An atrophic scar is an indented scar that heals below the normal layer of skin tissue. Atrophic scars form when the skin is unable to regenerate tissue. As a result, it leaves behind imbalanced scarring.

Atrophic scars are often the result of severe acne or chickenpox. They can also form after having a mole removed. The indentation can form into one of three types of scarring:

  • Ice pick scars. These scars are small and narrow, resembling deep pores.
  • Boxcar scars. Boxcar indentations look like chickenpox scars. They have flat bottoms and defined borders.
  • Rolling scars. This type of scar doesn’t have distinct edges. It is usually found on the cheeks.

Atrophic scars are the most common type of acne scars. They are subdivided into three main categories: ice pick, boxcar, and rolling scars. Treatment depends on the type of scar you have. Atrophic scars can be difficult to treat and can require multiple procedures that may need to be repeated over a period of time.

A licensed dermatologist can guide you through your treatment and provide recommendations to help speed your recovery. When discussing your options with a dermatologist, understand there is a risk your treatment may not be effective and could leave behind a new scar.

1. Chemical peels

Chemical peels are a common treatment method. The peeling process involves destroying the damaged layer of skin by applying chemicals to its surface. The chemical solution causes your skin to peel, producing a fresh layer underneath.

This regeneration decreases the appearance of atrophic scars. Peels can take days to weeks to show improvement. In some cases, your skin requires substantial time to heal.

Different chemical agents are used depending on the severity of your scarring. They range from mild chemicals used in everyday skin care products — such as glycolic acid — to chemicals used in deeper peels — such as phenol — that require sedation before being applied to the skin.

2. Fillers

Soft-tissue fillers are a common treatment specifically for rolling atrophic acne scars. They are used to level or raise the indented scars to match the normal layer of skin. Fillers are injected under the scar and provide almost immediate results. Over time, the soft tissue fillers improve skin volume and decrease scarring appearance.

3. Skin needling

Skin needling or microneedling therapy is a method that punctures the skin to regenerate a healthier layer. The microneedling procedure involves rolling a group of needles over your skin in various directions. These needles create hundreds of punctures on your skin and cause new collagen to form.

This therapy method triggers your skin to regenerate and increase collagen, a protein necessary to maintain skin elasticity and health.

4. Punch excision

Punch excision treatments are another common method for treating and eliminating atrophic acne scars, specifically ice pick scars. In this procedure, your doctor uses a needle the size of your scar to cut out the scar tissue. Then, your doctor closes the wound with stitches. If your scars are more severe, your doctor will take a small skin graft from behind your ear to fill the wound.

The punch excision and replacement graft methods may result in an uneven skin pigmentation and marks from the stitching. Be sure to discuss the risks with your doctor before starting.

5. Subcision

Subcision is an inexpensive surgical procedure best used to treat rolling atrophic scars. While effective as a solo procedure, subcision is often combined with other treatments including microneedling and chemical peels.

The subcision method loosens the area around the indented scar and creates a new wound that can heal properly and match your normal layer of skin.

During this procedure, your doctor will insert a needle under the skin repeatedly in various directions around the scar tissue, using a fanning motion. After the procedure, pressure and ice should be applied to the affected site to prevent bleeding. Subcision may be repeated if your scar is more severe.

Treating atrophic scars can reduce the appearance of indentations in your skin and eliminate feelings of insecurity. It is important to understand that there are no quick fixes to treat atrophic scars.

Each treatment method comes with its own set of risks. Some may leave you with new scarring or may not completely eliminate the initial scar. Other treatments may need to be repeated to provide the best results. Before choosing any treatment method, discuss your options with your doctor.