Skin & Aesthetics · Acne scars

Boxcar Scar Treatment: Matching the Method to Scar Depth

Boxcar scar treatment raises and softens boxcar scars, the round or oval acne scars with sharp, steep edges and a flat base that look like small craters, using resurfacing and targeted techniques. At Hommage Clinic in Gangnam, Seoul, Dr. Hwang Seonhwa grades each scar by width and depth, then matches it to a method, from fractional laser for shallow scars to TCA CROSS or punch techniques for deep ones.

Dr. Hwang Seonhwa
Medically reviewed by
, aesthetic physician
Last reviewed
Hommage Clinic, a women's health and skin clinic in Gangnam, Seoul

Quick answer

Boxcar scar treatment improves round or oval acne scars with sharp edges and a flat base. At Hommage Women's Clinic in Gangnam, Seoul, Dr. Hwang Seonhwa grades each scar as shallow or deep first. Shallow boxcar scars are usually resurfaced with fractional laser or RF microneedling over about 3–5 sessions, 4–6 weeks apart. Deep ones are treated individually with TCA CROSS or a punch technique, then blended. Scars become shallower and less visible over 3–6 months, but are not erased.

Key takeaways

  • Depth decides the method: shallow boxcar scars respond to resurfacing, deep ones need a targeted step first.
  • Boxcar scars make up an estimated 20–30% of depressed acne scars, and most people also have rolling or ice pick scars.
  • Active acne should be controlled before scar treatment starts.
  • Improvement is gradual and partial; a realistic goal is softer, shallower scars that catch less light.

Infographic

Boxcar scars in numbers

1.5–4 mm

Typical width

Round or oval, wider than ice pick scars (under 2 mm).

0.5 mm

Shallow vs deep

The approximate depth that separates shallow from deep boxcar scars.

20–30%

Share of acne scars

Estimated proportion of depressed acne scars that are boxcar type.

3–5

Resurfacing sessions

A typical series, spaced 4–6 weeks apart.

1–7 days

Downtime

From 1–3 days of redness to 5–7 days of crusting, by method.

3–6 mo

To judge results

Collagen keeps remodeling after the last session.

Figures from the dermatology literature listed in the references and from this page; your own plan is set after examination.
✚ Hommage Women's Clinic · Gangnam, Seoul

Boxcar scars at a glance

Key fact Details
What they are Round or oval depressed acne scars with sharp edges and a flat base, usually 1.5–4 mm wide
How they're assessed Examination under angled light; each scar graded as shallow or deep and mapped by area
Treatment options Shallow: fractional laser, RF microneedling. Deep: TCA CROSS, punch techniques
Sessions Typically 3–5 resurfacing sessions 4–6 weeks apart, plus targeted treatment as needed
Downtime From 1–3 days of redness to about 5–7 days of crusting, depending on the method
Results Gradual over 3–6 months; scars become shallower and softer but are not erased
Reviewed by Dr. Hwang Seonhwa, physician for skin and aesthetic treatments

Book a boxcar scar assessment if you have

  • Round or oval pitted scars with defined edges on the cheeks or temples
  • Scars that cast small shadows under overhead light and do not flatten when the skin is stretched
  • Mixed acne scars and want to know which methods suit each type
  • Acne that has been under control for a few months

Wait or discuss another option if you have

  • New breakouts still forming, or cold sores or infection in the area
  • Pregnancy or breastfeeding (cosmetic scar treatment is usually postponed)
  • A tendency to keloids or raised scars
  • Taken isotretinoin recently (timing is decided with your doctor)

What are boxcar scars?

Boxcar scars are depressed acne scars with a round or oval shape, steep, well-defined edges and a fairly flat base. They form when deep inflammation from a breakout destroys collagen in the dermis, and the skin heals with a pit instead of filling back in.

Dermatologists usually describe them as about 1.5–4 mm across, and grade them as shallow (roughly up to 0.5 mm deep) or deep (deeper than that). This distinction matters more than anything else, because shallow and deep boxcar scars respond to different treatments. They are common on the cheeks and temples and often sit alongside other scar types.

Boxcar vs rolling vs ice pick scars: how do you tell them apart?

The three depressed acne scar types differ in shape, edge and depth, and each responds to different methods.

  • Boxcar scars: round or oval, with sharp edges and a flat base, like small craters. Stretching the skin does not make them disappear.
  • Rolling scars: wider, shallow dips with soft, sloping edges that give the skin a wavy look. They are pulled down by fibrous bands and often soften when the skin is stretched. See rolling scar treatment .
  • Ice pick scars: very narrow, usually under 2 mm, and deep, like a puncture. See ice pick scar treatment .

Most people have a mix, which is why a scar map comes before any treatment plan.

Which treatments work for boxcar scars?

Shallow boxcar scars usually respond to resurfacing treatments, while deep ones need a targeted method first. Most plans combine both.

