Atrophic Scarring

Atrophic scars, also called rolling, boxcar, and ice-pick scars, are indentations in the skin that form when collagen production is lacking during healing. The main cause of atrophic scars is inflammatory acne, such as cystic or nodular acne. However, they can also result from chickenpox scars, mole removals, deep cuts, surgical incisions, or skin infections. Treating atrophic scars is often more challenging than managing the initial acne or injury, and for many people, it can cause feelings of self-consciousness or low self-esteem. Luckily, board-certified dermatologist Dr. Michele Green in NYC specializes in treating atrophic scars and has helped many men and women worldwide achieve smoother skin with non-invasive cosmetic procedures.

Common non-invasive treatments for atrophic scars include laser resurfacing, subcision with dermal fillers, microneedling, and chemical peels. These procedures either stimulate new collagen production or restore lost volume in indented scars, leading to smoother skin. They are simple procedures with little downtime or side effects, making them popular options for treating atrophic scars. Additionally, targeted topical products such as retinols, retinoids, and vitamin C can help maintain and boost treatment results, gradually improving the scar’s look. Most patients with atrophic scars have a mix of types, requiring a personalized treatment plan from an experienced, board-certified dermatologist like Dr. Green in NYC to effectively minimize their appearance. If you’re frustrated by atrophic scars and want clear, radiant skin, Dr. Green is ready to help.

Dr. Michele Green is a board-certified cosmetic dermatologist and a recognized expert in non-invasive treatments such as lasers, dermal fillers, and chemical peels for atrophic scars. 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, providing 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 involves subcision with dermal fillers, chemical peels, microneedling, laser resurfacing, or specialized skincare, Dr. Green will work with you to develop a personalized plan that effectively targets your scars and results in 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. 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. However, patients can undergo non-invasive cosmetic procedures such as chemical peels, dermal fillers, and laser resurfacing to stimulate collagen production, smooth the skin, 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 treatments or combination of treatments that will effectively minimize your atrophic 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 and have well-defined edges with deep vertical sides.
• Ice-pick scars — These scars are the hardest atrophic scars 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 due to 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. Other treatments focus on restoring lost volume to lessen the appearance of skin indentations. These treatments are long-lasting, and many patients choose to maintain their smoother skin with regular sessions. Additionally, certain skincare products can be combined with 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. The treatment of atrophic acne scars will depend on the type of acne scarring present. Often, patients receive a combination of these treatments to address all types of atrophic scars for optimal results. With so many treatment options available, it can be difficult to determine which ones 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 the production of new collagen and remove dead skin cells, revealing healthy, fresh skin. By restoring collagen levels and speeding up skin cell turnover, chemical peel treatments can greatly enhance the appearance of atrophic scars, as well as fine lines, wrinkles, melasma, post-inflammatory hyperpigmentation, sun damage, and discoloration. Chemical peels may use various chemical exfoliants to renew the skin. Dr. Green usually applies trichloroacetic acid (TCA) to resurface the skin and treat atrophic scars. Side effects from chemical peels depend on the type and strength of the peel used. Mild erythema, typically associated with chemical peel treatment, heals quickly after the procedure. 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. Dr. Green may turn to hyaluronic acid injectables such as Juvederm and Restylane, or liquid fillers such as Sculptra, for the treatment of atrophic scarring. Hyaluronic acid fillers provide immediate volume restoration to the treated area and are ideal for discreet depressed facial scars or localized volume loss. Sculptra is a biostimulating filler containing poly-L-lactic acid that encourages the production of new collagen for a smoother, more plump appearance. Sculptra is best suited for more diffuse volume loss caused by atrophic scarring. Hyaluronic acid fillers can last from nine to twelve months, depending on the specific filler used, while Sculptra can last up to two years after a series of injections. After dermal filler injections, patients can schedule a follow-up with Dr. Green to determine if any additional filler is needed.

Fraxel laser resurfacing for indented scars

The Fraxel laser is a non-ablative, non-invasive laser therapy designed to target various 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 there is minimal downtime. Patients treated for atrophic scarring with the 1550nm setting typically experience 48 hours of redness similar to a mild sunburn. Multiple sessions are usually needed to achieve optimal results. The Fraxel laser is not recommended for patients with darker skin tones, as it can cause adverse effects such as hyperpigmentation or hypopigmentation.

