Acne Scarring: Types, Causes and What Actually Treats Them

Acne itself is distressing enough — but the scars it leaves behind can feel like a constant, visible reminder long after breakouts have resolved. The important thing to understand is that acne scarring is not one thing. It encompasses several distinct types, each with different structural causes and different treatment requirements.

How acne scars form

Acne scars develop when the skin's healing response following a breakout is disrupted. Inflammatory acne — the deeper, nodular type — triggers collagen production as part of the repair process. If too much collagen is produced, you get raised (hypertrophic or keloid) scarring. If collagen production is insufficient or disorganised, the skin fails to fill the void left by damaged tissue, resulting in atrophic (depressed) scars.

Types of acne scarring

• Ice pick scars: Deep, narrow scars that extend into the dermis. They appear as small, sharp punctures and are among the most challenging to treat.

• Boxcar scars: Broad, depressed scars with well-defined edges. More superficial than ice pick scars and more responsive to resurfacing.

• Rolling scars: Shallow, wavy undulations caused by fibrous bands tethering skin to underlying tissue, creating a wave-like texture.

• Post-inflammatory hyperpigmentation (PIH): Dark marks left after inflammatory acne. Not true scars structurally, but often mistaken for scarring.

Treatments that deliver real improvement

The most effective treatments for atrophic acne scarring stimulate the skin's collagen remodelling response — encouraging the skin to rebuild the structure damaged during the original breakout.

• Infini RF Microneedling: Fine needles deliver radiofrequency energy at precise depths within the dermis, stimulating targeted collagen remodelling. Particularly effective for boxcar and rolling scars.

• Skin resurfacing: Removes outermost skin layers to smooth texture and reduce the visibility of superficial scarring while stimulating new cell growth.

• Lactic peels: For mild PIH and surface texture, lactic acid exfoliation brightens and smooths with minimal recovery time.

A combination approach — treating both structural scarring and associated pigmentation — typically produces the best overall result. Multiple sessions are usually required, and outcomes vary based on scar depth and type.

If acne scarring is affecting your confidence, our team at St James Aesthetics can assess your skin in detail and recommend the right treatment pathway. Book a consultation at our Camberwell, Moonee Ponds, or Geelong clinic.