cuts, insect bites, surgical incisions, or skin infections.

Do atrophic scars go away?

Unfortunately, atrophic scars result from permanent skin damage and will not go away or fade on their own. However, with non-invasive cosmetic treatments, significant improvements are possible. Many atrophic scar treatments aim to stimulate new collagen production to smooth skin texture, while others focus on restoring lost volume to reduce the appearance of skin indentations. These treatments are long-lasting, and many patients choose to maintain their smoother skin with regular maintenance sessions. Certain skincare products can also be used alongside cosmetic treatments to enhance results and help maintain a scar-free complexion.

How are atrophic scars treated?

Some of the most popular in-office options for treating atrophic scars include chemical peels, dermal fillers, laser treatments, and microneedling. Treatment for atrophic acne scars depends on the type of scarring present. Patients often receive a combination of these treatments to address rolling, boxcar, and ice pick scars for optimal results. With so many treatment options available, it can be difficult to determine which are best for your skin. When you consult with Dr. Green at her private NYC cosmetic dermatology office, she will evaluate your skin type and tone, as well as the type and severity of your scars, to develop a personalized treatment plan that helps you look and feel your best again.

Chemical peels for atrophic scar treatment

Chemical peels are exfoliating treatments that stimulate new collagen production and remove dead skin cells, revealing healthy, fresh skin. By restoring collagen levels and accelerating skin cell turnover, chemical peels can significantly improve the appearance of atrophic scars, fine lines, wrinkles, melasma, post-inflammatory hyperpigmentation, sun damage, and discoloration. Chemical peels may use various chemical exfoliants to renew the skin, though Dr. Green usually applies trichloroacetic acid (TCA) to resurface the skin and treat atrophic scars. Side effects depend on the type and strength of the peel used; mild erythema is typical and heals quickly, though multiple sessions are necessary to achieve optimal cosmetic results.

Subcision with dermal fillers

Subcision is a minimally invasive dermatologic procedure used to treat atrophic scars. It involves inserting a needle to break the fibrotic strands tethering the skin’s top layers to the underlying tissue. After disrupting these connections, the fibrotic bands are released, promoting new collagen production and gradually improving skin smoothness and evenness. Dr. Green often combines subcision with dermal filler injections to restore volume and enhance skin texture simultaneously, using hyaluronic acid injectables such as Juvederm and Restylane, or biostimulating fillers such as Sculptra, to treat atrophic scarring. Hyaluronic acid fillers provide immediate volume restoration and are ideal for discreet, depressed facial scars, while Sculptra encourages new collagen production and suits more diffuse volume loss. Hyaluronic acid fillers can last nine to twelve months, while Sculptra can last up to two years after a series of injections; patients can schedule a follow-up with Dr. Green to determine if additional filler is needed.

Fraxel laser resurfacing for indented scars

The Fraxel laser is a non-ablative, non-invasive laser therapy designed to address a range of skin concerns, including acne scars, fine lines and wrinkles, uneven texture, stretch marks, sun damage, and pigmentation. It features two wavelength settings: 1550nm for treating acne scars and uneven skin texture, and 1927nm for addressing sun damage, discoloration, and uneven skin tone. During treatment, the laser delivers fractionated energy to the dermis to promote collagen growth and smooth the skin. Its fractionated nature means minimal downtime. Patients treated for atrophic scarring with the 1550nm setting typically experience 48 hours of redness resembling a mild sunburn, and multiple sessions are usually needed for optimal results. The Fraxel laser is not recommended for patients with darker skin tones, as it can cause hyperpigmentation or hypopigmentation.