Clear + Brilliant laser

The Clear + Brilliant laser is often called a “mini-Fraxel” because it can treat atrophic acne scars, fine lines, wrinkles, sun damage, and hyperpigmentation without any downtime. Clear + Brilliant uses fractionated laser technology to create millions of tiny treatment zones, stimulating the body’s wound-healing response and new collagen growth. Since only a small part of the skin is treated during each session, the surrounding skin stays unaffected, resulting in no downtime. The Clear + Brilliant laser is safe and effective for patients of all skin types and tones. Patients typically 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 utilizes bipolar radiofrequency energy to stimulate the production of new collagen within the deeper layers of the skin. By bypassing the outermost layer, or epidermis, the eMatrix laser helps reduce downtime and the risk of unwanted side effects after treatment. Following the procedure, 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 cosmetic results.

CO2 laser

A CO2 laser is an ablative laser used to dramatically improve the appearance of severe atrophic scarring, fine lines, wrinkles, sunspots, and hyperpigmentation in the skin. During treatment, the entire top layer of skin is vaporized, accelerating skin cell turnover and boosting collagen production in the dermis. It can take two to four weeks for the skin to fully recover after CO2 laser treatment, 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 enhances the appearance of atrophic scars, fine lines, hyperpigmentation, sun damage, stretch marks, and various 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 elastin and collagen levels, microneedling results in smoother, firmer, tighter skin, a brighter complexion, and a more even skin tone. Minimal to no downtime is needed afterward, and patients typically see optimal results after a series of treatments spaced one month apart. These micro-injuries also enable skincare products to penetrate deeper into the skin. Dr. Green often incorporates platelet-rich plasma (PRP) into her patients’ treatment plans to boost the outcomes of microneedling. PRP is derived from the patient’s own blood and contains growth factors and proteins essential for tissue healing and regeneration. Microneedling is a safe and effective cosmetic 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 stimulate collagen production. 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, each 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 extract scar tissue surgically, and the resulting wound is closed with fine sutures. This method generally leaves slight scarring for acne scar revision, although the scars tend to be smaller, softer, and less noticeable than the original atrophic scars. The scar from punch excision usually appears as a small line rather than a depression.

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 unwanted cosmetic outcomes. Patients and healthcare providers usually prefer dermal fillers over 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 the results of scar treatment. Dr. Green has developed a proprietary skincare line, MGSKINLABS, with powerful ingredients designed to rejuvenate the skin. When you consult with Dr. Green, she will evaluate your skin and create a personalized skincare plan to help you achieve clear, radiant, and 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 speed up skin cell turnover, which can improve the appearance of acne scars, fine lines, wrinkles, sun damage, pigmentation, and uneven skin texture and tone. Retinols like the Essential Antioxidant Infusion from MGSKINLABS are available over the counter, while retinoids like tretinoin or Retin-A require a prescription from a board-certified dermatologist. When using a retinol or retinoid, it’s important to apply it only at night and to practice proper sun protection, as they can increase skin sensitivity to sunlight.

Another excellent active ingredient for treating atrophic scars is vitamin C. It is 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 for 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 or deepening atrophic scars and accelerating signs of aging, such as fine lines, wrinkles, and skin laxity. Additionally, treatments such as lasers and chemical peels can make the skin more sensitive to sunlight post-op, so patients must protect their skin to maintain results and minimize side effects. Patients should wear a broad-spectrum SPF of 50 to guard against UVA and UVB rays. MGSKINLABS’ Hydrating SPF 50 is ideal for sun protection across all skin types and tones, as it features 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 like retinol and vitamin C can gradually improve the appearance of atrophic scars by stimulating new collagen production, boosting skin cell turnover, and enhancing skin texture. However, topical treatments are usually not strong enough to fully resolve atrophic scars due to 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 all stimulate new collagen production, which creates a smoother, more even skin texture. Dermal fillers can restore lost volume in depressed scars and simultaneously improve skin texture. The best treatment option for atrophic scars depends on the patient’s skin type, tone, aesthetic goals, and the type and severity of acne scars. During your consultation with Dr. Green, she will develop a personalized treatment plan combining atrophic scar treatments 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 the 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. Acne should always be treated promptly, as 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 and may order blood tests to find out the underlying cause. She will 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 a type characterized by an indentation or depression on the skin. These scars form due to low collagen production during healing. Atrophic scars do not fade on their own and need 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. Hypertrophic scars can gradually fade and flatten over time. Keloid scars are hypertrophic scars that extend beyond the original injury or lesion. These scars will not disappear on their own and require corticosteroid treatment to shrink and flatten them.

