What Causes Pitted Acne Scars and 6 Ways to Treat Them Without Surgery

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Author: Natalie Ng|28 April 2025

Pitted acne scars form when the skin loses collagen during the healing process after severe acne. These types of scars—like ice pick scars, boxcar scars, and rolling scars—create visible dips or tiny craters in the skin's surface. They happen when inflammation damages healthy tissue and collagen fibers, leading to deeper scars that don’t heal flat. This damage can come from cystic acne, moderate to severe acne, or from picking at acne bumps, especially on areas like the lower cheeks. Over time, the skin structure changes, and scar tissue replaces the normal skin layers. This makes atrophic acne scars harder to treat with regular skincare alone. The good news is you don’t always need surgery. There are several effective treatments that can help improve skin texture and boost collagen production. These include chemical peels, microneedling, dermal fillers, laser treatments like fractional laser resurfacing, and active skincare ingredients such as salicylic acid and azelaic acid. If you’re dealing with post-inflammatory hyperpigmentation, darker skin tones, or different acne scar types, it’s helpful to understand your options. Keep reading to learn about six proven ways to treat acne scars and help your skin heal better—without going under the knife.

Understanding Pitted Acne Scars: Types and Formation

Pitted acne scars form when severe acne damages the skin deeply, preventing it from healing properly. This often happens with cystic acne or acne that’s picked or squeezed. When inflammation breaks down healthy skin tissue, the body can't produce enough collagen to repair the area fully. As a result, the skin heals unevenly, leaving behind small craters or depressions. These are known as atrophic scars or pitted acne scars.

The Three Main Types of Atrophic Acne Scars

Different types of pitted scars affect the skin’s surface in different ways. Recognising the scar type you have helps in choosing the right acne scar treatments. Ice Pick Scars Ice pick scars are small but deep. They look like tiny holes that go straight down into the skin, almost like they were made with a sharp object. These scars are hard to treat because they reach deep into the skin’s layers and often extend into the collagen fibers. They’re more common on the forehead and upper cheeks. Rolling Scars Rolling scars create a wavy look across the skin. They happen when bands of scar tissue pull down on the skin’s surface, making it look uneven. These usually appear on the lower cheeks and jawline. Unlike ice pick acne scars, rolling scars have softer, sloping edges. Boxcar Scars Boxcar scars are round or oval with sharp edges. They’re wider than ice pick scars but not as deep. These can show up anywhere on the face and are easier to treat because they don’t reach as deep into the skin’s structure.

Understanding how these acne scar types form is the first step to choosing the right treatment. In the next section, we’ll go over proven, non-surgical acne scar treatments that can improve skin texture and support collagen production—keep reading.

Chemical Peels: A Gradual Approach to Scar Reduction

Chemical peels are a widely used, non-surgical method to treat pitted acne scars, including ice pick scars, boxcar scars, and rolling scars. These treatments work by removing layers of damaged skin, which encourages collagen production and helps reduce the depth of atrophic scars over time.

How Chemical Peels Work

A chemical solution is applied to the skin's surface, which causes controlled exfoliation. This removes dead skin cells, improves skin texture, and stimulates new collagen fibers to grow. Over time, this process helps fill in deeper scars and smooth out uneven areas of the skin.

Types of Chemical Peels

Different chemical peels target different depths of scarring. The choice depends on your skin type, the severity of your pitted scars, and your tolerance for downtime. Superficial Peels These are the mildest form and often use salicylic acid or other alpha-hydroxy acids. They gently exfoliate the top layer of the skin, making them useful for post-inflammatory hyperpigmentation and mild skin scars. These peels are safe for darker skin and help prevent clogged pores, which can reduce the chance of developing new acne bumps. Medium-Depth Peels These use stronger acids like trichloroacetic acid (TCA) or a blend that includes azelaic acid. They penetrate deeper into the skin and are more effective for moderate pitted acne and boxcar scars. Medium-depth peels are commonly used for people with moderate acne scarring who need more than surface exfoliation. Deep Peels Reserved for more severe acne and deep pitted scars, these peels involve stronger chemicals that reach the deeper skin layers. They can trigger significant collagen formation, leading to more noticeable improvements in skin texture. These should only be done under medical supervision, as they require longer recovery and carry a higher risk of post-inflammatory side effects, especially in darker skin tones.

