Boxcar Scars: Causes, Treatment, and Best Results

Boxcar Scars are a common type of acne scar that can leave the skin with round or oval depressions. They often appear on the cheeks, temples, and forehead, and can be frustrating because they are usually more noticeable than shallow discoloration. The good news is that boxcar scars can often be improved significantly with the right treatment plan.

This article explains what boxcar scars are, what causes them, which treatments work best, and how to choose the right approach for the most visible results.

What Are Boxcar Scars?

Boxcar Scars are depressed acne scars with defined edges. They look like small craters or pits in the skin and are usually wider than ice pick scars, but less narrow and deep. Their edges are often sharp and vertical, which makes them stand out under light.

They form when inflammation from acne damages collagen and the deeper layers of skin. As the skin heals, it does not fully replace the lost tissue, leaving a sunken area behind. Because of that structural change, boxcar acne scars can be especially noticeable on areas with more facial light reflection, such as the cheeks and temples.

These scars may vary in depth. Some are shallow and blend into the surrounding skin more easily, while others are deeper and more difficult to improve. Their shape and depth are why treatment has to be tailored carefully instead of using a single approach for everyone.

What Causes Boxcar Scars?

Boxcar Scars most often develop after moderate to severe inflammatory acne, especially when:

• Pimples are large, deep, or cystic
• Acne lasts for a long time
• Breakouts are picked or squeezed
• Healing is delayed by repeated inflammation
• There is a strong family tendency to scar

The more damage acne causes to the skin’s support structure, the more likely a permanent scar will form. In short, boxcar scars happen when the skin loses collagen and cannot rebuild the area smoothly.

Inflammation is the key reason these scars form. When acne lesions become deep enough to damage the dermis, the body may repair the area unevenly. Instead of restoring a smooth surface, the healing process can leave a visible indentation. This is one reason early acne treatment matters so much: controlling acne sooner can reduce the chance of future scarring.

Picking, squeezing, and trying to drain pimples at home can make the damage worse. Even if the spot seems ready to heal, extra trauma can prolong inflammation and increase the odds of a scar forming. If you are dealing with ongoing breakouts, focusing on acne control is an important first step before scar revision.

For readers looking to better understand acne-related skin changes, this overview of another condition affecting body structure and appearance shows how different structural problems can influence treatment choices in dermatology and beyond.

Are Boxcar Scars Permanent?

Boxcar Scars are usually considered permanent without treatment, but that does not mean they cannot improve. Many people see meaningful improvement with professional procedures, sometimes combined with at-home skincare.

The goal of treatment is not always to erase scars completely. Instead, it is to reduce their depth, soften their edges, and make them less visible. In practical terms, this means improving texture and reducing shadowing so the skin looks smoother under normal lighting.

Older scars may be more established, but they can still respond to treatment. Newer scars sometimes improve more easily because the collagen remodeling process is still more active. Even so, older scars often benefit from combination therapy when the right procedures are used in sequence.

Best Treatments for Boxcar Scars

The best treatment depends on the size, depth, and number of scars, as well as skin type and the presence of active acne. In many cases, the best results come from combining treatments rather than relying on just one.

A dermatologist may recommend a single procedure for a small number of scars, but combination therapy is often more effective for widespread scarring. That is because different procedures address different parts of the problem: one may release tethering, another may build collagen, and another may resurface the outer layer of skin.

1. Subcision

Subcision is a procedure that releases scar tissue beneath the skin. It is especially helpful when scars are tethered down by fibrous bands.

Best for: deeper boxcar scars that are anchored in place
How it helps: lifts the depressed area by breaking the scar tissue holding it down

Subcision is often combined with fillers, microneedling, or laser treatment for better results.

This technique can be particularly useful when a scar has a fixed, sunken appearance rather than just a soft indentation. By releasing the bands below the surface, the area can rise more naturally and respond better to additional resurfacing treatments later.

2. Microneedling

Microneedling uses tiny needles to create controlled micro-injuries in the skin, which stimulates collagen production over time.

Best for: mild to moderate boxcar scars
How it helps: improves skin texture and gradually raises shallow depressions

Microneedling is often preferred for people with darker skin tones because it generally has a lower risk of post-inflammatory hyperpigmentation than some laser treatments.

Results are gradual, which is why it may take several sessions before the skin starts to look noticeably smoother. Many people appreciate that downtime is usually shorter than with more aggressive resurfacing procedures.

3. Fractional Laser Resurfacing

Fractional lasers, such as fractional CO2 or erbium lasers, treat scar tissue by removing or heating small columns of skin to encourage new collagen growth.