Clear + Brilliant laser

The Clear + Brilliant laser is often called a “mini-Fraxel” because it treats atrophic acne scars, fine lines, wrinkles, sun damage, and hyperpigmentation with no downtime. It uses fractionated laser technology to create millions of tiny treatment zones, stimulating the body’s wound-healing response and new collagen growth. Because only a small portion of the skin is treated in each session, the surrounding skin remains unaffected, resulting in no downtime. The Clear + Brilliant laser is safe and effective for patients of all skin types and tones, and most need 4 to 6 sessions, spaced 1 month apart, to achieve the best results.

eMatrix sublative rejuvenation laser

The eMatrix laser is a non-invasive skin-resurfacing treatment designed to target fine lines, wrinkles, atrophic acne scars, uneven texture, enlarged pores, and stretch marks. It uses bipolar radiofrequency energy to stimulate collagen production in the deeper layers of the skin. By bypassing the epidermis, it helps reduce downtime and the risk of unwanted side effects. After treatment, patients may experience mild redness and swelling for up to 48 hours. Unlike the Fraxel laser, the eMatrix laser is safe for all skin tones, including darker tones. Multiple sessions spaced about one month apart are recommended to achieve optimal results.

CO2 laser

A CO2 laser is an ablative skin-resurfacing treatment used to dramatically improve the appearance of severe atrophic scarring, fine lines, wrinkles, sunspots, and hyperpigmentation. During treatment, the entire top layer of skin is vaporized, accelerating skin cell turnover and boosting collagen production in the dermis. Recovery from CO2 laser skin resurfacing typically takes two to four weeks, during which patients may experience redness, swelling, and irritation. Patients with darker skin tones should not undergo CO2 laser treatment, as it can result in hyperpigmentation, hypopigmentation, and scarring.

Microneedling

Microneedling, also known as collagen induction therapy, is a minimally invasive procedure that improves the appearance of atrophic scars, fine lines, hyperpigmentation, sun damage, stretch marks, and other signs of aging. It uses tiny, surgical-grade needles to create micro-injuries on the skin’s surface, stimulating collagen and elastin production. By restoring collagen and elastin levels, microneedling yields smoother, firmer, tighter skin, a brighter complexion, and a more even skin tone. Downtime is minimal to none, and patients typically see optimal results after a series of treatments spaced one month apart. The micro-injuries also allow skincare products to penetrate more deeply into the skin. Dr. Green often incorporates platelet-rich plasma (PRP), derived from the patient’s own blood, into microneedling treatment plans to enhance results. Microneedling is a safe and effective option suitable for patients of all skin types and tones.

Vivace radiofrequency (RF) microneedling

Vivace RF microneedling combines two collagen-boosting methods to deliver comprehensive facial rejuvenation. Its microneedling component creates microchannels in the epidermis, triggering the natural wound-healing process and stimulating collagen production. At the same time, radiofrequency energy is applied to the dermal layers to further stimulate collagen. Patients experience virtually no downtime or adverse side effects, making it easy to fit appointments into busy schedules. Most patients need an initial series of Vivace treatments, spaced four weeks apart, to achieve the best results. Dr. Green advises patients to attend regular maintenance visits to maintain and improve their outcomes.

Punch excision

Punch excision is a technique used to remove deep, narrow pitted scars known as ice-pick scars. During the procedure, a punch tool is used to remove scar tissue surgically, and the resulting wound is closed with fine sutures. This method generally leaves a small mark for acne scar revision. The resulting scars tend to be smaller, softer, and less noticeable than the original atrophic scars, usually appearing as fine lines rather than depressions.

Fat grafting

Fat grafting is a surgical procedure in which unwanted fat is removed from one area of the body and injected into atrophic scars to fill depressions. It is not a common choice for treating atrophic scarring because of its invasive, permanent nature and the higher risk of adverse side effects and unsatisfactory cosmetic outcomes. Patients and providers usually prefer dermal fillers to fat grafts because they involve little to no downtime and can be adjusted over time to meet patients’ changing needs and preferences

What skincare products are effective in treating atrophic scars?

Using effective skincare products is essential for gradually fading atrophic scars and maintaining scar treatment results. Dr. Green has developed a proprietary skincare line, MGSKINLABS, featuring powerful ingredients designed to rejuvenate the skin. When you consult with her, she will evaluate your skin and create a personalized skincare plan to help you achieve clear, radiant, smooth skin.

