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Atrophic Scars: Causes, Types, and Treatment Options

Time may heal all wounds, but it does not erase them.

Scars are the result of injuries that slice through your skin’s top layer, penetrating and damaging the dermis. How the scar fades or heals depends on your body’s collagen response. If the skin generates enough of this reparation protein, expect a fainter and flatter scar. On the other hand, if your body is unable to produce the right amount of collagen, you end up with different kinds of scars — some can be addressed with injectable acne-scarring filler treatments, while others require more serious types of treatment.

A more specific type of scar called an  atrophic scar forms below a healthy layer of skin tissue. When your skin fails to regenerate tissue, it results in this type of scarring.

Understanding Atrophic Scars

Atrophic scars are often the result of chickenpox or severe acne. According to The Journal of Clinical and Aesthetic Dermatology, this type of scar is due to the inflammatory processes that lead to the degradation of the subcutaneous fat and collagen fibers under your skin.

Atrophic scars can also form if you have a mole removed. The imbalanced indentation results in one of three types of scarring:

  1. Boxcar Scars Indentations that look like chickenpox scars. They have defined borders and flat bottoms.
  2. Ice-Pick Scars These are smaller and narrower atrophic scars that look like deep pores.
  3. Rolling Scars These atrophic scars do not have distinct edges and are often found on the cheeks.

What Are the Treatments for Atrophic Scars?

The type of treatment depends on the type of atrophic scar you have.

For example:

  • Since ice pick scars are connected to the deeper parts of your skin, your dermatologist will remove the scar. First, they will numb the area before they cut around it. After, they will close the incision with a single stitch. The procedure, however, will still leave a scar, but it will be flatter and less noticeable.
  • Boxcar scars have defined borders, which require subcision for removal. Subcision involves popping the scarred skin with a needle to flatten the scar. As a result, you may have a bruise for about a week.
  • Erbium or CO2 lasers are often used for severe rolling scars. However, if the scarring is superficial, picosend or fraxel lasers can also work. These laser solutions tighten the skin and stimulate collagen growth. Unlike subcision, laser solutions leave your skin with only temporary redness.

Some atrophic scars can be difficult to treat and may require multiple and repeated surgeries over time. If you need help choosing a treatment, seek guidance from a licensed dermatologist. A dermatologist can offer recommendations for a speedy and effective recovery.

When discussing your options with your dermatologist, learn more about the pros and cons of a potential treatment. Also, understand that there is a risk of the treatment leaving behind a new scar.

Dermatologists often recommend one of the following solutions.


Soft-tissue injectable fillers are often recommended for rolling atrophic acne scars. They can raise or level the indented scars to match your skin’s normal layer. During the procedure, your dermatologist will inject the filler under the scar. Over time, the filler improves your skin volume, decreasing the appearance of the scar.

Chemical Peels

woman with smooth skin

Chemical peels are a common treatment for scars. The peeling process destroys the skin’s damaged layer using a chemical solution that triggers skin peeling, which produces a fresh layer of skin underneath. The chemical regeneration decreases the appearance of the scar within a few days or weeks. In some cases, however, the skin will require a substantial time to heal.

Dermatologists use different chemical agents that depend on the severity of your scarring. These chemicals range from mild solutions that you can use as everyday skincare products (e.g. glycolic acid) to chemicals used for deeper peels, which often require sedation before application.

Skin Needling

Microneedling therapy (otherwise known as skin needling) punctures the skin to regenerate a healthier layer. The procedure involves rolling a group of needles on the skin to create hundreds of punctures, which triggers the formation of new collagen, a protein that promotes skin health and elasticity.


As mentioned, subcision is an affordable procedure ideal for treating rolling atrophic scars. While they are effective treatments on their own, subcision is often combined with other treatments to achieve the best results. These treatments can be chemical peels and microneedling.

During the subcision, your dermatologist will insert a needle under the skin in different directions, using a fanning motion. After the treatment, ice and pressure will be applied to the affected site to prevent excessive bleeding.

Punch Excision

Another common treatment for atrophic scars, particularly ice pick scars, is punch excision. During the procedure, your dermatologist uses a needle to cut the scar out of the skin tissue. If your scars are more severe, your dermatologist will fill the wound with a small skin graft from behind your ear.

This treatment method may result in more scarring and uneven skin pigmentation. Discuss the risks first with your dermatologist before you proceed.

The Bottom Line

Proper treatment of atrophic scars can reduce the appearance of scar indentation and pigmentation, eliminating feelings of insecurity. Before you proceed with a treatment, however, understand that there are no quick fixes for atrophic scars.

Each treatment comes with its own set of pros and cons, and they may depend on your case. Some procedures will leave you with new scars or may not completely remove or fade your original scar. Other treatments may require multiple visits to your dermatologist to eliminate the original scar.

Before settling on a treatment method, discuss your options with a board-certified dermatologist first.

Here at the Vargas Face & Skin Center, we offer individualized treatment plans designed according to your skin requirements. Dr. Hannah Vargas, a skilled surgeon with an artistic eye, recommends on a case-to-case basis, ensuring the most effective treatment for you.

Time heals all wounds — but not completely. Fortunately, science has made it possible to reduce (if not, completely eliminate) the appearance of your scars.

Schedule a complimentary virtual consultation with us today to learn more.

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