Why identifying your scar type matters
The most common reason acne scar treatments fail — or produce only partial results — is misidentification. A patient with rolling scars gets laser resurfacing. A patient with ice pick scars gets RF microneedling. Neither treatment is wrong exactly, but neither addresses the actual cause of that specific scar type. The result is improvement that plateaus far short of what's possible.
At Plump Medical Spa in Newport Beach, every acne scar consultation begins with a thorough assessment of scar type before any treatment is recommended. The type of scar you have — and in many cases, the combination of types — determines everything about the approach.
This guide gives you the tools to identify your scar type before your consultation so you arrive with a clearer picture of what you're working with.
The stretch test — do this right now
Place your index fingers on either side of the scarred area and gently pull the skin taut in opposite directions. Watch what happens to the scar:
If the scar softens, flattens, or disappears when stretched — you almost certainly have rolling scars. The improvement under tension is caused by temporarily releasing the fibrous bands that normally pull the skin downward. This is the classic diagnostic sign of rolling scars.
If the scar stays exactly the same — sharp edges unchanged, depth unchanged — you have boxcar or ice pick scars. These are structural defects in the skin itself, not tethered tissue.
If some scars improve and some don't — you have a combination, which is the most common presentation.
The four main scar types
Rolling scars create a wavy, undulating surface without clearly defined edges. The skin looks uneven or depressed in broad areas rather than in distinct pits. They are the most common type and the most consistently treatable when the correct approach is used.
Stretch test result: Soften or disappear when skin is pulled taut — the defining diagnostic sign. If your scars improve dramatically under tension, you have rolling scars.
Boxcar scars have sharply defined vertical walls and a flat depressed base — like a stamp impression in the skin. They have clear, angular edges that remain visible at all lighting angles. Shallow boxcar scars respond well to laser alone; deeper ones with any tethering component benefit from the combination protocol.
Stretch test result: Remain unchanged. The sharp edges and flat base are a structural defect in the dermis — not caused by tethering.
Ice pick scars are narrow, deep pinholes that extend from the skin surface deep into the dermis — sometimes into the subcutaneous tissue. They are tiny in diameter but dramatic in depth. Under magnification they appear as small punctures. Very difficult to treat because their depth exceeds what surface treatments can reach.
Stretch test result: Unchanged. The depth of these scars means no surface tension changes them.
The majority of patients presenting for acne scar treatment have more than one type across different areas of the face. Cheeks often show rolling and boxcar; temples may show rolling; chin and nose bridge may have ice pick. A proper clinical assessment maps each area individually.
Stretch test result: Variable — some scars improve, others don't. Pay attention to which specific scars change.
Treatment matched to scar type
| Scar type | Root cause | Primary treatment | At Plump |
|---|---|---|---|
| Rolling | Fibrous bands tethering skin | Subcision | Standard or full combination protocol |
| Boxcar | Dermal structural loss | CO2 laser | CO2 or full combination |
| Ice pick | Deep epithelial tracts | TCA CROSS | TCA CROSS + surface laser |
| Mixed | Multiple mechanisms | Combination | Full combination protocol |
Why RF microneedling alone rarely resolves rolling scars: RF microneedling stimulates collagen in the dermis — which is valuable — but it cannot release fibrous tethers beneath the skin. If you have had multiple RF microneedling sessions and feel you've plateaued, you almost certainly have untreated rolling scars with active tethering. Subcision is the missing step. This is the most common pattern in acne scar consultations at Plump Medical Spa.
What to do next
Now that you have a clearer picture of what type of scar you're dealing with, the next step is a consultation with Dr. Mortazavi at Plump Medical Spa in Newport Beach. He will assess each scar area individually under proper lighting, confirm the types present, and design a protocol specific to your skin.
If the stretch test showed that your scars soften under tension — even partially — read the complete subcision guide before your consultation. It will give you a thorough understanding of what the procedure involves, what the protocol looks like at Plump, and what results to expect.