Boxcar Acne Scars

Acne is one of the most common skin conditions worldwide, affecting millions of Americans each year, according to the American Academy of Dermatology. While acne breakouts are frustrating and often painful, the effects of severe acne can linger long after the skin has cleared, in the form of acne scars. Acne scars form when collagen production is insufficient or excessive during wound healing, leading to atrophic or hypertrophic scars, respectively. Boxcar scars, a type of atrophic scar with rounded or oval craters and well-defined edges, tend to form when inflammatory acne or acne lesions go untreated for too long. Once formed, they will not fade on their own without professional treatment from a board-certified dermatologist like Dr. Michele Green.

Because many cosmetic procedures can treat acne scars, the best first step is to consult an expert, board-certified dermatologist in New York City, such as Dr. Green. After examining the scar type, depth, and skin texture, Dr. Green will recommend the acne scar treatment or combination of treatments most likely to be effective. These may include skin resurfacing treatments such as chemical peels or laser therapy, collagen-induction treatments such as microneedling, or minor procedures such as subcision and punch excision, paired with dermal fillers. With Dr. Green, every patient receives a safe, effective, and individualized treatment plan designed to improve skin texture and dramatically reduce the appearance of boxcar scars.

What are boxcar acne scars?

Boxcar acne scars are a type of atrophic acne scar characterized by round or oval depressions with sharply defined, box-like edges that resemble small craters in the skin. Hyperpigmentation can also occur within boxcar scars, so they may appear red or dark, though some patients find that their boxcar scars match the surrounding skin tone. These depressed scars form when inflammatory acne, such as nodules or cysts, damages the deeper layers of the skin and the body fails to produce enough new collagen during healing, leaving a visible indentation. Boxcar scars can range from shallow to severe and are among the most common types of acne scarring that board-certified dermatologist Dr. Michele Green treats in her New York City practice.

Causes of boxcar scars

The healing process can cause boxcar scars after a breakout of nodular or cystic acne. Acne breakouts occur when pores become clogged with excess sebum, dead skin cells, blackheads, and other debris. If the pores become infected with bacteria, inflammatory acne can develop into painful nodules or cysts. When these lesions are left untreated for an extended period, the healing process is impaired, leading to acne scars. Atrophic scars, such as boxcar scars, form when insufficient new collagen is produced, leaving craters on the skin’s surface. A deeper infection from an acne breakout often leads to deeper scarring.

What are the different types of acne scars?

The two main types of acne scars that can form from inflammatory acne are atrophic and hypertrophic scars. Atrophic acne scars are the most common and form when insufficient new collagen is produced during healing after a severe acne breakout, leading to indentations on the skin’s surface. Atrophic scars can be further categorized into three types of depressed scars: ice pick scars, which are deep, narrow indentations that look as though the skin was pierced with a thin, sharp object; rolling scars, which are characterized by uneven, sloping edges that give the skin a wavy texture; and boxcar scars, which are oval or round indentations with sharp edges. Deep boxcar scars, ice pick scars, and rolling scars tend to form when the infection present in nodules or cysts is particularly deep.

The second overarching type of acne scar is the hypertrophic acne scar, or raised scar, which can take the form of keloid scar tissue or an excess buildup of scar tissue. During the wound-healing process, some patients overproduce collagen, causing tissue buildup and a raised appearance that often extends beyond the original breakout; these scars will not go away on their own and need to be medically removed. Severe acne can also lead to post-inflammatory hyperpigmentation, or discoloration and redness at the breakout site, so treating both the skin depression and any accompanying discoloration typically requires a combination approach.

