Those crater-like indentations on your face are almost always atrophic scars, meaning the skin has lost underlying tissue and collapsed inward. The most common cause by far is acne, but chickenpox, skin infections, and even aging-related volume loss can create similar pits. Understanding what type of indentation you’re dealing with is the first step toward treating it effectively.
What Creates a Crater in Your Skin
When your skin is damaged by inflammation, whether from a deep pimple, a picked-at blemish, or an infection like chickenpox, the normal wound-healing process can go wrong. Healthy healing requires your body to lay down new collagen in a controlled, organized way. But when inflammation is severe or prolonged, immune cells flood the area and disrupt that process. Instead of rebuilding the skin to its original level, your body produces too little collagen in the damaged zone. The result is a depression where the skin surface dips below the surrounding area.
The deeper the original inflammation reached, the deeper the crater. This is why cystic acne, which forms well below the skin’s surface, produces worse scarring than a small whitehead. It’s also why picking or squeezing active breakouts dramatically increases your risk of permanent indentations. You’re pushing bacteria and inflammatory material deeper into the tissue, extending the damage beyond what the original blemish would have caused on its own.
Three Types of Facial Craters
Dermatologists classify these indentations into three distinct types, and knowing which kind you have matters because each responds best to different treatments.
- Ice pick scars are narrow (under 2 mm wide), deep, and V-shaped, like someone poked the skin with a sharp instrument. They’re the most common type after inflammatory acne and tend to appear on the cheeks.
- Boxcar scars are wider with sharp, defined edges and a flat bottom, almost like a small rectangular pit. They can be shallow or deep and often show up on the lower cheeks and jaw.
- Rolling scars have soft, sloping edges that create a wave-like unevenness across the skin. These form when bands of scar tissue pull the surface of the skin downward from underneath, tethering it to deeper layers.
Most people have a mix of all three types, which is one reason a single treatment rarely fixes everything.
Causes Beyond Acne
Acne isn’t the only culprit. Chickenpox scars produce sunken, round indentations that can persist for decades. The inflammation from chickenpox blisters damages the skin in a similar way to deep acne, and scratching the blisters while they heal makes permanent scarring far more likely.
Aging can also make existing minor scars or enlarged pores look dramatically worse. As you get older, your dermis (the skin’s structural layer) thins and weakens. You also lose fat volume in the mid-face, which means less padding beneath the skin’s surface. A scar that was barely noticeable at 25 can look like a noticeable pit at 40 simply because the surrounding skin has lost its fullness. The tear trough area under the eyes is especially prone to this kind of age-related deepening.
Less commonly, bacterial folliculitis (infected hair follicles), surgical wounds, or traumatic injuries can leave crater-like scars on the face.
Why New Craters Keep Appearing
If you’re noticing new indentations forming, active inflammation is likely still at work. Ongoing acne that goes untreated or undertreated will continue producing new scars with each deep breakout. Hormonal shifts, stress, and changes in skincare routines can all trigger new cycles of inflammatory acne. Getting your active breakouts under control is critical before pursuing scar treatment, because there’s no point repairing skin that’s still being damaged.
Compulsive picking or squeezing, sometimes called excoriation, is another reason craters seem to multiply. Even minor blemishes that would heal flat on their own can become permanent indentations after being aggressively extracted at home.
Topical Treatments and Their Limits
Topical retinoids can stimulate collagen production and gradually improve shallow scars. In one clinical study, 94% of patients treated with a low-concentration retinoid over three months showed a measurable decrease in scar depth. However, topical products work best on shallow, broad indentations. They won’t fill in a deep ice pick scar. Think of retinoids as a way to improve skin texture overall and soften mild scarring, not as a fix for significant craters.
Over-the-counter products containing vitamin C, niacinamide, or alpha hydroxy acids can improve skin tone and texture around scars, making them less conspicuous. But no cream or serum can rebuild the lost tissue that creates a true crater.
Professional Treatments That Work
Deeper craters require professional intervention, and the right procedure depends on the scar type.
Fractional Laser Therapy
Fractional lasers create thousands of microscopic wounds in the skin, triggering a controlled healing response that generates new collagen. This works well for rolling and boxcar scars. Timing matters significantly: patients who begin laser treatment early after scarring see roughly 35% improvement in scar depth, compared to about 12.5% for those who wait years before starting. Some patients see meaningful improvement after a single session, though a typical course involves around four sessions.
The CROSS Technique for Deep Pits
For narrow ice pick scars, a technique called CROSS uses a highly concentrated chemical acid applied precisely into each individual scar with a toothpick-sized applicator. This triggers new collagen formation from the bottom of the scar upward. In one study, 80% of patients achieved greater than 70% improvement in their ice pick scars after four sessions spaced two weeks apart. The remaining patients still saw 50 to 70% improvement. This technique is one of the most effective options for those deep, narrow pits that don’t respond well to lasers.
Subcision for Tethered Scars
Rolling scars are caused by fibrous bands pulling the skin surface downward. Subcision involves inserting a small instrument beneath the scar to physically cut those bands, releasing the skin so it can rise back to its natural level. The controlled injury also stimulates new connective tissue growth that fills in the space underneath. If you can stretch the skin around a scar and it temporarily looks flat, subcision is likely a good option. Results improve further when subcision is combined with other treatments like microneedling or fillers.
Dermal Fillers
Injectable fillers placed directly beneath individual scars can physically lift them to the level of surrounding skin. Temporary fillers last up to 18 months. Semi-permanent options that stimulate your body’s own collagen production can last two to three years. One permanent filler was specifically approved for moderate to severe atrophic acne scars in 2014, though permanent fillers carry a higher risk profile and aren’t right for everyone.
Punch Excision and Elevation
For particularly deep or well-defined craters, a dermatologist can physically cut out the scar and either stitch the tiny wound closed or elevate the base of the scar to skin level. This trades a crater for a fine line, which is often far less noticeable.
Why DIY Approaches Can Backfire
At-home dermarollers and microneedling devices are widely marketed for scarring, but the FDA has not authorized any microneedling devices for over-the-counter sale. Common side effects include bleeding, bruising, redness, and peeling. Less common but more serious risks include infection, changes in skin pigmentation, and cold sore flare-ups. If tools aren’t properly sterilized, you risk introducing bacteria into open wounds on your face, potentially creating new scars on top of the ones you’re trying to fix. Professional microneedling uses longer needles at controlled depths and is performed in a sterile environment, making it meaningfully different from what you can do at home.
Getting the Best Results
Most dermatologists recommend a combination approach rather than relying on a single treatment. A typical plan might involve subcision for rolling scars, the CROSS technique for ice pick scars, and fractional laser sessions for overall texture improvement. Results are cumulative, building over multiple sessions as new collagen forms and matures. Full collagen remodeling takes three to six months after each treatment, so patience is part of the process.
Starting treatment sooner rather than later consistently produces better outcomes. Scars become more rigid over time as the fibrous tissue matures, making them harder to treat. If you’re still in your teens or twenties with active scarring, getting both the acne and the early scars addressed now will save you from chasing deeper, more stubborn craters later.