women after performing acne pigmentation skin treatment before and after

Boxcar Acne Scars: Definitions, Causes, and Treatment Options

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    Boxcar acne scars cause your skin to appear dull and sunken. These scars commonly form in dense areas of the face, such as the lower cheeks and jaw — making it look unappealing. 

    Removing these Boxcar scars can be pretty challenging. If you find yourself fighting these stubborn scars, you’re in the right place!

    This article will talk about everything you need to know about these scars. Starting from what it is, how it forms, and several different ways to get rid of them.

    So, let’s find out the common characteristics and causes of your scars and determine which removal treatment is perfect for you!

    What are boxcar acne scars?

    Man Close Up Face With Boxcar Acne Scars

    Boxcar acne scars belong to the atrophic scar category, which is the most common type of scar for acne. According to Healthline, around 20 – 30% of atrophic scars are boxcar scars, while the rest consist of an ice pick and rolling scars.

    You can identify a boxcar scar by its oval or round indented shape that looks like a crater on the skin. Specifically, this kind of scar is named “box” due to the scar taking a squarish form on the skin surface.

    What causes boxcar acne scars?

    Inflammatory acne or chickenpox mainly causes boxcar scars. The inflammation that damages the skin surface may cause tissue loss on the epidermis. Unfortunately, the skin may not regenerate enough skin tissue during the healing process. 

    Subsequently, due to the slow skin regeneration, the skin repairs itself by pushing the skin under and leaving it looking indented on the skin. 

    How do boxcar scars form?

    As mentioned before, boxcar scars can form from an aggressive skin condition. Yet, the formation will depend on the skin’s healing process after the acne or chickenpox treatment.

    If you deal with boxcar scars, your skin cannot produce enough collagen to repair the damaged area. This issue primarily arises due to accidental peeling before the wounds completely heal.

    Peeled wounds can cause the skin to heal under the skin surface. Subsequently, the lesion will appear sunken and form a crater-like scar after healing.

    Can boxcar scars diminish on their own?

    Boxcar scars will not go away on their own. You will need to undergo some clinical acne scar treatment to repair these scars. There will be several treatment options that you can choose to diminish your indented scars. 

    In addition, you can use topical creams with brightening properties as an alternative to clinical treatments. The topical creams might help reduce the discolouration if you experience hyperpigmentation on boxcar scars. However, topical creams may not help in raising the depressed skin surface.

    How do I remove boxcar scars permanently?

    As mentioned before, boxcar scars are almost impossible to remove without the help of clinical treatments. As a result, you might need to undergo beauty procedures that help disguise or even permanently get rid of your boxcar acne scars.

    If you wonder why boxcar scars are challenging to eliminate, the answer is because these types of scars manifest as indented skin surfaces. Additionally, the dead tissue layers that form after the scars heal may cause the rejuvenation process to be more challenging. 

    Some acne scar treatment options are available if you wish to permanently remove your boxcar acne scars. As a result, you don’t need to worry about your sunken skin appearance as these choices can improve mild to severe forms of boxcar scars.

    Boxcar acne scars treatment

    Young Woman Wellness Center Having Boxcar Acne Scars Treatment

    Atrophic scars, such as boxcar wounds, can be challenging to treat and involve multiple treatments. In some cases, patients may require repeated treatments to minimise the appearance of these scars.

    Treatment options to remove boxcar scars

    Chemical peel

    A chemical peel treatment entails acid-like carbolic and glycolic applied to the marked skin. In the case of removing boxcar scars, our medical aesthetics doctor will apply chemical solution acids to exfoliate the top layer of the skin that can stimulate new skin cells growth. 

    You must keep in mind that a licensed and experienced medical aesthetics doctor must perform the Chemical peel procedure to avoid unnecessary circumstances. The treatment may have serious side effects such as flaking, redness, and painful sensations that last for a few days.

    After undergoing chemical peels, as specialists require, patients must follow a specialised skincare routine and use SPF to avoid sun damage. The procedures may cause your skin to be more sensitive to sun exposure. Neglecting the aftercare requirements may lead to more severe side effects and extended downtime.


    Dermabrasion is a cosmetics treatment that includes removing the skin’s epidermis. This procedure involves an abrasive method where your medical aesthetics doctor will scrape the skin’s top layer to stimulate new cell growth. 