What does an atrophic scar look like?

Atrophic scars manifest as depressions or indentations on the skin’s surface. Rolling scars are the shallowest type, characterized by a wavy, uneven, and rough appearance. Boxcar scars have a round or oval shape, with well-defined edges and deep, vertical sides. Ice-pick scars are narrow, deep V-shaped indentations that often resemble enlarged pores and usually measure 2 mm or less in width. Most patients exhibit a combination of different atrophic scar types on their skin.

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 serve as a painful reminder of breakouts and often lead to feelings of self-consciousness or low self-esteem. Fortunately, there are various treatments available, such as microneedling, chemical peels, laser resurfacing, and subcision with dermal fillers, to lessen the appearance of atrophic scars and boost confidence. Consulting with a scar specialist, like 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 often wonder, “Can atrophic scars heal on their own?” Unfortunately, they do not heal over time. These scars are usually permanent because the 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. Luckily, 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. She individualizes each treatment based on your skin type, the specific scars, your skin tone, and your aesthetic goals, helping you achieve a healthy, clear complexion that lasts.

Which atrophic scar is hardest to treat?

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

Can atrophic scars be fixed?

Yes! Atrophic scars can be minimized using various non-invasive treatments and targeted skincare products available at Dr. Michele Green’s private dermatology clinic in Manhattan’s Upper East Side. The acne scar treatment and skin care 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. She 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 very effective at creating a smoother, more even skin texture and reducing the appearance of scars. Laser treatments, chemical peels, and microneedling all stimulate new collagen production to smooth the skin and diminish the look of atrophic acne scars. Dermal fillers help restore lost volume to sunken acne scars and lessen the appearance of atrophic scars. While these treatments are long-lasting, they are not permanent, but 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 of treatments 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.

How to prevent and treat atrophic scarring today

Atrophic scars can be difficult to treat and often serve as a painful reminder of previous acne breakouts or skin injuries. Fortunately, various treatments are available to lessen their appearance and enhance skin texture. Common options include resurfacing lasers, microneedling, subcision with dermal fillers, and chemical peels, which typically cause minimal downtime and few side effects. Since most patients have multiple types of atrophic scars, a tailored combination of treatments is usually necessary for effective results. It is advisable to consult a board-certified dermatologist, such as Dr. Green, promptly after a breakout, as scars tend to be harder to treat than the acne itself. Dr. Green will evaluate your skin type, tone, and concerns, and treat any active acne. After managing breakouts, she will develop a personalized treatment plan for your scars, aiming to achieve a healthy, smooth, clear, and beautiful complexion that lasts.

Dr. Michele Green in New York City is a highly reputable, board-certified cosmetic dermatologist with over 25 years of experience. She offers some of the most discerning individuals worldwide the best non-invasive treatments for atrophic scars and other skin issues. Dr. Green adopts a holistic approach and follows a less-is-more philosophy in facial rejuvenation, delivering natural-looking, long-lasting results by tailoring each treatment plan to the patient’s specific skin condition, needs, and aesthetic goals. She is consistently recognized by Castle Connolly, Super Doctors, New York Magazine, and The New York Times as one of NYC’s top dermatologists for her dedication and expertise. When you consult with Dr. Green at her private dermatology office in Manhattan’s Upper East Side, she will collaborate with you to develop a personalized atrophic scar treatment plan that best fits your skin type, tone, and the nature of your scars. To get started with atrophic scar treatment, call 212-535-3088 or contact us online to schedule a consultation with Dr. Green.