The best ways to get rid of boxcar acne scars

The best way to get rid of boxcar acne scars is often a combination approach, using several different cosmetic procedures for more effective elimination of the scarring. Boxcar acne scars are often characterized by both skin indentations and discoloration, which are best addressed with different treatment methods. During your initial consultation, Dr. Green will examine the treatment area to develop an individualized treatment plan, taking into account the depth and severity of the scarring, skin texture, and skin type. Depending on these factors, Dr. Green may recommend different types of lasers, different concentrations of chemical peels, or other collagen-induction or skin-resurfacing treatments, such as microneedling, dermabrasion, or microdermabrasion. In some cases, injectables such as dermal fillers or Sculptra can help reduce the appearance of scarring. No single treatment is considered universally “best,” so Dr. Green will help determine which option is right for you.

Microneedling for boxcar scars

Microneedling, sometimes called collagen-induction therapy, is a treatment that creates controlled micro-injuries in the epidermis to trigger the body’s natural healing response. When treating boxcar acne scars, tiny, surgical-grade needles pierce the skin to stimulate collagen production in the treatment area, improving skin texture and reducing the appearance of indentations. The procedure is non-invasive, requires no downtime, and carries no risk of serious side effects. Dr. Green often pairs microneedling with platelet-rich plasma (PRP) infusions, infusing the patient’s own PRP into the tiny channels created by the needles to support the natural healing process.

Subcision for boxcar scars

Subcision is an effective treatment for boxcar scars, particularly those that are deep or tethered to the tissue below by fibrous bands of scar tissue. During the procedure, Dr. Green uses a small needle to break up these fibrous attachments beneath the scar, allowing the skin’s surface to release and lift, which immediately smooths its appearance and encourages new collagen to form beneath the skin. Subcision is often paired with dermal fillers or laser resurfacing to enhance further and prolong the results.

Punch excision for boxcar scars.

Punch excision is a minor surgical procedure that can be highly effective for treating deep, well-defined boxcar scars that do not respond well to non-invasive treatments. During the procedure, Dr. Green uses a small circular tool to excise the individual acne scar, and the resulting tiny wound is closed with sutures, leaving a much less noticeable mark than the original scar. Punch excision is often combined with laser resurfacing or dermal fillers further to blend the treated area with the surrounding skin.

Fillers for boxcar scars

Dermal fillers can be an effective option for temporarily improving the appearance of boxcar scars by adding volume beneath the depression, lifting the skin’s surface. Dr. Green typically uses hyaluronic acid fillers, such as Restylane, though she generally avoids permanent fillers because of the increased risk of complications and lumps over time. Filler is often used alongside subcision, since releasing the fibrous bands beneath the scar allows the filler to sit more evenly and produce a smoother, more natural-looking result.

For patients seeking a longer-lasting alternative, Dr. Green may also recommend Sculptra, a poly-L-lactic acid filler that works differently from hyaluronic acid fillers such as Restylane. Rather than simply adding immediate volume, Sculptra gradually stimulates the body’s own collagen production over a series of sessions, gently filling in depressed boxcar scars from within as new collagen builds beneath the skin’s surface. Because results develop gradually and can last up to two years or longer, Sculptra is often a good option for patients with widespread atrophic scarring who want a more subtle, natural-looking improvement over time.

Chemical Peels for boxcar scars

Chemical peel treatments vary in depth and concentration and work by applying an acid solution to exfoliate the epidermis, resulting in smoother, clearer, brighter skin. Chemical peels come in three depths: mild or superficial peels, best for minor acne breakouts and mild hyperpigmentation; medium-depth peels, effective for reducing the appearance of acne scars, fine lines, and uneven skin tone and texture; and deep peels, the most powerful type, most commonly used to eliminate early signs of skin cancer. When treating boxcar acne scars, Dr. Green most frequently uses a trichloroacetic acid (TCA) peel, a medium-depth peel that penetrates deeper layers of skin to promote skin cell turnover and improve texture over a series of sessions.