Treatment Process and Timeline

Improving pitted acne scars through chemical peels takes time and consistency. Most people need multiple sessions, spaced about 4 to 6 weeks apart. - A skin consultation helps determine the best type of peel and plan for your scar type - The first session begins the process of exfoliation and collagen stimulation - Ongoing treatments continue to reduce the appearance of atrophic scars - Maintenance treatments every few months help preserve results You’ll typically need at least 4 to 6 sessions to see clear, long-term improvements. As your skin heals between treatments, new skin cells and healthy tissue replace scarred areas, slowly rebuilding the skin.

At-Home vs. Professional Chemical Peels

At-Home Peels These contain lower concentrations of acids and are designed for gradual improvement. They’re safer for regular use and help maintain results between professional sessions. Common ingredients include hyaluronic acid for hydration and mild chemical exfoliants to remove surface debris. Professional Peels Administered by a dermatologist or trained practitioner, these are more potent and better for deeper scars. They may also be combined with other treatments like dermal fillers or fractional laser resurfacing to treat stubborn icepick scars or scar tissue. Choosing between at-home and professional peels depends on the severity of your scars and your overall skin condition. For best results, many people use both approaches together.

Up next, we’ll cover microneedling, another effective way to treat atrophic acne scars by helping your skin heal from the inside.

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Microneedling: Stimulating Natural Collagen Production

Microneedling is a non-surgical treatment that helps reduce pitted acne scars by using your skin’s own ability to heal. It works by creating tiny injuries in the skin, which triggers the production of collagen fibers and healthy tissue. Over time, this process fills in atrophic scars and smooths out uneven skin texture.

How Microneedling Works

During microneedling, a device with fine needles creates small punctures in the skin. These micro-injuries are controlled and shallow, but they activate the skin’s natural healing process. As your skin repairs itself, it produces new collagen and elastin, two key components needed to repair scarred skin. Microneedling is especially useful for: - Ice pick scars - Rolling scars - Boxcar scars It also helps improve post-inflammatory hyperpigmentation by increasing skin cell turnover and supporting fresh, even-toned skin growth.

Treatment Process and Expectations

Microneedling is done in sessions spaced about 4 to 6 weeks apart. Most people need at least 3 to 6 treatments to see noticeable improvement in pitted scars. What to expect: - Each session lasts around 30 minutes - Numbing cream is applied beforehand to reduce discomfort - After treatment, your skin may feel warm and appear red for a few days - Minor peeling or dryness may follow as dead skin cells shed and new skin cells form Improvement is gradual, with visible changes in skin texture appearing over a few months. The skin becomes smoother as collagen formation continues between sessions.

Safety and Skin Types

Microneedling is safe for most skin types, including darker skin. Unlike some laser treatments, it carries a lower risk of post-inflammatory pigmentation. It’s important, though, to avoid treatment if you have active acne, as microneedling over breakouts can spread bacteria and worsen inflammation. Because microneedling supports natural collagen production without removing layers of skin, it’s considered one of the most effective treatments for atrophic acne scars, especially when combined with other procedures like radiofrequency devices or chemical peels.

Next, we’ll explore how dermal fillers can provide fast, visible improvement for deeper scars—keep reading.

Dermal Fillers: Temporary but Effective Relief

Dermal fillers are an in-office treatment used to improve the appearance of pitted acne scars, especially rolling scars and shallow boxcar scars. These fillers work by adding volume beneath the scarred area, raising it to match the level of the surrounding skin. This results in a smoother skin surface and more even skin texture.

How Dermal Fillers Work

The filler, usually made from hyaluronic acid, is injected directly under the pitted scars. Hyaluronic acid attracts water and supports the surrounding skin cells, helping to lift the depressed areas instantly. In addition to this immediate effect, the injection can also stimulate collagen production, helping the skin rebuild itself naturally over time. This method is especially helpful for scars that have softened over time and no longer have tight bands of scar tissue pulling the skin down.

