Boxcar Scars Treatment: Options, Microneedling and Costs
Clinically Reviewed by: Angelica McWilliams, Licensed Advanced Esthetician
Boxcar scars are best treated with a plan matched to their depth, not with one device. Shallow boxcar scars often respond to a series of collagen-stimulating treatments such as microneedling or radiofrequency (RF) microneedling. Deeper ones usually need a combination of procedures. Rolling scars are a different shape and often need a different first step. Below we explain how to tell them apart, what each option does, and what to expect from a course of treatment.
TL;DR
- Boxcar scars are wide, sharp-edged, U-shaped dents. Rolling scars are broader, wave-like dips. Both are atrophic, meaning depressed by collagen loss.
- Dermatologists treat them with microneedling, radiofrequency, chemical peels, fillers, lasers and scar surgery, often in combination.
- Microneedling has little downtime, but your skin type and the skill of the provider matter for avoiding discoloration.
- At our Portland clinic, microneedling starts at $185 per area, and RF microneedling and microneedling with PRF are $285 per area.
- A free consultation is the fastest way to find out which scar types you have and in what order to treat them.
Table of Contents
- What boxcar scars are, and how they differ from rolling scars
- Treatment options for boxcar scars
- Microneedling for boxcar and rolling scars
- How scar depth and skin tone shape the plan
- What results to expect
- Treatment costs at our Portland clinic
- Book a free scar consultation in Portland
- FAQ
- Sources
What boxcar scars are, and how they differ from rolling scars
Boxcar scars are wide, U-shaped depressions with distinct, sharp vertical edges, typically 1 to 4 mm across. Picture a small cookie-cutter dent in the skin. They are common on the cheeks and temples, where the skin is thicker than at the nose.
Rolling scars are also wide, but they are broader still (about 4 mm or more) and have no sharp edge. According to the same systematic review, they are undulating depressions caused by fibrous bands tethering the skin to the tissue below. The surface looks wavy, and the dips often soften when you stretch the skin.
A quick way to tell them apart at home:
| Feature | Boxcar scars | Rolling scars |
|---|---|---|
| Shape | Round or oval dent with steep, defined walls | Soft, wave-like dip with sloping edges |
| Typical width | 1 to 4 mm | 4 mm or wider |
| Stretching the skin | Dent stays visible | Dip often flattens |
| Cause of depth | Lost tissue and collagen | Fibrous bands pulling skin down |
| Common first focus | Rebuilding collagen, smoothing walls | Releasing tethering, then rebuilding collagen |
Many people have both, plus a few narrow ice pick scars. That mix is normal, and it is why a single-treatment promise rarely fits.
Atrophic vs. hypertrophic scars
Boxcar and rolling scars are both atrophic. DermNet describes atrophic acne scars as depressed scars that result from net collagen loss during healing. Hypertrophic and keloid scars are the opposite: they are raised because the body makes too much collagen.
This matters because the treatments differ. Atrophic scars need collagen rebuilt and tethers released. Raised scars need to be flattened. If you have a firm, raised scar along with dents, mention it at your consultation so each is treated appropriately. Our guide to matching acne scars to the right treatment walks through each type.
Treatment options for boxcar scars
The American Academy of Dermatology lists microneedling, radiofrequency, chemical peels, fillers, lasers and scar surgery among the options, and notes that dermatologists may combine procedures. Here is what each does in plain terms.
Microneedling
Fine needles create controlled micro-channels in the skin. The healing response lays down new collagen, which gradually lifts shallow depressions and smooths texture. It suits shallow to moderate boxcar scars and mild rolling scars, and it can be repeated in a series.
RF microneedling
This adds radiofrequency energy at the needle tips, delivering heat into the dermis while the needles create the channels. The extra heat is designed to encourage firmer collagen remodeling and tighten the skin. It is a popular step up when standard microneedling has plateaued, and it pairs well with scars on skin that has also lost some firmness.