    In the case of boxcar scars, this procedure aims to remove the skin surface to induce collagen and integrate the sunken scars into the surrounding skin. Your medical aesthetics doctor can conduct dermabrasion on the whole face or individual scars.


    Microdermabrasion is a mild form of dermabrasion. Instead of removing the entire top layer of skin, this treatment only removes the very top layer of your skin. As a result, this method may be suitable for shallow boxcar scars.

    Microdermabrasion, due to the gentle techniques and with fewer side effects than dermabrasion, can be a solution to treat your scarring. This way, you can improve the appearance of your boxcar scars without the need for an invasive method.


    Microneedling involves a medical aesthetics doctor pressing tiny needles on the skin surface to create minor injuries that trigger collagen production. When applied to the boxcar scars, the methods can help reduce the sunken appearance as there will be enough collagen production on the skin surface. 

    Intracel is one of the microneedling technology used. This treatment combines microneedling with radiofrequency technology. Through this procedure, patients may repair their acne scars more effectively.

    However, patients will not see immediate results after undergoing this treatment. You are required to repeat the treatment 3 – 6 times with a 1-month interval between each session to achieve the optimal results.

    Laser treatment

    Laser treatment helps with skin resurfacing and effectively reduces the appearance of mild to moderate boxcar acne scars. Patients can choose between the two types of laser treatments presented to them based on their skin’s condition.

    • Ablative laser treatment: This procedure involves removing a small skin area. It is adequate to give a smoother appearance on the boxcar scars. However, this method may cause hyperpigmentation when applied to patients with darker complexions.
    • Non-ablative laser treatment: This procedure stimulates collagen production without removing any skin area. It’s practical to reduce scar’s appearance with lower risk. Additionally, due to the minimally invasive technique, this method is often used for patients with darker skin.

    Both types of laser treatments require medical assistance. Inappropriate procedures can increase the chance of skin infection. Furthermore, patients will also experience sensitivity to sun exposure after undergoing laser treatments. 


    Subcision is a part of cosmetic surgery and involves an experienced medical aesthetics doctor who inserts needles under the skin’s surface. The needles will pass in multiple directions below the damaged skin areas during this procedure.

    The treatment aims for separating the boxcar scar tissues from the skin surface. As the scar tissues are released, your skin stimulates to produce new skin cells leading to the appearance of sunken skin surface will be minimised over time.

    Punch excision

    Punch excision is an invasive procedure that involves removing the boxcar scars by creating a new scar that is less obvious than the original one. After scar removal, the medical aesthetics doctor will sew back the cut. 

    This treatment is best for permanently removing deeper boxcar acne scars. However, choosing an experienced licensed doctor would be best before undergoing punch excision. Improper handling during this procedure may result in severe scarring formations.

    Dermal Fillers

    To reduce the appearance of boxcar scars, you may opt to consider dermal fillers. Dermal fillers can effectively raise sunken skin and appear smooth when injected into the skin.

    The volume loss restoration provided by dermal fillers typically lasts for 6 – 9 months, depending on the individual’s skin condition. Once the effect subsides, you may repeat the treatments to maintain the results.

    Collagen Stimulator

    A collagen stimulator made of Poly-L-Lactic acid can be another solution to minimise the appearance of your boxcar scars. This treatment involves injecting the substance into your skin, resulting in a gradual improvement of your sunken, atrophic scars.

    Unlike dermal fillers that restores your sunken scars, collagen stimulators promote natural collagen production from the body. Most patients notice the results from this treatment up-to two years post recommended number of sessions (2 – 3 sessions).

    Factors affecting treatments

    Before After Portrait Woman Boxcar Acne Scars Treatment

    Although clinical treatments may be beneficial in minimising the visibility of boxcar scars, the results will vary depending on the patients. Several other factors may also influence the effects on each patient. 

    So, what are the factors that affect the treatment results?

    The level of scars inflammation

    Inflammation is also a factor in the formation of boxcar acne scars. The deeper the inflammation from an acne lesion infiltrates the skin, the more likely it to scar when it heals. 

    As a result, it is essential to treat your acne as soon as possible to prevent deep inflammation. Healing the breakouts may become more difficult once the inflammation has reached the deep layers of your skin.

