Quick answer: Acne scars are not all the same. Depressed scars are usually described as ice pick, boxcar or rolling scars, while raised scars include hypertrophic scars and keloids. Red or brown marks left after acne are colour changes, not necessarily permanent scars. Because one face often has more than one
Acne scars often appear in more than one shape and depth. A professional assessment looks at scar structure, active acne, skin tone and recovery preferences before recommending treatment.
If you have searched for acne scar treatment in Vancouver, you have probably encountered a long list of options: microneedling, radiofrequency (RF) microneedling, laser resurfacing, peels, injections and surgical techniques. The important question is not simply, “Which treatment is best?” It is, “Which treatment fits the type and depth of my scars, my skin tone and my goals?”
This guide explains the main acne-scar patterns, what clinicians assess and why combination plans are common. It is educational and cannot diagnose your skin or replace a consultation with a qualified healthcare professional.
Are acne marks the same as acne scars?
No. A flat red, pink, purple or brown spot that remains after a breakout may be a post-acne colour change rather than a structural scar. A true scar changes the skin’s texture: it may sit below the surrounding skin, rise above it or alter the skin’s contour.
The distinction matters because colour and texture respond to different approaches. The American Academy of Dermatology (AAD) explains that acne scars may appear as depressions or raised tissue, sometimes accompanied by discoloration. The colour can fade over time even when the textural scar remains. Active acne should also be controlled because new inflammatory breakouts can create new scars. (AAD: Acne scars overview)
A useful at-home observation: Look at the area in soft side lighting. If you see shadows, depressions or raised tissue, texture is likely involved. If the surface feels smooth but the colour remains, it may be mainly a post-acne mark. Only an in-person assessment can confirm what you are seeing.
What are the three main types of depressed acne scars?
The three commonly recognized atrophic, or depressed, acne-scar patterns are ice pick, boxcar and rolling scars. These names describe shape, not severity. A person may have all three patterns in the same treatment area.
Simplified comparison of the three main depressed acne-scar patterns. Real scars vary in depth, width and colour and may overlap.
1. What do ice pick scars look like?
Ice pick scars are narrow, deep pits that are often wider at the surface and taper as they extend into the skin. They can resemble enlarged pores, but their depth makes them structurally different. Published clinical classifications generally describe them as narrow, sharply defined tracts.
Because the opening is small but the scar can extend deeply, broad surface treatments may have limited reach when used alone. A clinician may consider focal techniques or a combination plan, depending on the depth, number and location of the scars. The goal is improvement—not erasing every scar. (Clinical review of acne-scar classification)
2. What do boxcar scars look like?
Boxcar scars are round or oval depressions with clearer, steeper edges. They may be shallow or deep and often look wider at the surface than ice pick scars. Shallow boxcar scars can respond differently from deep boxcar scars, so the label alone does not determine the treatment.
Clinicians assess the scar’s depth, edge, location and how it changes when the skin is gently stretched. Resurfacing or collagen-remodelling procedures may be considered for appropriate shallow scars, while deeper scars may require a more targeted or combined approach.
3. What do rolling acne scars look like?
Rolling scars are broad, shallow depressions that give the skin a wave-like or uneven appearance. They can form when fibrous tissue beneath the surface pulls the skin downward. This tethering is why the skin may look smoother when it is stretched.
Energy-based collagen remodelling can improve overall texture in selected patients, but a clinician may first consider whether tethering must be addressed. A review of acne-scar management notes that scar-directed combinations are often more appropriate than treating every depressed scar with one device. (Acne scarring: evaluation and treatment options)
Quick comparison: acne-scar type and treatment logic
| Scar or mark | Typical appearance | What an assessment considers | Treatments that may be discussed* |
| Ice pick | Narrow, deep pit | Depth, number and location | Focal scar techniques; selected resurfacing; combination plans |
| Boxcar | Round or oval depression with defined edges | Shallow vs. deep; edge sharpness | Laser resurfacing, microneedling or RF microneedling; targeted techniques for deeper scars |
| Rolling | Broad, shallow, wave-like depression | Whether the scar is tethered underneath | Tether-release techniques, RF microneedling, laser resurfacing or combinations |
| Raised scar | Firm tissue above the skin | Hypertrophic scar vs. keloid; symptoms and growth pattern | Medical evaluation; injections, laser or other scar-specific care |
| Flat red or brown mark | Colour change without a depression or raised area | Pigment, redness, skin tone and active acne | Skin care, medication, peels or selected energy-based treatment |
This table is educational, not a treatment prescription. The appropriate option depends on an examination, medical history, skin type, active acne and the clinician’s scope of practice.
Is RF microneedling good for acne scars?
RF microneedling combines controlled microneedle penetration with radiofrequency energy delivered below the skin’s surface. It is used to stimulate a wound-healing response and collagen remodelling while allowing treatment depth and energy to be adjusted. It may be considered for selected depressed acne scars and broader texture concerns.
A 2024 systematic review included 16 studies and 481 patients. The authors concluded that fractional RF microneedling is likely effective as a standalone treatment for acne scarring, while also emphasizing the need for more randomized trials and standardized treatment settings. That is a useful evidence signal, but it is not proof that RF microneedling is the best choice for every scar or patient. (Systematic review of fractional RF microneedling)
The AAD also lists microneedling, RF microneedling, laser treatment, radiofrequency, fillers, scar surgery and other procedures among options used for acne scars. Its guidance emphasizes that treatment is individualized and that more than one method may be recommended. (AAD: Acne-scar consultation and treatment)
Is laser treatment better than RF microneedling for acne scars?
