Raised and Indented Acne Scars: Why Scar Type Changes the Plan

Why do two people with “acne scars” end up with such different treatment plans? Because the phrase covers several quite different things. One person has shallow, wavy dips across their cheeks, another has a handful of narrow, deep pits, and someone else has firm, raised scars along the jawline. The shape, depth, and behaviour of a scar change which treatments are worth considering, and which aren’t.

You don’t need to label your own scars before a consultation. Knowing the main types simply makes it easier to describe what bothers you, and to understand why a practitioner might suggest one approach, a combination, or a referral elsewhere.

Texture, not colour

A scar is a change in the structure of the skin, so it sits below or above the surrounding surface. That’s different from the flat brown, grey, or pink marks that spots can leave behind, which are colour changes and often fade with time. Many people have both, but the plan for texture is not the same as the plan for colour.

Lighting makes a big difference to how scars look. Overhead or side lighting casts shadows into dips and exaggerates them, while soft, even light can make the same skin look smoother. Try looking at your skin by a window, then under a ceiling light, and notice which areas change. That shadowing is a clue you’re looking at texture.

It’s also worth deciding which feature bothers you most day to day. A plan built around what you actually notice is more useful than one built around the most dramatic close-up photograph.

Three kinds of indented scar

Most acne scars are indented, sometimes called atrophic scars. They form when inflammation damages the deeper layers of skin and the tissue doesn’t fully rebuild. The NHS acne complications page describes three common types: ice-pick, rolling, and boxcar scars.

Ice-pick scars are narrow and deep, like a small puncture in the skin. The opening at the surface is small, but the scar runs down further than it looks, which is why treatments that work mainly across the wider surface can struggle to reach them.

Boxcar scars are broader depressions with sharper, more defined edges. Shallow boxcar scars often respond differently to deep ones, so depth and edge shape both matter when a practitioner looks at them.

Rolling scars give the skin a wavy, uneven look. They’re caused by bands of tissue beneath the surface pulling the skin down, so a practitioner will look at how the skin moves when it’s gently stretched, not just at how it looks when still.

In practice, many people have a mix of all three across one cheek. A good assessment explains that mixture, and makes clear which parts a proposed treatment is aimed at and which parts it’s unlikely to change.

Raised scars need a different conversation

Raised acne scars are less common, and more often seen on the chest, back, shoulders, and jawline. They form when the skin produces too much scar tissue during healing. The NHS page on scars explains that hypertrophic scars stay within the boundary of the original wound, while keloid scars extend beyond it and can keep growing.

That difference matters because many skin treatments work by creating a controlled injury to prompt repair. If your skin tends to over-repair, that same process could make things worse. Tell your practitioner if you’ve ever had raised scars after acne, piercings, surgery, or minor injuries anywhere on your body, even if you don’t have them on your face.

Raised scars that are itchy, painful, growing, or spreading should be looked at by your GP, who can refer you to a dermatologist if needed. This isn’t a sign that anything is seriously wrong, but it does mean a medical scar assessment is the right starting point rather than an aesthetic appointment.

Settle active acne first

New inflamed spots can leave new marks and scars while older ones are being treated, so bringing breakouts under control is the first step. For mild acne, a pharmacist can suggest over-the-counter options. If your acne is moderate or severe, includes painful deep lumps, or hasn’t improved with pharmacy treatments, see your GP, as these types carry a higher risk of scarring and may need prescription treatment or a referral to a dermatologist.

Tell us about any acne medicines you use or have taken recently, including tablets. Some prescription treatments affect how the skin heals, which can change when a skin procedure is appropriate. Please don’t stop a prescribed medicine to fit around an aesthetic appointment without talking to the person who prescribed it.

Where microneedling fits

For suitable indented scars, particularly rolling and shallower boxcar scars, microneedling may help to soften their appearance over a course of treatments. It works by creating tiny, controlled channels that prompt the skin’s own repair response, and that response builds gradually over weeks and months.

Our microneedling treatment begins with an assessment of your scars and skin, so we can talk honestly about what might improve. Deep ice-pick scars tend to respond less predictably, and raised or keloid-prone scars may not be suitable for needling at all. Results vary, and the aim is improvement rather than perfectly smooth skin.

Where scars sit alongside other concerns, such as dull or uneven skin, a combination of treatments may be recommended to address different concerns for a more optimal result. Our PRP and PRF page explains how platelet-rich plasma (PRP) is prepared from a small sample of your own blood, and PRP is sometimes discussed alongside microneedling. Any combination should come with a clear reason for each part.

Some scars are better suited to other procedures, including ones offered in dermatology or surgical settings rather than aesthetic clinics. If that’s the case for you, a good assessment should say so plainly, and your GP can talk you through referral options. The British Association of Dermatologists’ guide to cosmetic dermatology gives a clear overview of skin procedures and their possible side effects.

Measuring progress fairly

Agree what improvement would look like before you start. Softer edges, less shadowing, and a more even overall surface are realistic goals for many indented scars. Making every scar disappear usually isn’t, and it helps to know that from the outset.

Take photographs before treatment and at review points in the same place, with the same lighting and angle. Skin can look swollen and plumper for a few days after needling, so early pictures aren’t a fair guide. Follow the aftercare advice you’re given between sessions, and avoid adding harsh scrubs or strong acids at home in the hope of speeding things up.

If progress stalls, go back to the original assessment rather than simply booking more of the same. Was the main concern colour, shallow texture, or a deeper scar? Rethinking the fit between the scar and the treatment is more useful than repeating something that isn’t helping.

When to see a GP or dermatologist

See your GP if your acne is moderate or severe, is leaving new scars, or is affecting your mood or confidence. They can discuss treatment and refer you to a dermatologist where appropriate. A raised scar that’s growing, itchy, or painful also deserves a medical opinion.

Any mole, patch, or lump that’s new, changing in size, shape, or colour, or bleeding without a clear reason should be checked by your GP and not treated as a scar. If a treated area becomes hot, increasingly painful, swollen, or starts to ooze pus, contact the clinic that treated you, your GP, or NHS 111.

Questions about acne scar types