Acne scars are not all the same, and the right treatment depends on the type of scar you have. The main types of acne scars include ice pick, boxcar, rolling, and hypertrophic or keloid scars. Dark or red marks left after acne, known as post-inflammatory hyperpigmentation (PIH), are different from true scars and usually need a different approach.
Understanding the types of acne scars and treatment options is the first step toward choosing the right plan. A treatment that works well for rolling scars may do little for deep ice pick scars, while raised scars require a completely different approach. Many people also have a combination of scar types, which means treatment often needs to be tailored rather than relying on a single procedure.
In this guide, we explain how dermatologists distinguish between the different types of acne scars, which treatments are commonly matched to each type, what patients with darker or South Asian skin should consider, and when treatment in Dhaka may be sufficient versus when advanced options in Thailand may be worth considering.
The Real Types of Acne Scars
Dermatologists generally group acne scars into two broad categories: atrophic (depressed, from tissue loss) and hypertrophic (raised, from excess tissue). Atrophic scars are far more common.
| Scar type | What it looks like | Why it forms |
| Ice pick scars | Narrow, deep, pin-like pits, usually under 2mm wide | Severe inflammation destroys tissue in a very small, deep column |
| Boxcar scars | Wider depressions with sharp, defined edges (1.5–4mm) | Broader tissue loss with a sudden drop-off at the edges |
| Rolling scars | Broad, wave-like depressions with sloping (not sharp) edges | Fibrous bands tether the skin’s surface to deeper tissue, pulling it down |
| Hypertrophic / keloid scars | Raised, firm, sometimes red or itchy | The opposite problem — too much collagen produced during healing |
| Post-inflammatory hyperpigmentation (PIH) | Flat dark or red marks — not a true scar | Pigment or vascular change after inflammation; usually fades over months on its own |
If you only remember one thing from this section, remember this: PIH is not a scar. It’s a temporary mark that typically improves with time and topical treatment. Confusing it with true atrophic scarring leads a lot of people to pay for procedures they didn’t actually need.
Why Most People Have More Than One Type
Here’s something most clinic websites gloss over: very few people have just one type of scar. Most patients have a mix a few ice pick scars near the nose, some rolling scars on the cheeks, and PIH scattered across both. This matters because a single treatment rarely addresses a mixed pattern. A plan built only for boxcar scars will underperform on ice pick scars sitting right next to them, and vice versa.
This is exactly why generic “one machine fixes all scars” marketing, which you’ll see a lot of, both locally and abroad, deserves some skepticism. A proper treatment plan is usually a combination matched to your specific mix, not a single procedure.
Which Treatment Matches Which Scar Type
This is general medical education on how these scar types are typically approached in dermatology, not a claim that every clinic (including ours) offers every option below. Always confirm with your treating doctor which of these are actually available to you.
| Scar type | Commonly matched approaches |
| Ice pick scars | Among the most stubborn to treat; usually needs multiple sessions and, often, a combination of approaches rather than one alone |
| Boxcar scars | Resurfacing lasers, chemical peels, or microneedling, depending on depth |
| Rolling scars | Often improves with a combination of resurfacing and microneedling over several sessions |
| Hypertrophic/keloid scars | Different logic entirely — flattening-focused approaches rather than resurfacing |
| PIH | Topical treatment and time; procedural treatment is usually unnecessary |
Advanced laser resurfacing and medical-grade microneedling/chemical peels, two of the most broadly useful approaches across several of these scar types are treatments we provide directly; you can see how we approach them on our Dermatology & Cosmetic page. A proper in-person evaluation will tell you which of these fits your specific case, and whether a combination makes sense.
A Note on Darker and South Asian Skin
Most of the acne-scar research and marketing content available online was developed with lighter skin types in mind. That gap matters, because darker skin, including most Bangladeshi and South Asian skin, can respond differently to the same procedure, and carries a higher risk of post-procedure pigmentation changes if the technique isn’t chosen carefully.
This is actually one of the reasons microneedling has become such a widely-used option for darker skin types specifically. Published research, including a 2021 study in the Journal of Cosmetic Dermatology, has found microneedling to be a safe and effective option for reducing acne scarring with a low rate of side effects, and it’s specifically noted for being well-tolerated across darker skin tones because it doesn’t rely on targeting pigment the way some laser treatments do.