TCA CROSS for boxcar scars

TCA CROSS, or chemical reconstruction of skin scars, is one of the most effective peel-based treatments for boxcar scars, particularly those that are shallow to medium in depth. During the procedure, Dr. Green applies a high concentration of trichloroacetic acid directly to the scar with a fine applicator, creating a controlled “frosting” effect that stimulates new collagen production as the treated area heals over the following days. Because the acid is applied only to the scar rather than the entire face, the surrounding skin remains undisturbed, allowing for targeted, precise improvement over a series of sessions.

Laser Therapy for boxcar scars

Several types of laser treatments are used to reduce the appearance of boxcar acne scars, including Fraxel, eMatrix, and VBeam. Each type of laser works differently and can be combined to improve skin texture and tone and to address scarring-related hyperpigmentation.

Fraxel Laser – The Fraxel laser uses fractional laser technology to resurface the top layer of skin, resulting in smoother, more evenly toned, and more textured skin. By creating controlled micro-wounds in the dermis with fractional energy, the Fraxel laser triggers the body’s natural healing process, which boosts collagen production in the treatment area. The increase in new collagen helps fill in skin depressions, improving texture. Dr. Green recommends five to six treatment sessions spaced a month apart for the best results.

eMatrix Laser – The eMatrix laser uses radiofrequency energy to improve the appearance of boxcar scars for patients of all skin types, including those with darker skin. When applied to the treatment area, the eMatrix laser delivers targeted radiofrequency energy to stimulate the body’s natural collagen production, improving skin texture. Because the treatment leverages the body’s natural collagen production, results continue to improve over time, with full results becoming visible 3-6 months after treatment.

VBeam Laser – The VBeam laser uses wavelengths of light to target redness and hyperpigmentation often present in scar tissue. Some boxcar scars are characterized by discoloration at the scar site, which can make the depression in the skin more noticeable. The VBeam laser targets this discoloration by delivering light energy that is absorbed by the tissue’s pigmentation. The energy is converted into heat, destroying the pigmentation while leaving the surrounding skin unaffected.

What can you do to avoid boxcar acne scars?

One of the major risk factors for developing acne scars is severe inflammatory acne that remains untreated for an extended period. As such, one of the best ways to avoid boxcar scarring is to treat inflammatory acne early with the help of a board-certified dermatologist, such as Dr. Green. For severe acne, over-the-counter products are often ineffective, so patients may need to turn to prescription products. With her proprietary MGSKINLABs line, Dr. Green offers topical retinoids and other prescription products to dry out and unclog pores, and in some cases may prescribe antibiotics to eliminate acne-causing bacteria. Mild chemical peels, such as glycolic acid and salicylic acid peels, can also help with active acne breakouts, while more severe cases may call for a mild surgical procedure to open the lesion, paired with corticosteroid injections to reduce inflammation.

Frequently Asked Questions About Boxcar Acne Scars

What do boxcar scars look like?

Boxcar scars appear as round or oval depressions with sharply defined, vertical edges, giving the skin an uneven, pitted texture. They can be shallow or deep and may be accompanied by post-inflammatory hyperpigmentation, which can appear red, dark, or match the surrounding skin tone. Boxcar scars most commonly develop on the cheeks, temples, and jawline, where cystic and inflammatory acne lesions tend to run deepest.

Why do boxcar acne scars happen?

According to the American Academy of Dermatology, researchers are still unclear about why some people are more likely to develop atrophic acne scars rather than hypertrophic scars, or why some patients do not experience scarring. Certain risk factors, including genetics, may increase the likelihood of developing boxcar acne scars after a breakout:

• Developing severe inflammatory acne, including the appearance of cysts or nodules
• Leaving cystic or nodular acne untreated for an extended amount of time
• Popping or squeezing pimples, which can lead to a wider-spread infection or force bacteria deeper into the inflamed pores
• Having a family history of boxcar scars

Patients can decrease their risk of developing acne scars by treating severe acne early and refraining from touching or squeezing pimples.

Do boxcar scars go away?