Shallow boxcar scars

  • Fractional laser: ablative or non-ablative columns of laser energy remodel the scar and soften its edges.
  • RF microneedling: radiofrequency heat delivered through needles, with a lower pigment risk in Asian and darker skin.
  • Classic microneedling: a gentler option for mild scars, usually needing more sessions.

Deep boxcar scars

  • TCA CROSS: a high-strength acid applied only to the base of narrower deep scars to build collagen from below.
  • Punch techniques: for deep scars with very sharp edges, the scar can be cut out and closed (punch excision) or its base freed and lifted level with the skin (punch elevation). Resurfacing a few weeks later blends the area. Your doctor explains whether a punch technique suits you and how it would be arranged.
  • Subcision: helps when a boxcar scar is also tethered to deeper tissue.

For broad, soft-edged scars, fillers or collagen stimulators may add volume underneath.

How is a boxcar scar plan built?

A good plan follows the scars, not a fixed package. It usually runs in stages.

  1. Control active acne first. New breakouts can create new scars and make healing less predictable. If needed, acne treatment comes before scar work.
  2. Map the scars. Each area is examined under angled light and boxcar scars are graded as shallow or deep, alongside any rolling or ice pick scars.
  3. Treat deep scars individually. TCA CROSS or punch techniques usually come first, because they change the scar's depth.
  4. Resurface the whole area. A series of fractional laser or RF microneedling sessions smooths edges and texture.
  5. Review and adjust. Progress is compared at each visit, and the next step is chosen from what has changed.

How many sessions do boxcar scars need, and when will you see results?

Most people need several months of treatment. A resurfacing series of about 3–5 sessions, 4–6 weeks apart, is typical, and deep scars may need 2–3 rounds of TCA CROSS or a punch technique on top.

Results build gradually as new collagen matures, so the outcome of a plan is usually judged about 3–6 months after the last session. Shallow boxcar scars often soften noticeably; deep ones improve more slowly. Scars become shallower and less noticeable, but they are improved rather than erased.

Downtime depends on the method: about 1–3 days of redness after non-ablative laser or RF microneedling, and about 5–7 days of crusting after ablative laser or TCA CROSS. Daily broad-spectrum SPF 30+ sunscreen protects your result.

Risks and possible side effects

Every scar treatment carries risks, and Dr. Hwang will go through those of your specific plan before you consent:

  • Redness, swelling and crusting , lasting days to a week depending on the method.
  • Post-inflammatory hyperpigmentation : temporary darkening, more likely in Asian and darker skin and after sun exposure. It usually fades over weeks to months.
  • Infection or cold sore reactivation while the skin is healing.
  • Acne flares or milia (tiny white bumps).
  • With TCA CROSS, rarely, a widened scar or lighter spot ; with punch techniques, a fine line scar or a slightly raised or sunken graft.

Call the clinic if pain or redness worsens after the first few days, or if you notice pus, yellow crusts, clusters of small blisters or a fever.

Boxcar scar treatment at Hommage Clinic

Hommage Clinic is a women's health and skin clinic in Gangnam, a short walk from Sinnonhyeon Station. Boxcar scars are graded one by one before treatment, and the doctor who assesses you plans each step rather than applying the same setting to the whole face. Hormone-related acne behind recurring breakouts can be assessed by our OB/GYN team under the same roof, and you can browse our otherskin and aestheticsservices for related care.

Cost depends on the methods used, the number of scars and sessions, and the area treated. Cosmetic scar treatment is not covered by Korea's National Health Insurance, although many medical tests and treatments are for enrolled patients. You receive a written quote for the whole plan before starting, and walk-ins are welcome during opening hours.

Know your scars

Boxcar scars vs ice pick and rolling scars: a cross-section

The fastest way to understand boxcar scar treatment is to look at the skin from the side. A boxcar scar is a flat-bottomed pit with steep walls, a little like a small crater stamped into the skin. Ice pick scars are narrower and plunge deeper, while rolling scars are wide, soft-edged dips pulled down by fibrous bands underneath. The classification most dermatologists use, published by Jacob, Dover and Kaminer in 2001, describes boxcar scars as usually 1.5 to 4 mm across, shallow when roughly 0.1 to 0.5 mm deep and deep when about 0.5 mm or more.

That depth line is what decides your plan. Resurfacing treatments such as fractional laser work on the upper part of the skin, so they reach the edges and floor of a shallow boxcar scar well. A deep boxcar scar has a floor that sits too low for resurfacing alone, so it is usually treated one scar at a time first.