Comparative research on resurfacing approaches has similarly found that microneedling-based techniques tend to carry a lower risk of post-treatment pigmentation changes than some laser options in darker or Asian skin types. None of this means one approach is automatically right for you. It means the choice of technique, not just the choice of clinic, matters more for darker skin. Ask any provider directly which approach they recommend for your specific skin tone, and why.
Which of These Can You Get Done in Dhaka — and Which Might Need Thailand?
This is the question I actually get asked once patients understand their scar type. Here’s the honest, type-by-type answer:
- Mild boxcar scars, early PIH, or a small number of shallow scars. A qualified Dhaka clinic with modern equipment can typically manage this well. There’s rarely a strong reason to travel for this alone.
- Moderate, mixed scarring (a combination of types). This is genuinely a gray zone. Outcome depends more on the specific doctor’s experience matching treatments to your mix than on the country. Ask detailed questions locally before assuming you need to travel.
- Deep ice pick scarring, extensive rolling scars, or scarring that hasn’t responded to previous local treatment. This is where the broader range of advanced laser platforms and higher case volume available at major hospitals in Thailand can genuinely make a difference. This is also where our Medical Tourism service is designed to help, coordinating the full process rather than leaving you to navigate a foreign hospital system alone.
If you read our earlier comparison of Thailand vs. Dhaka for skin treatment, this is the more specific, scar-type-level version of that same honest framework.
What to Realistically Expect
Regardless of scar type or location, a few things are consistently true:
- Most effective scar treatments require multiple sessions (commonly 3–6), spaced several weeks apart, not a single visit
- The realistic goal is significant improvement, not complete erasure – be cautious of anyone promising scars will fully disappear
- Combination approaches, matched to your specific mix of scar types, generally outperform a single procedure used alone
Getting Properly Classified — Don’t Skip This Step
None of the above should be used to self-diagnose your scars from a mirror or a photo. Ice pick, boxcar, and rolling scars can look similar under normal lighting, and most people have a mix that’s genuinely hard to categorize without a proper in-person examination. This classification step is exactly what a dermatology consultation is for. You can request a free medical consultation to get an accurate assessment before deciding on any treatment plan or travel decision.
Dr. Abdullah Al Mamun’s Note
“Patients often come to me already convinced they need a specific treatment they read about online, and sometimes they’re right, but often the actual scar type calls for something different, or a combination they hadn’t considered. Getting the classification right the first time saves you money and disappointment, whether you end up treating it here in Dhaka or with us in Thailand.” — Dr. Abdullah Al Mamun
Frequently Asked Questions
Are all acne scars the same, and treated the same way?
No. Acne scars fall into distinct types, ice pick, boxcar, rolling, hypertrophic, and post-inflammatory hyperpigmentation (PIH) and each generally responds best to a different treatment approach or combination.
Is post-inflammatory hyperpigmentation (PIH) a permanent scar?
No. PIH is a flat dark or red mark from inflammation, not a structural scar, and it typically fades on its own over months, often helped along with topical treatment.
Can one treatment fix all my acne scars?
Usually not, if you have a mix of scar types, which most people do. Combination treatment plans matched to your specific scar pattern generally produce better results than relying on a single procedure.
Is scar treatment different for South Asian or Bangladeshi skin?
Darker skin types can respond differently to some procedures and carry a higher risk of post-procedure pigmentation changes if technique isn’t adjusted. Published research on darker skin specifically is encouraging for certain combination approaches, but you should always confirm your provider’s experience with your specific skin tone.
How do I know which scar type I have?
Reliably, only through an in-person examination by a qualified dermatologist, not from photos or online descriptions alone. A free consultation is a good first step.
Ready to Find Out What Your Skin Actually Needs?
Understanding your scar type is the first real step toward the right treatment plan, whether that plan takes place here in Dhaka or with us in Thailand. Request your free medical consultation here and get an honest, doctor-led assessment before spending on any procedure.
This article is for general education and does not replace a personal medical consultation. Scar classification should be done in person by a qualified dermatologist rather than through photos or self-assessment. Medically reviewed by Dr. Abdullah Al Mamun, MBBS, MPH, MSc Dermatology & Dermatosurgery