While boxcar scars may fade over time, they are permanent and will never fully go away on their own. Acne scars often frustrate patients and leave a permanent blemish on the face, which can lower self-esteem. Fortunately, patients can turn to the wide range of cosmetic treatments available at Dr. Green’s dermatology office to eliminate or reduce the appearance of atrophic boxcar scars.

Can boxcar scars be removed permanently?

While boxcar scars will not disappear completely without intervention, many patients achieve dramatic, long-lasting improvement with a combination of in-office treatments. Options such as laser resurfacing, microneedling, chemical peels, subcision, and punch excision work by rebuilding collagen or physically releasing fibrous scar tissue beneath the skin, which can produce permanent or near-permanent smoothing of the skin’s surface. The degree of improvement depends on the depth and severity of the scarring, which is why Dr. Green customizes each patient’s treatment plan after a thorough in-person evaluation.

How are boxcar scars different from ice pick and rolling scars?

Boxcar, ice pick, and rolling scars are all types of atrophic, depressed scars, but each has a distinct shape and depth. Ice pick scars are narrow, deep, and pointed, resembling a puncture wound, while rolling scars have broad, sloping edges that create a wavy, undulating texture across the skin. Boxcar scars, by contrast, have sharply defined, box-like edges and a wider surface area than ice pick scars, which can make them more noticeable in certain lighting.

How to fix boxcar scars naturally?

While at-home and natural remedies cannot eliminate boxcar scars the way in-office procedures can, certain habits can support the skin’s healing and improve overall texture and tone. Gentle exfoliation, a consistent skincare routine featuring vitamin C and retinol-based products, daily use of broad-spectrum sunscreen, and proper hydration can all help minimize the appearance of scarring and prevent additional post-inflammatory hyperpigmentation. However, because boxcar scars result from a genuine loss of collagen, patients seeking significant improvement will ultimately need professional treatment from a board-certified dermatologist, such as Dr. Green.

Which serum is best for boxcar scars?

Serums containing retinol, vitamin C, and niacinamide can help improve the skin’s texture and tone around boxcar scars by boosting cell turnover and collagen production, though they cannot fill deep depressions on their own. Dr. Green’s proprietary MGSKINLABS skincare line offers targeted serums designed to support collagen renewal and brighten post-inflammatory hyperpigmentation that often accompanies boxcar scarring. For best results, Dr. Green typically recommends pairing a personalized serum regimen with in-office collagen-stimulating treatments, such as microneedling or laser therapy.

Can retinol remove boxcar scars?

Retinol cannot completely remove boxcar scars, but it can meaningfully improve the surrounding skin’s texture and tone over time. As a topical derivative of vitamin A, retinol increases skin cell turnover and stimulates collagen production, which can soften the appearance of shallow boxcar scars and reduce associated discoloration. For deeper or more well-defined boxcar scars, Dr. Green typically recommends combining a prescription-strength retinoid with procedures such as microneedling, chemical peels, or laser resurfacing for more noticeable results.

How do you get boxcar acne scars?

Boxcar acne scars can form when severe acne breakouts become infected with bacteria, leading to nodular or cystic acne. Not everyone who experiences nodules or cysts will necessarily develop boxcar acne scars, and researchers are not entirely sure why some patients are more susceptible to atrophic scarring. However, researchers do know that depressed acne scars, such as boxcar scars, form when severe inflammatory acne inhibits the healing process, leading to insufficient new collagen production. Collagen is the protein that gives structure to the skin, and not enough of it leads to the indents and depressions that form boxcar scars.

How much does boxcar scar treatment cost?

The cost of boxcar scar treatment varies widely depending on the type and number of procedures needed, the severity of the scarring, and the specific combination of treatments recommended. Because Dr. Green tailors every treatment plan to the individual patient, whether that involves microneedling, chemical peels, laser therapy, subcision, or a combination approach, the most accurate pricing information is provided during an in-person consultation at her New York City office.

How many treatment sessions are needed for boxcar scars?