Best for: moderate boxcar scars and textural irregularities
How it helps: smooths skin and improves scar depth and edges

Fractional laser treatment can be very effective, but it requires careful selection based on skin type and downtime tolerance. It may not be the first choice for everyone, especially if there is a higher risk of pigmentation issues.

Because lasers create a stronger resurfacing effect, they may be ideal for people who want a more noticeable change and can tolerate a longer recovery period. That said, the best laser settings depend on the scar pattern and how your skin tends to heal.

4. TCA CROSS

TCA CROSS uses a high concentration of trichloroacetic acid applied directly into individual scars to trigger collagen remodeling.

Best for: narrower, deeper boxcar scars and certain atrophic scars
How it helps: encourages the skin inside the scar to rebuild

Although it is often used more commonly for ice pick scars, it can help specific boxcar scars when performed by an experienced professional.

This method is more targeted than full-face resurfacing. For people with a few especially stubborn scars, that precision can be useful because it focuses treatment exactly where needed.

5. Dermal Fillers

Fillers can temporarily raise depressed scars by adding volume beneath them.

Best for: selected boxcar scars, especially when immediate improvement is desired
How it helps: lifts the scar from below and improves surface smoothness

Fillers do not permanently remove scars, but they can be useful as part of a combination approach. Some providers use fillers after subcision to maintain the lifted result.

For patients who want a quicker visual change, fillers may provide an early improvement while longer-term collagen-building treatments continue to work. They can also help show what the final result might look like after structural support is restored.

6. Punch Excision or Punch Elevation

For very deep, well-defined individual boxcar scars, a minor surgical technique may be the most effective option.

Best for: isolated deep boxcar scars with sharp borders
How it helps: removes the scar or lifts it into a better position for healing

This is usually reserved for scars that are too deep or sharply edged to respond well to resurfacing alone.

Punch techniques are often considered when a single scar or a small cluster of scars remains highly visible after other treatments. Because the method is selective, it can produce strong improvement in the right cases.

What Treatment Works Best for Boxcar Scars?

There is no single best treatment for every boxcar scar. The most effective approach depends on the scar’s characteristics:

• Shallow scars: microneedling, fractional laser, or fillers
• Tethered scars: subcision
• Deep, isolated scars: punch excision or punch elevation
• Mixed scars: combination therapy

For many people, the best results come from a combination of subcision, resurfacing, and sometimes fillers. This approach addresses both the depth of the scar and the texture of the surrounding skin.

In real-world practice, dermatologists often combine treatments in stages. For example, they may release tethered scars first, then use microneedling or laser sessions later to improve surface texture. That layered approach often produces more balanced results than trying to correct everything in one step.

If you want to read more about related treatment options for facial skin concerns, you may also find this guide to Botox for Hair: Smooth, Shine, Repair in One Treatment useful for understanding how different cosmetic procedures are chosen based on the treatment goal.

How Many Treatments Are Needed?

Most boxcar scar treatments require more than one session.

• Microneedling: usually 3 to 6 sessions
• Fractional laser: often 1 to 4 sessions depending on severity
• Subcision: sometimes 1 to 3 sessions
• Fillers: repeated as needed since results are temporary
• TCA CROSS or punch techniques: may require fewer sessions, but depend on the number of scars

Results usually improve gradually over several months because collagen remodeling takes time.

It is also common for treatment plans to be adjusted after the first session or two. A provider may notice that certain scars respond well, while others need a different technique. That flexibility is often what leads to the most natural-looking outcome.

What Results Can You Expect?

The best realistic outcome is usually visible softening and blending of scars, not complete removal. Many people notice:

• Smoother skin texture
• Shallower scar depth
• Less shadowing under light
• More even skin appearance
• Improved confidence

The extent of improvement depends on how old the scars are, how deep they are, and how well the treatment matches the scar type. Earlier treatment often produces better results because newer scars may respond more readily than older ones.

Results can also be influenced by aftercare. Sun protection, avoiding picking, and following post-procedure instructions all matter. Healing skin is more vulnerable to irritation, so protecting it can help the visible improvements last longer and appear more even.

In many cases, progress is measured in percentages rather than complete removal. A meaningful improvement may still leave some visible texture, but the overall change can be enough to make the scars much less obvious in daily life.

At-Home Treatments for Boxcar Scars

Over-the-counter skincare cannot remove boxcar scars, but it can support skin healing and prevent acne from causing more scars.

Helpful at-home steps include:

• Using sunscreen daily to reduce contrast and pigmentation
• Treating active acne early
• Using gentle cleansers and non-irritating moisturizers
• Considering retinoids if recommended by a dermatologist
• Avoiding picking or squeezing pimples

At-home products may improve skin tone and texture slightly, but they will not replace professional scar treatment.