Microneedling with PRF
PRF (platelet-rich fibrin) is made from a small sample of your own blood and applied during microneedling. It is used to support healing and collagen production in the treated area. People choose it when they want to put their own growth factors to work on their scarring.
Chemical peels
Peels remove outer layers of damaged skin and improve tone, texture and discoloration left behind by acne. They do more for surface texture and post-acne marks than for deep dents, which is why they are often a supporting treatment. In one Egyptian study, subcision followed by 35% TCA peeling improved acne scars, as did subcision followed by microneedling.
Lasers, fillers and scar surgery
Ablative fractional lasers resurface deeper layers. In a 2024 comparison, fractional CO2 laser improved boxcar scores but caused more post-inflammatory hyperpigmentation and a longer healing time than microneedling. Fillers lift depressions temporarily. Punch techniques and subcision are minor procedures for scars that are very deep or tethered. These are performed in a dermatologist’s or surgeon’s office.
Microneedling for boxcar and rolling scars
Microneedling is the treatment readers ask about most, so here is a realistic picture.
Boxcar scars. Microneedling works by remodeling collagen from within, so it softens edges and raises the floor of shallow boxcar scars. Deep, sharply cut ones improve more slowly and may need more sessions or a stronger modality such as RF microneedling.
Rolling scars. The AAD describes microneedling as a way to fade scars and even skin tone. Rolling scars respond well to the general collagen stimulation, particularly when they are mild. Where fibrous bands hold the skin down, a provider may add another step to release them, which is where combination plans come in.
Sessions and timeline. Collagen builds over weeks, so results appear gradually. Treatments are generally spaced several weeks apart. We lay out what a year looks like in our 12-month microneedling timeline for acne scars, and the RF microneedling version covers that path.
Downtime. The AAD says microneedling has minimal downtime. Redness, darker skin, discomfort or swelling usually resolves within days to a week. Plan for a pink, slightly tight face for the first day or two.
Safety. The same AAD page warns that treatment by someone without proper training raises the risk of long-lasting discoloration. Have the procedure done by a trained, licensed provider who asks about your skin tone, medications and recent acne activity. If you have active acne, a history of keloids or a skin condition, or you are pregnant, tell the provider and ask your dermatologist before booking.
Afterward, follow the instructions closely. Our microneedling post-care instructions and aftercare steps for skin renewal cover the first week.
How scar depth and skin tone shape the plan
No single treatment suits every scar. A 2022 review in JAAD notes that choice depends on the scar type and number, the patient’s Fitzpatrick skin type, and the downtime they can accept. In practice that means:
- Shallow, wide boxcar scars: a series of microneedling or RF microneedling sessions is a sensible start.
- Deep, sharply cut boxcar scars: expect a combination. RF microneedling plus peels or other modalities, sometimes with a procedure from a dermatologist for the deepest ones.
- Rolling scars: treat the tethering first when it is present, then rebuild collagen so the surface evens out.
- Darker skin tones: the risk of post-inflammatory hyperpigmentation rises with some heat- and injury-based treatments, which is why technique, settings and a skin-tone-aware plan matter. A review of acne scar advances lists hyperpigmentation, redness and swelling among the risks of treatment.
- Lots of different scar types: sequence the treatments instead of stacking them all at once.
Combination plans are well documented. One Indian study combined subcision, microneedling and TCA CROSS in sequence for atrophic scars. TCA CROSS places a high-strength acid directly into individual scars and is a dermatologist-administered procedure, separate from the in-clinic microneedling and peel services we describe here. Ask your dermatologist whether it suits your scar type.
What results to expect
Acne scar treatments aim to improve how scars look, and the published review is clear that results vary by scar and by person. Think in terms of smoother texture, shallower dents and softer shadows rather than perfectly flat skin. Photos taken in the same light before your first session and after each one are the best way to track change, because daily mirror checks are misleading.
What tends to help most:
- Start early in the plan, not at the end. Collagen takes months to remodel.
- Finish the series. One session rarely tells you what a course can do.
- Protect your skin from the sun. Daily broad-spectrum SPF reduces the risk of discoloration while skin heals.