Retinol and retinoids are topical vitamin A derivatives that help exfoliate dead skin cells, revealing healthier new cells on the skin’s surface. These ingredients also support collagen production and accelerate skin cell turnover, improving the appearance of acne scars, fine lines, wrinkles, sun damage, pigmentation, and uneven skin texture. Retinols, such as the Essential Antioxidant Infusion from MGSKINLABS, are available over the counter, while retinoids, such as tretinoin or Retin-A, require a prescription from a board-certified dermatologist. When using a retinol or retinoid, apply it only at night and practice proper sun protection, as these ingredients can increase skin sensitivity to sunlight.

Another effective active ingredient for treating atrophic scars is vitamin C, a potent antioxidant that promotes skin cell renewal and protects the skin from oxidative stress and free radical damage. The Vita-C Serum from MGSKINLABS contains a high concentration of vitamin C to smooth and brighten the skin, resulting in a more youthful appearance.

Sunscreen is the most important part of any skincare routine, especially when treating atrophic scars. UV rays can damage collagen fibers, worsening atrophic scars and accelerating signs of aging. Treatments like lasers and chemical peels can make skin more sensitive to sunlight post-op, so protecting the skin is essential to maintain results and minimize side effects. Patients should wear a broad-spectrum SPF 50. MGSKINLABS’ Hydrating SPF 50 is ideal for all skin types and tones, featuring zinc oxide to block harmful UV rays along with hyaluronic acid and lactic acid to hydrate and soften the skin.

Will atrophic scars fade with topical products?

Topical ingredients such as retinol and vitamin C can gradually improve the appearance of atrophic scars by stimulating collagen production, boosting skin cell turnover, and improving skin texture. However, topical treatments are usually not strong enough to fully resolve atrophic scars because of the deep tissue damage involved. They work best when combined with in-office procedures such as dermal fillers, chemical peels, and resurfacing lasers. Dr. Green can help you develop a skincare plan to improve the results of your atrophic scar treatment and achieve clearer, smoother skin.

Are atrophic scars permanent?

Yes, atrophic scars indicate permanent damage to the underlying skin tissue. Although the damage is irreversible, cosmetic procedures can help reduce the appearance of scars and smooth the skin. Chemical peels, laser treatments, and microneedling stimulate new collagen production, creating a smoother, more even skin texture. Dermal fillers can restore lost volume in depressed scars and improve skin texture. The best treatment option depends on the patient’s skin type, tone, aesthetic goals, and the type and severity of acne scars. During your consultation, Dr. Green will develop a personalized treatment plan to help you achieve a smooth, radiant, scar-free look.

Can atrophic scars be prevented?

Yes! The best way to prevent atrophic scarring is to treat trauma or injury immediately. Patients with chickenpox should avoid scratching their lesions, keep the skin moisturized, and protect the lesions from sun exposure. Patients with acne should see a board-certified dermatologist as soon as an outbreak occurs, since acne should always be treated promptly. The atrophic scars left behind are often more difficult to treat than the acne itself. An experienced dermatologist like Dr. Green may recommend topical antibiotics such as Clindamycin, oral antibiotics like Doxycycline, or oral medications such as Spironolactone or Accutane (isotretinoin), depending on the type and severity of the breakouts. When you see Dr. Green regarding your acne, she will review your medical history, may order blood tests to find the underlying cause, and then use a combination of topical treatments, oral medications, and in-office procedures to manage your acne and help prevent atrophic scars.

FAQs about Atrophic Scarring

What is the difference between an atrophic scar and a regular scar?

A scar is any mark on the skin left after trauma or injury. Atrophic scars are characterized by an indentation or depression in the skin, resulting from low collagen production during healing; they do not fade on their own and require cosmetic treatment to lessen their appearance. Hypertrophic scars are another type that can develop: these scars are raised and thick, caused by excessive collagen during healing, and can gradually fade and flatten over time. Keloid scars are hypertrophic scars that extend beyond the original injury or lesion; these will not disappear on their own and require corticosteroid treatment to shrink and flatten them.

How do you get rid of hypertrophic scars?