A retinoid can sometimes support overall skin turnover and help acne stay controlled, but it should be introduced gradually and only when appropriate for your skin. Harsh scrubs, strong acids used too often, and over-exfoliation can make irritated skin worse instead of better.

Sunscreen is especially important because post-inflammatory hyperpigmentation can make scars appear darker and more noticeable. Even if the scar depth does not change, reducing surrounding discoloration can improve how the skin looks overall.

Who Is a Good Candidate for Boxcar Scar Treatment?

You may be a good candidate if:

• Your acne is under control or improving
• You want to reduce the appearance of depressed scars
• You have realistic expectations
• You are willing to do multiple sessions if needed

If you still have active acne, it is usually best to control it first or at the same time. Treating scars without addressing ongoing breakouts can lead to new scars forming.

People with different skin tones can still benefit from treatment, but the safest procedure may vary. A careful evaluation is important because the risk of pigmentation changes is not the same for every skin type. A dermatologist can help balance effectiveness, recovery time, and safety.

Possible Side Effects and Risks

Most boxcar scar treatments are safe when performed correctly, but side effects can happen. These may include:

• Redness
• Swelling
• Temporary darkening or lightening of the skin
• Crusting or peeling
• Infection, rarely
• Uneven results

People with darker skin tones may have a higher risk of post-inflammatory hyperpigmentation after certain procedures, especially aggressive resurfacing. This is why treatment should be chosen carefully.

Downtime also varies. Some procedures leave only short-lived redness, while others can require a longer recovery with peeling or crusting. Understanding that recovery phase ahead of time can make the process less stressful and help you plan appropriately.

In general, following aftercare instructions closely lowers the risk of complications. That may include avoiding sun exposure, using gentle skincare, skipping makeup for a short period, or pausing certain active ingredients until the skin has healed.

How to Get the Best Results

To improve the chances of successful boxcar scar treatment:

1. See a qualified dermatologist or skin specialist
2. Treat active acne first
3. Match the procedure to the scar type
4. Consider combination therapy
5. Follow aftercare instructions carefully
6. Use sunscreen consistently
7. Be patient with collagen-building treatments

The best results usually come from a personalized plan rather than a one-size-fits-all procedure.

If your scars are a mix of boxcar, rolling, and ice pick types, the plan may need to be adjusted to address each one differently. That is normal and often necessary. Acne scarring is rarely uniform, so treatment is most effective when it reflects the actual pattern on the skin.

It is also helpful to set expectations around timing. Some procedures create immediate improvement, while others work more slowly as collagen rebuilds. Knowing which phase you are in can help you stay realistic and motivated during the process.

Boxcar Scars vs. Other Acne Scars

Boxcar Scars are often confused with other scar types, but treatment choices differ.

• Ice pick scars are narrow and deep, often needing TCA CROSS or punch techniques
• Rolling scars are wider and wavy, often responding well to subcision
• Boxcar Scars have sharper edges and a crater-like shape

Identifying the scar type correctly is important because the wrong treatment may produce limited improvement.

Sometimes the distinction is subtle, especially when acne scarring includes more than one pattern. A trained clinician can examine how the scar behaves under different lighting and how it moves with the skin to determine the best approach.

Understanding the difference also helps explain why a treatment that works well for one person may not work as well for another. Scars that look similar at first glance can have very different underlying structures.

When to See a Dermatologist

You should see a dermatologist if:

• Your scars are deep or widespread
• You want the most effective treatment plan
• You have dark skin and are concerned about pigmentation
• You still have active acne
• Over-the-counter products have not helped

A professional evaluation can help determine whether your scars are best treated with laser, subcision, microneedling, fillers, or a combination.

If you are unsure where to start, a consultation can be useful even if you are not ready for treatment right away. A dermatologist can map out options, explain recovery time, and help you understand which results are realistic for your skin.

For a reliable external overview of acne and scarring, the American Academy of Dermatology’s acne scar guidance explains common treatment approaches and what to expect from professional care.

Conclusion

Boxcar Scars are depressed acne scars with defined edges that can be difficult to treat with skincare alone. They are caused by inflammation that damages collagen, leaving permanent indentations in the skin. While they may not disappear completely, boxcar scars can often be greatly improved with procedures such as subcision, microneedling, fractional laser resurfacing, fillers, TCA CROSS, or punch techniques.

The best results usually come from a treatment plan tailored to the scar’s depth, shape, and severity. If you want the most effective improvement, a dermatologist can help choose the right combination of treatments and create a plan that fits your skin type and goals.

With the right approach, the skin can look smoother, the scars can become less noticeable, and confidence can improve along with texture.