- Keep acne controlled. New breakouts make new scars.
- Follow aftercare. Skip actives and heavy exfoliants until your provider says you can resume.
Perspective
When someone comes in asking about boxcar scars, the first thing we do is look at the whole face, not just the deepest dent. Most clients have a mix: some boxcar, some rolling, some post-acne discoloration. Each part responds to something different, so we build the plan in layers.
We start with the scar type and skin tone, then choose between standard microneedling, RF microneedling, microneedling with PRF and peels. Collagen rebuilding is the foundation of all of it. We would rather plan a series with sensible spacing than promise a miracle after one visit.
Our protocols are also adapted for the Pacific Northwest climate. Gray, damp winters and bright summers affect healing, hydration and sun exposure, and we plan treatment timing and aftercare around that.
The free consultation exists so you can hear the plan, the number of sessions and the price before you decide anything. There is no pressure to book.
Angelica McWilliams, Licensed Advanced Esthetician
Treatment costs at our Portland clinic
These are our published prices as of September 2026. Pricing is per area, and your plan is confirmed at your consultation.
| Treatment | Price | Best suited to |
|---|---|---|
| Microneedling (single area) | $185 per area | Shallow boxcar scars, mild rolling scars, texture |
| RF microneedling (single area) | $285 per area | Moderate scars, scars with some loss of firmness |
| Microneedling with PRF (single area) | $285 per area | Clients who want their own platelet-rich fibrin used for healing support |
| MandeliClear with Vitamin A Accelerator | $175 | Texture and post-acne discoloration |
| VI Peel Original | $300 | Tone, texture and pigmentation |
| VI Peel Purify | $350 | Acne-prone skin with marks |
A course usually means several sessions, so ask at the consultation for your total. Our Portland acne scar removal guide explains how local treatment planning works.
Book a free scar consultation in Portland
If you want a plan for your own boxcar or rolling scars, we offer a free consultation at our Northwest Portland clinic. A licensed provider will look at your scar types, depth and skin tone, then recommend a course of microneedling, RF microneedling, PRF or peels, with the price for each step.
See the microneedling options and prices or visit Laser Skin Solutions Portland to book.
FAQ
Can microneedling fix boxcar scars completely?
Microneedling can make boxcar scars shallower and smoother by rebuilding collagen, but results vary by depth and skin type. Deep, sharp-walled scars often improve most with a combination plan. Expect gradual improvement across a series, not a single-session change.
Is microneedling good for rolling scars?
Yes, it is a common choice, especially for mild to moderate rolling scars. It stimulates collagen across the whole area. When fibrous bands are pulling the skin down, a provider may recommend an additional step to release them first.
How long does recovery take after microneedling?
Redness, mild swelling, discomfort or darker-looking skin usually settles within days to about a week, according to the American Academy of Dermatology. Avoid sun exposure and follow your aftercare sheet to protect healing skin.
What is the difference between atrophic and hypertrophic scars?
Atrophic scars are depressed because of collagen loss, and boxcar and rolling scars fall in this group. Hypertrophic scars are raised because of excess collagen. They are treated differently, so a provider should identify which you have before planning.
Do I need a dermatologist or can I start with a clinic consultation?
A consultation can identify your scar types and map a plan. If you have active cystic acne, a history of keloids, a skin condition or take medications that affect healing, check with your dermatologist first.
Sources
- A systematic review of treatments for acne scarring (PMC)
- Acne Scarring, DermNet
- Acne scars: Consultation and treatment, American Academy of Dermatology
- Microneedling can fade scars, uneven skin tone, and more, American Academy of Dermatology
- Procedural and surgical treatment modalities for acne scars, JAAD
- Combined treatment modalities in atrophic acne scars, IJORD
- Advances in the treatment of acne scars (PMC)
- Evaluating the pros and cons of fractional CO2 laser, Indian Dermatology Online Journal
- Novel subcision technique combined with microneedling or TCA peeling, JEWDS
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