Acne scars come in all shapes and sizes. Some are small and barely noticeable, while others – like boxcar acne scars – can be quite prominent.
These scars can take longer to treat and require patience and proper care before everything else.
However, even though challenging, there are plenty of methods that can help improve their appearance.
Therefore, in this article, we will discuss what boxcar acne scars are and how to treat them effectively.
What Are Boxcar Acne Scars?
Boxcar acne scars are a type of atrophic scar, meaning that the base of the scar sits lower than the surface of the surrounding skin.
This is one of the more common types of acne scarring, and they tend to be wider and box-shaped, hence their name.
Boxcar scars can be shallow or deep, which will affect their appearance and the treatment options.
Typically, boxcar scars appear on the cheeks and temples. However, they can also show up on the jawline, chin, and forehead.
How Do Boxcar Acne Scars Develop?
Boxcar acne scars are usually the result of severe acne breakouts, also known as nodular-cystic acne.
This type of acne has a high inflammatory component, and this inflammation sets off a cascade of different responses that can damage the surrounding skin.
One of these responses is the production of enzymes called matrix metalloproteinases, which, when left unchecked, can wreak havoc on the skin, degrading collagen and other components of the extracellular matrix that make up the dermis.
With all these materials degraded, the inflammation from the acne lesions damages the collagen and elastin fibers that provide structure to the skin, thus creating an indentation or divot in the skin surface.
Additionally, sometimes fibrous bands are also formed, which anchor down that area of skin, pulling the scar even deeper.
The deeper the boxcar scar, the more tissue is lost, and therefore, the more noticeable it will be.
Do Boxcar Acne Scars Heal on Their Own?
Boxcar acne scars may improve slightly with time, but they won’t fully heal and disappear on their own.
Depending on the treatment and how well your skin responds to it, boxcar acne scars can be made to disappear fully.
Best Boxcar Acne Scars Treatments?
Shallow scars can be easier to treat and usually don’t require more than a few treatments.
Deep scarring, on the other hand, usually requires a combination of treatments, and therapy lasts longer in general because the skin will likely need time to heal and bounce back from the controlled injury introduced by these treatments.
With all that said, here are the best treatments for boxcar acne scars:
Dermabrasion is a mechanical exfoliation treatment that uses a rotating brush with a diamond tip to remove the topmost layer of skin.
This treatment can be effective for boxcar acne scars which are more shallow, but it does come with some drawbacks.
For one, dermabrasion is associated with causing the skin to temporarily become darker than normal, lighter than normal, or blotchy.
These concerns are more common in darker skin tones, and while professionals are unsure why they happen, it could have something to do with the treatment being too harsh for some skins.
In addition, dermabrasion can also lead to skin infections, so it’s essential to take care of your skin, keep it clean, and not apply makeup before and a couple of days after the treatment.
Dermal fillers are a popular treatment for boxcar acne scars, as they can help plump up the skin and smooth out the indentations left behind by deeper scarring.
Dermal fillers are usually recommended for deep scarring but in smaller areas.
The most commonly used filler for this purpose is made of hyaluronic acid, a substance that occurs naturally in our skin.
One of the advantages of fillers is that they are relatively quick and easy to get, with most people only needing one treatment session.
The drawback of fillers is that the results aren’t permanent and will fade away after 6-9 months.
Subcision is a surgical procedure that involves inserting a needle under the skin and manually loosening the fibrous bands that are pulling down on the skin and causing boxcar acne scars.
This treatment can be effective, but it does come with some side effects, such as initial bleeding and bruising that can last up to a week post-treatment.
Additionally, subcision usually requires several treatments before you see any results, but luckily, the results are permanent.
Microneedling is one of the best treatments for unpigmented boxcar acne scars and involves using a device with very fine needles to puncture the skin and create a controlled injury, which in turn triggers the body’s healing response leading to collagen production.
This collagen production will fill up the indentations from the scarring, and although it can be very effective, micro-needling does require some commitment.
Most people need at least four treatments before they see any significant results, but once you get there, the results will be permanent.
However, one major contra-indication to micro-needling is keloids and hypertrophic scarring, so if you are prone to either of these, it’s best to stay away from micro-needling devices.
Laser is one of the best treatments for pigmented boxcar acne scars. This includes hyperpigmentation such as dark and brown spots as well as red marks known as post-inflammatory erythema.
One of the most popular lasers for boxcar acne scars is the fractional CO₂ laser, which uses a beam of light to remove the top layer of skin and stimulate collagen production.
Laser treatments can be very effective, but they come with some drawbacks, such as a longer downtime that might require painkillers to minimize the discomfort.
Chemical peels are another popular treatment for boxcar acne scars that can be effective, especially medium to deep peels that go deeper than the superficial layer of the skin and target collagen renewal.
Common types of peels include glycolic acid, that’s primarily used for sun damage and uneven skin tone; Jessner’s solution, that’s primarily used to target hyperpigmented scarring; and trichloroacetic acid (TCA), which is a deeper peel that can treat hyperpigmented scarring and improve the appearance of boxcar acne scarring.
While they can be helpful in some instances, chemical peels aren’t the best treatment for boxcar acne scarring alone and are usually suggested in combination with other treatments.
Besides that, deeper peels cause discomfort that can last up to several weeks and include symptoms such as excessive peeling, itching, redness, and irritation.
Punch grafting is a surgical procedure that involves taking a small piece of skin from another area of the body, such as the back of the ear, and using it to cover up boxcar acne scars.
This skin graft will eventually grow new blood vessels and blend in with the surrounding skin, making it an effective treatment for boxcar acne scarring.
However, it’s important to note that this treatment comes with a few potential risks, such as infection, scarring, and pigmentation changes.
Additionally, it’s a more invasive procedure that requires anesthesia and a longer recovery time.
Can You Treat Boxcar Acne Scars With Skincare Products?
While boxcar acne scars can’t be fully treated with skincare, some products can improve their appearance over time.
Some of these include:
Retinoids are vitamin A derivatives commonly used to treat acne and can also help improve the appearance of boxcar acne scars.
Retinoids work by increasing cell turnover, which helps smooth out the skin’s surface and improve the overall texture.
They can also help improve the appearance of hyperpigmentation and uneven skin tone, making them a good choice for boxcar acne scars that are also hyperpigmented.
However, it’s important to note that while retinoids are effective in improving acne scarring, they can cause irritation, redness, and dryness that can last up to several weeks until the skin gets used to the increased cellular turnover.
Alpha Hydroxy Acids
AHAs are a group of acids commonly used in skin care products to exfoliate the skin’s surface.
The most common AHAs are glycolic acid and lactic acid, which can help improve the appearance of boxcar acne scars by increasing cell turnover and stimulating collagen production.
In addition, AHAs can also help improve the overall texture of the skin and reduce the appearance of hyperpigmentation.
However, it’s important to note that although effective, AHAs can make the skin more prone to UV damage, photosensitivity, and burning.
Therefore, it’s important to be diligent with using high SPF when relying on exfoliating acids to improve acne scarring.
If you are interested in reducing the hyperpigmentation on your skin I highly recommend checking our approved face washes for hyperpigmentation. These facial washes have been evaluated by our team so there is a high-quality option for every skin type.