The number of treatment sessions needed to improve boxcar scars depends on the severity and depth of the scarring, as well as the treatment or combination of treatments used. Many patients see the best results after a series of four to six sessions of microneedling, laser therapy, or chemical peels, spaced several weeks to a month apart to allow the skin to heal and regenerate collagen between treatments fully. Dr. Green provides a personalized treatment timeline during your consultation, tailored to your unique skin concerns.

How long does it take to see results on boxcar scars?

Most patients begin to notice gradual improvement in the texture and appearance of their boxcar scars within a few weeks of starting treatment, as the body’s natural collagen production takes effect. Full results, however, can take several months to become fully visible, particularly with treatments like the eMatrix laser or microneedling, which continue to stimulate collagen long after the procedure. Patients undergoing a combination approach, such as subcision paired with non-ablative laser treatments, may see more dramatic results emerge gradually as each treatment builds on the last.

Do acne scars get worse with age?

As part of the natural aging process, the production of collagen and elastin begins to decline, resulting in sagging skin and fine lines on the surface. Decreased collagen production also makes atrophic acne scars appear more pronounced, as the indentations become increasingly noticeable over time. Many acne scar treatments help address both concerns at once: chemical peels, microneedling, and laser treatments that boost collagen production to fill in acne scars also improve skin tone and texture, resulting in smooth, bright, youthful-looking skin.

What is the difference between keloid scars and atrophic scars?

Keloid scars and atrophic scars differ in both appearance and formation. Atrophic scars are depressions that form on the skin’s surface, whereas keloid scars are raised scar tissue that creates bumps, often extending beyond the original lesion’s surface area. Atrophic scars form due to insufficient new collagen production during healing, while keloid scars form due to an overproduction of collagen. Researchers are still unsure why certain patients are more susceptible to keloid scarring, but if that is the case for you, be sure to inform Dr. Green before undergoing any ablative procedures.

What is the hardest acne scar to treat?

Acne scars that leave deep indents on the skin’s surface, such as ice pick scars and deep boxcar scars, are often the hardest to treat because filling deep depressions is especially challenging. These scars typically require a combination approach, pairing multiple treatments for the best possible results. Dr. Green may use a higher-concentration chemical peel, a CO2 laser, or non-ablative laser resurfacing to boost collagen production when treating deeper acne scars, as well as dermal fillers, such as hyaluronic acid fillers like Restylane or a poly-L-lactic acid filler like Sculptra, to restore lost volume. During your initial consultation with Dr. Green, she will create a treatment plan designed to reduce the appearance of even the toughest acne scars.

Schedule Your Boxcar Acne Scar Treatment with Dr. Michele Green Today

Boxcar acne scars can often be even more challenging to treat than the initial breakouts themselves, and for many patients, they cause real feelings of self-consciousness and low self-esteem. Fortunately, a wide range of effective solutions exists to reduce their appearance and help restore your self-confidence, including microneedling, subcision, TCA CROSS, laser therapy, dermal fillers, and punch excision. Dr. Green offers all of these options and more at her NYC dermatology office and will design an individualized treatment plan based on the depth, severity, and pattern of your scarring.

Dr. Michele Green in NYC is an internationally renowned, board-certified dermatologist with over 25 years of experience providing some of the world’s most discerning individuals with the best non-invasive cosmetic procedures available, including treatment for boxcar acne scars. Dr. Green takes a holistic approach and embraces a less-is-more philosophy toward rejuvenation, carefully customizing each patient’s treatment plan best to suit their specific skin concerns and aesthetic goals. For her dedication to her patients and her expertise, Dr. Green is consistently recognized as one of New York City’s best dermatologists by Castle Connolly, New York Magazine, and Super Doctors. To find out which boxcar scar treatment options are best for you, schedule your initial consultation with Dr. Green by calling the NYC office at 212-535-3088 or by contacting us online today.