    Type of scars

    There are two types of scarring appearances – atrophic (indented) scars and hypertrophic (raised) scars. Boxcar scars, icepick, and rolling scars belong to the atrophic scars category. Therefore, minimising the appearance of atrophic scars requires a different approach than treating hypertrophic scars.

    Depth of the scarring

    Boxcar scars can appear in a variety of ways on different people. Some people have shallow boxcar scars, while others have deeper scars. As a result, combining treatments is the most effective way to reduce the appearance of boxcar scars.


    Scars on your face may heal more slowly because of constant exposure to your environment. Compared to the rest of your body, your face doesn’t have clothing covering to protect it. As a result, fully protecting facial wounds as they heal may be impossible. Furthermore, germs and dirt can negatively impact your boxcar scars, making the healing process more difficult.

    Location of scarring

    The scar’s location on your body and the amount of movement friction it receives can impact wound healing and scar development. 

    For example, if you wear glasses and get boxcar scars on your nose or around your temples, the constant friction from your glasses may slow down the healing process.

    Skin thickness

    Your skin thickness can determine the size of scarring after trauma. Often, inflammation within thick skin tends to cause more severe scarring than wounding around thin skin.

    Referring to the boxcar acne scars, some people may exhibit more profound or more extensive crater-like scarring depending on the location of their scar formation. Different parts of the facial skin will have different thicknesses. Thus the severity of the boxcar scars may vary.

    Your age, as well as the age of your scars

    Good blood supply is one of the factors that helps in healing scars. Commonly, younger people have an adequate blood supply. Thus they may benefit more after undergoing boxcar scars removal treatments.

    Furthermore, the age of your scars will also define the effectiveness of scars removal procedures. Scars that have been present for a long time may be more challenging to minimise than the newly formed scars. 

    Hence, you may benefit more if you treat your scars as soon as they form to increase the likelihood of being removed optimally through a procedure. 

    How to prevent boxcar scars from occurring?

    Preventing boxcar scars to form requires you to avoid touching or picking the inflammatory acne or chickenpox. You will need to wait until the wounds completely heal on their own to prevent further damage to your skin. If you feel any discomfort, it’s advisable to apply topical creams to reduce the itchy or painful sensations.

    Other types of acne scars

    As mentioned before, a boxcar scar is one of the three atrophic or indented scars. The other two indented scars are ice pick and rolling scars. These two types of scarrings appear differently than boxcar scars. 

    Let’s see the difference between ice pick and rolling scars!

    Ice pick scars

    Ice pick scars appear narrower and deeper than boxcar scars. The small and dark pits can distinguish ice pick scars within the skin surface.

    Acne inflammation is a common cause of this type of scarring. Besides, ice pick scars are the deepest type of acne scar. Thus removing them may also be problematic.

    Rolling scars

    Rolling scars give the skin a wavy or uneven appearance. Acne inflammation causes rolling scars like boxcar and ice pick scars, leading to tissue loss.

    Rolling scars appear shallower than other types of atrophic scars. However, this type of scarring may manifest as a more prominent sunken appearance on the skin surface. Due to the large size, reducing the appearance of this scarring may also be challenging.


    Boxcar acne scars that belong to the atrophic scar category are relatively challenging to treat. With the advancement of clinical treatment, it’s now possible to reduce or even remove the appearance entirely.

    Consult with our medical aesthetics doctor to get the most suitable treatment plan for your boxcar acne scars.

    About Celevenus Wellness & Aesthetic Clinic

    Celevenus is an aesthetic clinic in Singapore that offers a variety of signature treatments to rejuvenate the body and skin. Our series of treatments use non-surgical methods, so they are suitable for anyone unsure about going under the knife.

    Led by Dr Dylan Chau, who is an expert in blending science and artistry, we are here to provide several face enhancement methods, such as Sculptra, dermal fillers, HIKO nose threadlift, and acne scar treatments, that are safe and provide optimal results for our patients.

    What’s more, we also perform non-surgical body contouring using the Venus Legacy method. This treatment makes an ideal choice for anyone who dreams of having a slimmer body silhouette but fear undergoing an invasive procedure that takes longer to heal.

    Overall, we strive to be a trustworthy aesthetic clinic that prioritises the right solutions for our patients through the variety of face and body enhancements we offer.

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