Acne scars fall into two broad categories: depressed scars that sit below the skin’s surface and raised scars that form bumps above it. Nearly half of all people with acne develop some degree of scarring, and the scars vary widely in shape, size, and texture depending on how the skin healed after a breakout. Knowing what you’re looking at is the first step to understanding your options.
Depressed Scars: The Most Common Type
The majority of acne scars are atrophic, meaning the skin lost tissue during healing and now sits lower than the surrounding area. These form when the body doesn’t produce enough collagen to fully repair the damage from an inflamed breakout. They come in three distinct shapes, each with a different look and feel.
Ice Pick Scars
Ice pick scars look like the skin has been punctured with a sharp, narrow tool. They’re less than 2 millimeters wide but extend deep into the skin, creating tiny crater-like holes. From a distance, they can resemble enlarged pores, but up close the depth is obvious. You’ll most often find them on the forehead and upper cheeks, where the skin is naturally thinner.
Boxcar Scars
Boxcar scars are wider and more defined than ice pick scars. They look like round or oval depressions with sharp, vertical edges, almost like someone pressed a small cookie cutter into the skin. They typically measure 1.5 to 4 millimeters across. Some are shallow (under half a millimeter deep), while others are noticeably deep. The sharp edges are the giveaway: where rolling scars blend gradually into surrounding skin, boxcar scars have a distinct border. They’re most common on the lower cheeks and jawline.
Rolling Scars
Rolling scars give the skin a wavy, uneven texture rather than creating individual holes or dents. They’re caused by bands of scar tissue that form underneath the surface and pull the skin downward in an irregular pattern. They’re usually 4 to 5 millimeters wide and create a gentle, undulating look sometimes described as resembling the letter “M.” These scars tend to appear on the lower cheeks and jaw, where the skin is thicker. One quick way to identify them: if you gently stretch the skin and the scar temporarily flattens out, it’s likely a rolling scar being pulled down by those sub-surface bands.
Raised Scars: Hypertrophic and Keloid
While depressed scars result from too little collagen, raised scars happen when the body overproduces scar tissue during healing. These are less common on the face and more frequently appear on the chest, back, shoulders, and jawline. They can feel firm, rubbery, or tender to the touch, and some people find them itchy or mildly painful.
There are two types. Hypertrophic scars are raised bumps that stay within the boundary of the original breakout. They tend to be pink to red in color. Keloid scars, on the other hand, grow beyond the edges of the original wound and can become quite large over time. They typically appear darker, ranging from red to purple. The key visual difference is spread: if the raised tissue is confined to where the pimple was, it’s hypertrophic. If it’s expanded outward, it’s a keloid.
Flat Marks That Look Like Scars but Aren’t
Not every mark left behind by acne is a true scar. Two common types of discoloration can linger for weeks or months after a breakout and are often mistaken for permanent scarring.
Post-inflammatory erythema shows up as flat pink, red, or purple spots. On lighter skin these marks lean pink or red; on darker skin tones they tend toward violet or purple. The skin is smooth to the touch with no indentation or raised texture. These marks are caused by lingering inflammation in the small blood vessels beneath the skin’s surface, and they fade on their own over time.
Post-inflammatory hyperpigmentation looks different. These are flat brown, grey, or dark spots caused by an overproduction of melanin after the skin was irritated. They’re essentially a concentration of pigment in one area. Like erythema, the skin surface is smooth, with no change in texture.
The simplest way to tell these apart from true scars is to run your finger across the mark. If the skin feels flat and even, you’re dealing with discoloration. If you can feel a dip, a pit, or a raised bump, that’s a scar. Both types of discoloration can exist alongside true scars, which is why many people see a mix of colors and textures after a bad breakout.
How to Tell Which Scars You Have
Most people don’t have just one type. It’s common to see ice pick scars on the upper cheeks, boxcar or rolling scars along the lower face, and discoloration scattered throughout. Looking at your skin in natural, side-angled light makes depressed scars much easier to spot, since overhead lighting casts small shadows inside the depressions. Raised scars are obvious to both sight and touch.
Identifying your specific scar types matters because each responds to different treatments. Rolling scars caused by sub-surface tethering, for example, are treated differently than deep ice pick scars. A dermatologist can map out which types you have and where, which makes any treatment plan far more targeted and effective.