Why scar type matters before choosing a treatment
One of the most common mistakes in acne scar treatment is applying the same protocol to every patient. Subcision, laser resurfacing, RF microneedling, TCA CROSS — each of these targets a fundamentally different mechanism. Using the wrong treatment for your scar type does not just fail to help — it can sometimes make scars more visible by altering the surrounding skin without addressing the actual problem.
The starting point for any acne scar consultation at Plump is identifying exactly what type of scars you have, in what proportion, and at what depth. That assessment determines the entire treatment plan.
The three main types of depressed acne scars
How to identify your scar type at home
A physician examination with proper lighting remains the gold standard — but this simple stretch test gives you a strong signal about which type of scars you're dealing with.
How to identify rolling scars at home
Most patients have a mix. The cheeks tend to accumulate rolling and boxcar scars, while the nose and around the mouth more often show ice pick and boxcar. A full assessment at consultation maps the exact distribution before any treatment is planned.
Which treatments work for which scar types
Rolling scars — the subcision case
Rolling scars are caused by fibrous bands that form between the dermis and the subcutaneous tissue during the healing process of inflammatory acne. These bands physically pull the skin surface downward, creating the wave-like depression. The skin itself may be perfectly healthy — the problem is structural, not surface-level.
This is why surface treatments alone fail for rolling scars. Laser resurfacing improves skin quality but cannot release a structural tether. Subcision addresses the cause directly by severing those bands from below with a cannula. Once released, the skin lifts. Sculptra is then injected into the space to prevent re-adhesion and stimulate long-term collagen production.
At Plump Medical Spa, the combination of cannula subcision with Sculptra and CO2 laser represents the most comprehensive single-session approach to rolling scar treatment available in Newport Beach. The protocol is $1,350. The subcision-only version with Sculptra is $1,100.
Boxcar scars — the laser case
Boxcar scars have sharp, clearly defined edges and a flat depressed base. They are caused by localized collagen destruction from the inflammatory process — not fibrous tethering. Because the problem is collagen loss and surface architecture rather than structural tethering, subcision has little to offer.
Ablative laser resurfacing — CO2 or erbium — works by removing the sharp scar edges and the surface surrounding them, allowing the skin to remodel to a smoother surface. The heat from the laser also stimulates new collagen formation in the dermis below, filling some of the volume deficit. For very deep boxcar scars, TCA CROSS applied to the base before laser resurfacing improves outcomes by filling from the bottom up before the surface is addressed.
PiXel8 RF microneedling offers a meaningful alternative for patients who cannot accommodate laser downtime — it produces skin tightening and collagen remodeling with 2–3 days of redness versus the 7–10 days of CO2 laser. Results are more gradual.
Ice pick scars — the most challenging
Ice pick scars are the most difficult acne scar type to treat. They extend deep into the dermis — sometimes reaching the subcutaneous fat — creating a narrow tract that laser energy and microneedling cannot reliably reach.
TCA CROSS (trichloroacetic acid chemical reconstruction of skin scars) involves the precise application of high-concentration TCA into the narrow scar tract using a fine applicator. The chemical causes controlled destruction within the tract, followed by collagen remodeling that fills and narrows the scar over weeks. Multiple sessions are typically required. For very deep or wide ice pick scars, punch excision — surgically removing the scar and closing the wound — may be the most effective option before any resurfacing is performed.
Most patients have all three types in different proportions. The treatment plan at Plump addresses each type in the appropriate sequence — subcision first to release tethering, TCA CROSS for ice pick areas if present, then laser resurfacing after healing to address surface texture and boxcar architecture. The sequencing matters as much as the treatments themselves.