Atrophic Scarring

Atrophic scars are the most common type of acne scars, making up an estimated 80 to 90 percent of all cases. These scars appear as depressions in the skin where inflammation from acne has damaged the underlying support structures. Dr. Jane Yoo offers targeted treatments for all subtypes of atrophic scars, using a combination approach tailored to your skin.

What are atrophic scars?

Atrophic scars form when the skin cannot regenerate enough collagen after inflammation or injury, such as moderate to severe acne. As the skin heals, it loses structural proteins that normally help keep the surface smooth and firm. The result is a permanent indentation or hollowed-out appearance.

Atrophic scars can occur anywhere on the face or body, but they are especially common on the cheeks, temples, and jawline.

What are the types of atrophic scars?

Atrophic scars are categorized into three main types based on their shape and depth:

  • Ice pick scars: Deep, narrow indentations that extend vertically into the skin. These scars are typically less than 2 mm wide and are considered the most resistant to treatment.
  • Boxcar scars: Round or oval depressions with steep vertical edges. They may be shallow or deep and often appear on the cheeks and temples.
  • Rolling scars: Broad, sloping depressions that give the skin a wavy texture. These are typically wider than other types and often result from long-standing inflammation.

Most patients have a combination of these scar types, which is why a multi-modal treatment plan is often recommended.

What causes atrophic acne scars?

The primary cause is prolonged inflammation from acne lesions, particularly nodules and cysts. Other contributing factors include:

  • Delayed treatment of active acne
  • Frequent picking or squeezing of lesions
  • Family history of acne scarring
  • Hormonal changes, including testosterone therapy
  • Skin tone and healing response

How are atrophic scars treated?

Because atrophic scars vary in type and depth, no single treatment works for everyone.

Treatment options include:

  • Microneedling and RF Microneedling: Controlled injury to the skin stimulates collagen and elastin. Radiofrequency enhances the effect and can help reduce scar depth.
  • Laser resurfacing: Fractional lasers target scarred tissue and trigger skin remodeling. Both ablative and non-ablative lasers may be used depending on the depth of scarring and downtime tolerance.
  • Dermal fillers: Hyaluronic acid or other fillers can be injected beneath rolling or boxcar scars to raise the skin and smooth the surface.

Who is a good candidate?

You may benefit from atrophic scar treatment if you:

  • Have visible textural depressions from past acne
  • Are no longer experiencing active breakouts
  • Are interested in improving skin texture and evenness
  • Are open to undergoing a series of treatments

Safe for all skin types

Treating atrophic scars in skin of color requires special expertise to avoid pigmentary side effects. Dr. Yoo has significant experience treating Asian skin and other skin of color, using technologies and protocols that are safe and effective.