Best for Specific Acne Scar Types

Dermal fillers are most effective for: - Rolling scars: These have broad, shallow depressions and respond well to volume restoration - Boxcar scars: Shallow ones with defined edges can also benefit from fillers They are less effective for ice pick scars, which are narrow and deep. These often require more targeted treatments like punch excision or TCA CROSS.

Treatment Process and Results

The procedure is quick and usually takes under 30 minutes. A numbing agent is applied to reduce discomfort. Results are visible immediately after the injection, but mild swelling or redness may occur and usually fades within a day or two. What to expect: - Immediate visual improvement in scar depth - Smoother skin in treated areas - Results that last from 6 to 18 months depending on the filler used - Repeat treatments required for maintenance Some patients combine dermal fillers with treatments like microneedling or laser resurfacing to treat different types of atrophic scars in one plan. While fillers do not prevent pitted acne scars from forming, they can provide a significant improvement in appearance with little downtime.

In the next section, we’ll cover laser resurfacing—an advanced option for treating deeper scars and improving overall skin texture.

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Enhancing Results with Professional Acne Treatment

While treatments like laser resurfacing, microneedling, and chemical peels help repair pitted acne scars, maintaining results and supporting the healing process often requires additional care. This is where New Beauty’s Acne Treatment can play a supportive and complementary role.

How New Beauty’s Acne Treatment Supports Scar Repair

New Beauty’s Acne Treatment uses a dual-action system that combines deep pore cleansing with hydration. It helps manage active acne, removes buildup from dead skin cells, and creates a healthier foundation for scar healing. For those dealing with ongoing moderate to severe acne, this treatment also helps prevent future breakouts that can lead to new atrophic scars.

The Treatment Process

1. Deep Cleansing and Exfoliation The treatment begins with a dual spiral suction and drainage system. This process removes debris from clogged pores and exfoliates the skin to prevent inflammation, infection, and further scar tissue development. 2. Hydration and Oil Control After exfoliation, a medical-grade hydrating serum is infused into the skin. It balances oil production, calms irritated sebaceous glands, and supports collagen production—a key factor in softening pitted scars and improving skin texture. 3. Collagen Support and Scar Management With regular use, the treatment helps reduce acne breakouts, minimizes post-inflammatory hyperpigmentation, and promotes clearer skin. This makes the skin more responsive to other scar-focused procedures like fractional laser resurfacing or chemical reconstruction (TCA CROSS).

Benefits of New Beauty’s Acne Treatment

- Helps prevent future pitted acne scars by reducing breakouts - Promotes healthy collagen formation and skin healing - Non-invasive, with no needles or downtime - Suitable for various skin types, including darker skin - Safe to use alongside other acne scar treatments

A Smart Add-On for Long-Term Results

When you're treating atrophic acne scars, especially after procedures like laser treatments or microneedling, keeping your skin calm, balanced, and clear is essential. New Beauty’s Acne Treatment helps extend the results of more intensive treatments by reducing oil buildup, preventing further scarring, and promoting a smoother healing process.

Ready to support your skin’s recovery and stop new scars before they form? Book your consultation today and see how New Beauty’s Acne Treatment can fit into your acne scar care plan.

New Beauty's Acne Treatment

At-Home Skincare and Prevention Strategies

Professional treatments play a key role in improving pitted acne scars, but maintaining results and preventing new scars also depends on consistent, daily care. An effective at-home routine can support collagen production, improve skin texture, and reduce the chance of future acne breakouts that lead to atrophic scars.

How to Support Healing at Home

Daily Sun Protection UV exposure can darken post-inflammatory hyperpigmentation and slow down the healing process. Use a broad-spectrum sunscreen with SPF 30 or higher every day—even indoors. This protects your skin from sun damage and helps your treatments work better over time. Gentle Cleansing and Exfoliation Choose a non-irritating cleanser that removes dirt and oil without stripping the skin. To help clear dead skin cells and prevent clogged pores, use gentle exfoliants that contain salicylic acid 1–2 times a week. Avoid harsh scrubs that can damage the skin’s surface and worsen scar tissue. Use Targeted Serums Look for skincare products with vitamin C, azelaic acid, or niacinamide. These ingredients brighten dark spots, calm inflammation, and improve skin tone. They also help support the skin as it heals from acne scars. Retinoids for Skin Renewal Topical retinoids promote skin cell turnover, fade hyperpigmentation, and stimulate collagen formation. Use them at night to help reduce the appearance of pitted scars and improve overall skin condition. Start slowly and use a moisturiser to reduce irritation.

