Types of Acne Scars: A Complete Guide for Pakistani Skin

Written by: BioFlex Aesthetics Editorial Team
Reviewed by: Dr. Maria Ahmed
Credentials: MBBS, Dermatologist/Aesthetic Physician
PMDC Registration: 625405
Last Medically Reviewed: August 2026
Last Updated: August 2026

Most people who have dealt with acne end up dealing with something else afterward: what it left behind. Not every mark on the skin after a breakout is the same thing, though, and that distinction matters more than it sounds. A dark spot that will fade in a few months and a pitted scar that has been sitting there for five years need completely different treatments, and mixing the two up is an easy way to waste money on a product that was never going to work.

This guide walks through the actual types of acne scars, how a dermatologist tells them apart, and what tends to work for each one. If you’re looking for a full breakdown of treatment costs and procedures available in Pakistan, our Acne Scar Treatment in Pakistan guide covers that in depth. This article focuses on identification.

Why Acne Leaves Scars in the First Place

Scarring happens when a breakout damages the deeper layers of skin badly enough that the body’s repair process doesn’t fully restore the original tissue. During healing, the skin either produces too little collagen, leaving a dent, or too much, leaving a raised lump. There are two basic types of scar depending on whether there is a net loss or gain of collagen, known as atrophic and hypertrophic scars.

Not every mark is a true scar, though. Skin that looks red, brown, or purple after a pimple but is otherwise smooth to the touch is usually post-inflammatory hyperpigmentation rather than scarring, and it tends to fade on its own with time and sun protection. A true scar changes the texture of the skin, not just its colour, and it generally needs a professional treatment to improve.

Two Broad Categories, Five Common Types

Dermatologists group acne scars into two families based on how the skin healed:

• Atrophic scars: depressed, pitted scars caused by collagen loss. These make up the large majority of acne scarring.
• Hypertrophic and keloid scars: raised scars caused by excess collagen production.

Atrophic scars occur far more often than hypertrophic scars and keloids, affecting roughly 80 to 90 percent of people with acne scars. Within that group, there are three recognised subtypes.

The Three Types of Atrophic Scars

Ice Pick Scars

Ice pick scars are small and narrow, usually under 2mm across, with a cylindrical shape that pits down into the skin like it was punctured with a small tool. Because they form after severe, deeply inflamed breakouts and go straight down into the dermis rather than spreading sideways, they’re often the hardest of the three to treat. This is also the most common type of atrophic acne scar, accounting for roughly 60 to 70 percent of cases.

Boxcar Scars

Boxcar scars are the next most common atrophic type: wider than ice pick scars, with a round or oval shape and distinct, defined edges. Picture a chickenpox scar and you’re close. Since they sit at a consistent depth and don’t taper to a point the way ice pick scars do, they generally respond better to resurfacing treatments.

Rolling Scars

Rolling scars are wide and shallow, with sloped edges instead of sharp ones, which gives the skin a wavy, uneven look rather than a punched-out one. Fibrous bands forming under the skin pull the surface down at irregular points, and because that damage sits below the surface, rolling scars often respond well to treatments that work at depth, such as subcision combined with resurfacing.

Raised Scars: Hypertrophic and Keloid

Hypertrophic Scars

Hypertrophic scars are raised, firm scars caused by excess collagen production during healing, and unlike keloids they stay within the boundary of the original acne lesion. The texture is often rubbery, and colour can range from pink and red to a shade close to the surrounding skin. Many hypertrophic scars soften and flatten somewhat on their own over time, though they usually need treatment to fully settle.

Keloid Scars

A keloid forms when a hypertrophic scar keeps growing beyond the original wound and spreads into surrounding skin. These can range from small bumps to larger raised areas, tend to look shiny and rounded, and are often purple, pink, or brown depending on skin tone. Itching or tenderness is common too.

This is worth flagging specifically for patients in Pakistan: people with Asian and African skin types are more prone to developing keloids than others. If you’ve noticed a scar that keeps growing rather than fading, it’s worth having it looked at rather than waiting it out.

Quick Self-Check: What Am I Looking At?

What you see	Likely type
Small, deep, narrow pits	Ice pick scar
Round or oval pits with sharp edges	Boxcar scar
Wide, shallow, wavy depressions	Rolling scar
Raised, firm, stays within the original spot	Hypertrophic scar
Raised, spreading beyond the original spot	Keloid scar
Flat discoloration, smooth to the touch	Post-inflammatory hyperpigmentation, not a scar

This table is a starting point, not a diagnosis. Many people have a mix of two or three scar types at once, and an in-person consultation is the only reliable way to build a treatment plan around your specific skin.

How These Scars Are Typically Treated

There’s no single fix that works for every scar. What tends to help depends heavily on which type you’re dealing with:

• RF Microneedling works well for boxcar and rolling scars by triggering new collagen at a controlled depth. Read more on our RF Microneedling page.
• Chemical peels help resurface shallow boxcar scars and improve overall skin texture and tone. See our Chemical Peel service for details.
• PRP therapy, often paired with microneedling, supports the skin’s own healing response and is commonly used alongside other resurfacing treatments. Learn more about PRP Therapy.
• Deeper ice pick and rolling scars sometimes need subcision or targeted procedures in addition to resurfacing.
• Hypertrophic and keloid scars are usually managed differently from pitted scars, often with steroid injections or other scar-specific treatments rather than resurfacing alone.

The right combination depends on scar type, skin tone, and how long the scarring has been present, which is why an in-person assessment matters more than any single product or procedure.

Getting Acne Scars Assessed in Islamabad, Rawalpindi, Karachi and Peshawar

Acne scarring is common across Pakistan, and the humid summers in Karachi or the sun exposure across Islamabad and Rawalpindi can make post-acne marks linger longer if they’re not managed early. BioFlex Aesthetics offers in-person consultations at our clinics in Islamabad, Rawalpindi, Karachi and Peshawar, where a practitioner can examine your scarring in person and tell you which type or types you’re dealing with before recommending a treatment plan. You can book a consultation at your nearest location to get a proper assessment rather than guessing from a mirror.

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