Unlike atrophic scars, hypertrophic scars are raised and thick due to an overproduction of collagen during wound healing, and they often improve on their own over time. When treatment is needed, options include corticosteroid injections to flatten and soften the tissue, silicone sheeting or gel to reduce thickness, and laser therapy to fade redness and smooth the texture. Because hypertrophic scars differ markedly from atrophic scars, an accurate diagnosis by a board-certified dermatologist like Dr. Green is essential before starting any scar revision treatment.

Is atrophic scarring normal?

Atrophic scarring occurs when collagen production is abnormal or insufficient during the skin’s wound-healing process. Many patients develop atrophic scars, which can be a painful reminder of breakouts and often lead to self-consciousness or low self-esteem. Fortunately, treatments such as microneedling, chemical peels, laser resurfacing, and subcision with dermal fillers can reduce the appearance of atrophic scars and boost confidence. Consulting with a scar specialist, such as board-certified dermatologist Dr. Michele Green, is the best way to create an effective treatment plan tailored to your specific needs and aesthetic goals.

Do atrophic scars heal with time?

The presence of atrophic scars can be frustrating, and many patients wonder whether they can heal on their own. Unfortunately, they do not heal over time because inflammation from acne or trauma permanently damages the underlying tissue. Without treatment from an experienced, board-certified dermatologist like Dr. Green in NYC, they are unlikely to improve on their own. Fortunately, there are many non-invasive options to improve the appearance of atrophic scars. At her boutique dermatology practice on NYC’s Upper East Side, Dr. Green offers a range of treatments, including chemical peels, subcision with dermal fillers, laser resurfacing, and microneedling, tailored to your skin type, tone, and specific scars, helping you achieve a healthy, clear complexion that lasts.

How long does it take for atrophic scars to fade?

Because atrophic scars result from permanent collagen loss, they will not fade or disappear without treatment. However, most patients notice visible improvement in skin texture within four to six weeks of their first chemical peel, microneedling, or laser resurfacing session, as new collagen production takes hold. Since most patients require a series of treatments spaced about a month apart, optimal results, meaning smoother skin with significantly reduced indentations, typically become apparent after three to six sessions, depending on the depth and type of scarring. During your consultation, Dr. Green will provide a realistic timeline for your atrophic scar treatment based on your skin type, tone, and the severity of your rolling, boxcar, or ice pick scars.

Which atrophic scar is hardest to treat?

Ice-pick acne scars are among the most challenging atrophic scars to treat because of their depth, forming V-shaped indentations that can penetrate deeply into the skin. Treating ice-pick scars usually requires a combination of methods and may require more sessions than other acne scars. Common treatments include resurfacing laser procedures and chemical peels.

Do lasers work for atrophic scars, and which type?

Yes, laser treatments are among the most effective options for improving atrophic scars, boosting collagen production, and smoothing skin texture with minimal downtime. Dr. Green typically recommends the Fraxel or CO2 laser for deeper rolling and boxcar scars, the Clear + Brilliant laser for patients seeking little to no downtime, and the eMatrix laser for patients with darker skin tones who aren’t candidates for more aggressive resurfacing lasers. The right laser therapy for your atrophic scars depends on your skin type, tone, and the depth of your scarring, all of which Dr. Green will evaluate during your consultation.

Can you treat atrophic scars at home?

While at-home skincare cannot reverse the deeper tissue damage that causes atrophic scars, targeted products can meaningfully improve skin texture and help maintain results between in-office visits. Retinol, vitamin C serums, and daily broad-spectrum sunscreen, such as those in Dr. Green’s MGSKINLABS line, support ongoing collagen production and protect the skin from further damage. However, at-home products alone are typically insufficient to significantly reduce the appearance of rolling, boxcar, or ice pick scars, so most patients achieve their best results by pairing a strong skincare routine with in-office treatments such as chemical peels, microneedling, or laser resurfacing.

How many sessions will I need?