Preventing Future Pitted Acne Scars

- Avoid picking or squeezing acne bumps—it increases inflammation and worsens ice pick scars or boxcar scars - Keep your skin moisturised to protect your skin barrier - Treat active acne early to stop the formation of new scars - Visit a professional if over-the-counter products aren’t helping - Stay consistent—prevention and healing both take time

Daily care may not replace in-office procedures, but it does make your treatments more effective and reduces the chance of new scarring. By combining targeted home care with professional support, you give your skin the best chance to heal and stay clear long term.

FAQ

Can Pitted Acne Scars Appear Years After Acne Has Cleared Up?

No, pitted acne scars don't suddenly appear years after your acne has cleared up. These scars form during the active phase of acne when inflammation damages the skin's collagen. While existing scars may appear more noticeable over time due to natural aging and collagen loss, you won't develop new pitted scars unless you're experiencing new acne breakouts that cause tissue damage.

Are Certain Skin Types More Prone to Developing Pitted Acne Scars?

You're more likely to develop pitted acne scars if you have darker skin due to increased melanin production and inflammatory responses. People with naturally oily or combination skin types also face higher risks because excess sebum can lead to more severe acne breakouts. Additionally, if you have thin or sensitive skin, you'll be more susceptible to scarring since your skin has less structural support and healing capacity.

Does Picking at Active Acne Always Lead to Pitted Scarring?

Studies show that approximately 30% of people who pick at their acne develop permanent scarring. While picking at active acne doesn't always result in pitted scars, you're substantially increasing your risk when you do. The outcome depends on several factors, including your skin type, the depth of inflammation, and your genetic predisposition to scarring. You can protect yourself by keeping your hands away from active breakouts.

How Long Should I Wait After Active Acne Before Starting Scar Treatment?

You should wait until your active acne has completely healed before starting scar treatment, which typically takes 3-4 weeks. During this time, your skin needs to repair its barrier function and reduce inflammation. If you begin treatments too early, you risk irritating active breakouts and potentially worsening scarring. Once the acne lesions are flat, no longer red, and don't have any scabs, you can safely start your chosen scar treatment.

Can Stress or Hormonal Changes Make Existing Pitted Scars Appear Worse?

Your pitted acne scars can appear more noticeable during times of stress or hormonal fluctuations. When you're stressed, your body releases cortisol, which can affect your skin's collagen production and make scars look deeper. Similarly, hormonal changes can impact your skin's texture and hydration levels, creating temporary changes in how your scars appear. However, these effects are usually temporary and don't cause permanent worsening of scars.

Book Now to Experience
Acne Treatment

1 Minute Self-Registration

Date should not be before minimal date

I have read and agree to the Privacy Statement and Terms & Conditions

What Causes Pitted Acne Scars and 6 Ways to Treat Them Without Surgery

Understanding Pitted Acne Scars: Types and Formation

The Three Main Types of Atrophic Acne Scars

Chemical Peels: A Gradual Approach to Scar Reduction

How Chemical Peels Work

Types of Chemical Peels

Treatment Process and Timeline

At-Home vs. Professional Chemical Peels

Read More

Microneedling: Stimulating Natural Collagen Production

How Microneedling Works

Treatment Process and Expectations

Safety and Skin Types

Dermal Fillers: Temporary but Effective Relief

How Dermal Fillers Work

Best for Specific Acne Scar Types

Treatment Process and Results

Enhancing Results with Professional Acne Treatment

How New Beauty’s Acne Treatment Supports Scar Repair

The Treatment Process

Benefits of New Beauty’s Acne Treatment

A Smart Add-On for Long-Term Results

At-Home Skincare and Prevention Strategies

How to Support Healing at Home

Preventing Future Pitted Acne Scars

FAQ

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