Neither is universally better. Laser systems and RF microneedling interact with tissue differently, and each category includes multiple devices and settings. The right comparison depends on the scar pattern, depth, skin tone, treatment history, tolerance for downtime and the operator’s training.
Health Canada notes that cosmetic laser outcomes and risks depend on the device, wavelength, power, pulse settings, number of sessions, operator skill and the person’s skin colour. Possible effects include pain, redness, bruising and swelling; less common complications can include burns, infection, pigment changes and scarring. Health Canada advises seeking a licensed healthcare professional with specialized laser training for treatments such as skin resurfacing. (Health Canada: Cosmetic laser treatments)
For some people, laser resurfacing may offer a strong texture-focused option. For others, RF microneedling may better match the treatment objective or risk profile. In mixed scarring, a staged combination can be more logical than choosing one winner.
Can acne scars be treated safely in darker skin tones?
Yes, acne-scar procedures can be considered across a wide range of skin tones, but device selection, settings, preparation and aftercare matter. Skin rich in melanin can be more susceptible to post-inflammatory hyperpigmentation after heat or inflammation. That does not automatically rule out laser or RF-based treatment; it makes individualized planning and informed consent more important.
A 2023 clinical review reported that laser treatment can be performed safely and effectively in skin of colour when protocols are tailored to the patient’s skin type and scar pattern. It also cautioned that no treatment eliminates scarring completely and that pigment change is a recognized risk. (PubMed: Laser treatment of acne scarring in skin of colour)
Ask your provider which device will be used, why it fits your skin, how settings are selected, what pigment-related risks apply and what aftercare is required.
Why do acne-scar treatment plans often combine procedures?
One device rarely addresses every feature of mixed acne scarring. A person may have deep ice pick scars, shallow boxcar scars, rolling tethered areas, redness and brown marks at the same time. Each feature has a different physical target.
A combination plan may therefore sequence treatment—for example, first controlling active acne, then addressing focal or tethered scars, and later improving broader texture or colour. The exact sequence must be personalized. “Combination treatment” does not mean doing everything at once; it means matching each step to a defined problem while allowing appropriate healing.
This scar-by-scar logic is more realistic than promising a single “best acne scar treatment.” It also creates a clearer way to measure progress: standardized photos, consistent lighting, agreed treatment goals and review after healing.
What should happen during an acne-scar consultation?
A useful consultation should identify more than a device. Expect the clinician to assess:
- Whether acne is still active. Ongoing inflammatory acne can create new scars and may need to be managed first.
- Scar pattern and depth. Ice pick, boxcar, rolling and raised scars require different treatment logic.
- Colour changes. Redness and brown marks may need a separate plan from texture.
- Skin tone and pigment response. This affects device selection, settings and aftercare.
- Medical and treatment history. Medications, previous procedures, healing history and tendency toward keloids can influence candidacy.
- Downtime and expectations. Improvement is usually gradual, and a series or combination may be recommended.
- Photography and follow-up. Consistent images and adequate healing time help determine whether a plan is working.
At Ovo Medi Spa in Point Grey, Vancouver, acne-scar consultations can include an assessment of scar type, skin condition and treatment goals. Depending on suitability, the discussion may include laser acne-scar reduction, RF microneedling, standard microneedling or a staged approach. A consultation is not a promise of candidacy or outcome.
Questions to ask before choosing acne-scar treatment
- Which scar types do I have, and which one are we treating first?
- Is my active acne controlled well enough to begin scar treatment?
- Why is this device or procedure appropriate for my skin tone?
- What realistic improvement are we aiming for?
- How many sessions might be considered, and when will results be assessed?
- What downtime, aftercare and sun precautions should I expect?
- What are the risks of pigment change, infection, burns or additional scarring?
- Who will perform the procedure, and what training do they have?
- Is the device licensed in Canada for the intended use?
- What alternatives are available if I am not a good candidate?
Frequently asked questions
Can I identify my acne-scar type from a photo?
A photo may suggest a pattern, but it cannot reliably show depth, tethering, skin response or whether a mark is primarily pigment, redness or a structural scar. Lighting and phone processing can also exaggerate or hide texture. An in-person assessment is more reliable.
Can acne scars go away completely?
Acne scars can often be made less noticeable, but complete removal is not a realistic promise. Results vary with scar type, depth, skin tone, treatment choice, healing and adherence to aftercare. A good plan defines achievable improvement rather than guaranteeing flawless skin.
Should active acne be treated before acne scars?
Usually, active inflammatory acne should be controlled before or alongside scar treatment so that new scars are less likely to form. The AAD recommends early and continued acne treatment and advises against picking or squeezing breakouts because added inflammation can increase scarring risk.
How many acne-scar treatments will I need?
There is no universal number. The plan depends on the scar mix, device or procedure, treatment intensity, healing interval and target outcome. Be cautious of anyone who promises a fixed result before examining your skin.
What is the best acne-scar treatment in Vancouver?
The best option is the one that matches your scar structure, skin tone, health history, risk tolerance and recovery preferences—and is performed by a properly trained professional. For mixed scars, that may be a sequence or combination rather than one treatment.
The bottom line
The most useful first step is not choosing between laser and RF microneedling. It is identifying what you are treating. Ice pick, boxcar and rolling scars differ in shape and depth; raised scars and flat post-acne marks require still different thinking. Once the scar pattern, skin tone, active acne and goals are clear, a qualified professional can explain suitable options, limitations and risks.
If you would like a personalized assessment in Vancouver, book a consultation with OVO Medi Spa. Bring a list of previous treatments, current skin-care products and any history of pigment changes or keloid scarring.
