First, is it actually a scar?
Many of the marks people call scars are not scars at all. Flat brown or red marks left after a pimple are post-inflammatory pigmentation or erythema — colour changes in otherwise normal skin, which fade over months with sun protection and topical treatment.
A true scar involves a change in skin texture: a depression, a raised area, or a tethered dimple that becomes obvious in side lighting. That distinction changes the entire plan, and it is often the most reassuring thing a patient hears at a first consultation.
The four patterns worth knowing
Ice-pick scars are narrow and deep, like a puncture. Boxcar scars are wider with sharply defined edges. Rolling scars are shallow, broad depressions tethered to tissue underneath, which is why they look like gentle waves across the cheek. Hypertrophic and keloid scars, less common after facial acne, are raised rather than depressed.
Most faces have a mixture. That is why a plan built on a single procedure — a course of one thing, repeated — often produces partial results and lasting disappointment.
- Ice-pick: narrow, deep — often treated with CROSS
- Boxcar: sharp-edged depressions — fractional resurfacing, MNRF
- Rolling: tethered, wavy — subcision first, then resurfacing
- Flat marks: pigment, not scar — topicals, peels, sun protection
Why subcision changes the conversation
A rolling scar is being pulled down from underneath by fibrous bands. No amount of surface resurfacing lifts a scar that is anchored, which is the mechanical reason microneedling alone often underdelivers on cheeks with rolling scars.
Subcision releases those bands through a tiny entry point under local anaesthesia. Bruising for about a week is normal. Once released, resurfacing procedures have something to work with.
Sequence and patience
Active acne is controlled first — resurfacing inflamed skin risks new marks and poorer results. Scar work then runs over several sessions spaced four to six weeks apart, and collagen remodelling continues for months after the final session.
Anyone promising complete removal of acne scars is overstating what is possible. The honest goal is a marked reduction in depth and a visible improvement in texture, judged in consistent lighting and photographs rather than day to day.
In short
Get your scar type identified before committing to a course of anything. Rolling scars need release, ice-pick scars need CROSS, texture needs resurfacing — and most faces need a planned combination.