Most patients need multiple sessions to achieve optimal improvement in atrophic scars because treatments such as chemical peels, microneedling, and laser resurfacing gradually stimulate new collagen production over time. Depending on the treatment and the severity of scarring, Dr. Green typically recommends three to six sessions spaced about four weeks apart. Patients with a mix of rolling, boxcar, and ice pick scars may benefit from a longer, combined treatment plan. Many patients also choose periodic maintenance sessions to help preserve their smoother skin texture long-term.

How much does atrophic scar treatment cost?

The cost of atrophic scar treatment varies widely based on the type and number of procedures needed, the severity of the scarring, and whether treatments such as dermal fillers, laser resurfacing, or microneedling are combined for optimal results. Because most patients require a personalized series of sessions rather than a single treatment, Dr. Green provides a detailed cost estimate only after evaluating your skin type, tone, and scar pattern during an in-person consultation at her Upper East Side practice.

Are atrophic scar treatments safe / what are the risks?

Non-invasive treatments for atrophic scars, including chemical peels, microneedling, subcision, dermal fillers, and most laser treatments, are considered safe when performed by an experienced, board-certified dermatologist. Mild side effects, such as redness, swelling, or sensitivity, are common and typically resolve within a few days. However, more aggressive options, such as the CO2 or Fraxel lasers, carry a higher risk of hyperpigmentation or hypopigmentation in patients with darker skin tones. For this reason, Dr. Green carefully selects treatments based on each patient’s skin type and tone to minimize risk and maximize results.

Can atrophic scars be fixed?

Yes! Atrophic scars can be minimized with non-invasive treatments and targeted skincare products available at Dr. Michele Green’s private dermatology clinic on Manhattan’s Upper East Side. The acne scar treatment and skincare products used should be suitable for your skin tone, type, and specific scars. With over 25 years of experience, Dr. Green specializes in treating acne scars across all skin types and tones and will collaborate with you to develop a personalized plan to achieve long-lasting, healthy, smooth, clear, and radiant skin.

How effective are atrophic scar treatments?

Atrophic scar treatments are highly effective at creating a smoother, more even skin texture and reducing the appearance of scars. Laser treatments, chemical peels, and microneedling stimulate new collagen production to smooth the skin and diminish the look of atrophic acne scars. At the same time, dermal fillers help restore lost volume in sunken acne scars. While these treatments are long-lasting, they are not permanent. Patients can undergo maintenance sessions to maintain optimal results. The safety and effectiveness of these treatments have been proven through numerous clinical studies and trials, providing patients with an evidence-based approach to atrophic scar treatment. Some patients may benefit from a single treatment, but many choose a combination to address different types of atrophic scars and achieve complete rejuvenation. Consulting with an acne scar expert, such as board-certified dermatologist Dr. Michele Green, is the best way to create a personalized atrophic scar treatment plan tailored to your specific needs and aesthetic goals.

Schedule Your Atrophic Scar Treatment Consultation with Dr. Michele Green

Atrophic scars, whether rolling, boxcar, or ice-pick, can be frustrating reminders of past acne breakouts, chickenpox, or skin trauma, but they don’t have to be permanent obstacles to clear, confident skin. With a personalized combination of chemical peels, subcision, dermal fillers, laser resurfacing, and microneedling, most patients see significant improvement in skin texture and a noticeable reduction in the appearance of their scars. Because atrophic scar treatment works best when tailored to each patient’s skin type, tone, and scar pattern, partnering with an experienced, board-certified dermatologist like Dr. Michele Green in NYC gives you the best chance of long-lasting results.

Dr. Michele Green is a board-certified dermatologist in New York City with more than twenty-five years of experience treating atrophic scars and a wide range of cosmetic and medical skin concerns. At her private practice on Manhattan’s Upper East Side, she takes a holistic, less-is-more approach to facial rejuvenation, customizing each atrophic scar treatment plan to each patient’s unique skin and aesthetic goals. Recognized by Castle Connolly, Super Doctors, New York Magazine, and The New York Times as one of NYC’s top dermatologists, Dr. Green has helped patients from around the world achieve smoother, healthier-looking skin. To schedule a consultation for atrophic scar treatment, call 212-535-3088 or contact us online today.