Boxcar scar vs ice pick and rolling scar cross-section diagram, Hommage Women's Clinic, Gangnam, Seoul Abstract side view of skin layers showing four acne scar types: a narrow deep ice pick scar, a shallow boxcar scar with a flat floor, a deep boxcar scar with steep walls, and a wide rolling scar tethered by fibrous bands. BOXCAR VS OTHER ACNE SCARS Ice pick Shallow boxcar Deep boxcar Rolling Dermis Fat under 2 mm wide 0.1–0.5 mm deep 0.5 mm or deeper wide, tethered HOMMAGE WOMEN'S CLINIC · GANGNAM, SEOUL
Ice pick Narrow and deep, like a puncture. Usually treated scar by scar with TCA CROSS or punch excision.
Shallow boxcar Flat floor close to the surface. Usually responds to a fractional laser or RF microneedling series.
Deep boxcar Steep walls and a low floor. Often needs TCA CROSS or a punch technique before resurfacing.
Rolling Wide, soft-edged dip pulled down by bands. Usually treated with subcision first.
Original illustration by Hommage Women's Clinic, Gangnam, Seoul. Abstract diagram, not to scale; depth bands follow Jacob, Dover and Kaminer (2001).
Assessment

How boxcar scars are graded before treatment

A boxcar scar plan starts with a scar map, not a machine. Dr. Hwang examines your skin in good light and then with a light held at a low angle from the side, which throws shadows into every pit and shows how steep its walls are. The skin is also gently stretched: rolling scars tend to soften when stretched, while boxcar and ice pick scars stay visible, which helps tell them apart.

Each area of the face is then recorded by scar type and, for boxcar scars, by width and approximate depth. Photographs taken in the same light at the start and at each review make progress easier to judge, because scar change is gradual and easy to underestimate in a mirror.

What the map tells your doctor

  • Which scars can be left to a resurfacing series and which need individual treatment first
  • Whether rolling scars are mixed in and would benefit fromsubcision
  • How strong treatment can safely be, given your skin tone and tendency to darken after inflammation
  • A realistic estimate of the number of sessions and the change to expect
Doctor examining skin under a magnifying lamp to grade boxcar acne scars, Hommage Women's Clinic, Gangnam, Seoul Hommage · Gangnam Hommage Women's Clinic · Gangnam, Seoul

Every boxcar scar plan begins with a close examination and a scar map. Illustrative photo.

Treatment guide

Best treatment for boxcar scars: a depth-and-width guide

There is no single best treatment for boxcar scars, because a 0.3 mm dip and a 1 mm pit are different problems. The classic algorithm from Jacob and colleagues still shapes practice: shallow boxcar scars are best treated with resurfacing, narrow deep boxcar scars (under about 3 mm) with punch excision, and wider deep ones with a healthy-looking floor with punch excision or punch elevation. Since then, TCA CROSS has become a common office alternative for narrower deep scars. The guide below shows how those choices fit together.

Boxcar scar treatment decision guide by depth and width, Hommage Women's Clinic, Gangnam, Seoul Flowchart. Shallow boxcar scars go to a fractional laser or RF microneedling series of 3 to 5 sessions. Deep narrow scars under about 3 mm go to TCA CROSS or punch excision. Deep wider scars go to punch elevation or excision. All paths then resurface the whole area to blend. BOXCAR SCAR TREATMENT GUIDE Boxcar scar Shallow about 0.1–0.5 mm deep Deep about 0.5 mm or deeper Resurfacing series Fractional laser or RF microneedling 3–5 sessions, 4–6 weeks apart Narrow TCA CROSS or punch excision Wider Punch elevation or excision Then resurface the whole area to blend HOMMAGE WOMEN'S CLINIC · GANGNAM, SEOUL
Method Best for Typical course Downtime
Fractional laser Shallow boxcar scars, overall texture 3–5 sessions, 4–6 weeks apart 1–3 days (non-ablative) to 5–7 days (ablative)
RF microneedling Shallow boxcar scars in skin prone to darkening 3–5 sessions, 4–6 weeks apart About 1–3 days of redness
TCA CROSS Narrow, deep boxcar and ice pick scars Often 2–4 rounds, several weeks apart About 5–7 days of small dark crusts
Punch excision or elevation Deep boxcar scars with very sharp walls Usually one procedure per scar, then resurfacing Stitches or tape for about a week
Subcision Boxcar scars also tethered underneath 1–3 sessions Bruising for about 1–2 weeks
Original illustration by Hommage Women's Clinic, Gangnam, Seoul. A guide only; your plan is set after examination.
Fractional laser resurfacing on the face for shallow boxcar acne scars, Hommage Women's Clinic, Gangnam, Seoul Hommage · Gangnam Hommage Women's Clinic · Gangnam, Seoul

Resurfacing works best on shallow boxcar scars and on the texture around deeper ones. Illustrative photo.

Comparing options

Fractional laser vs RF microneedling for boxcar scars

Both treatments create thousands of tiny, controlled injuries that prompt the skin to lay down new collagen, which gradually lifts the floor of shallow boxcar scars and softens their edges. The difference is how the energy arrives. A fractional laser delivers light in microscopic columns; ablative versions vaporize tissue and give more change per session with more downtime. RF microneedling sends radiofrequency heat through fine needles into the dermis while sparing much of the surface.

For Asian skin, the main trade-off is pigment. Stronger surface heat raises the risk of post-inflammatory hyperpigmentation, temporary brown marks that can take weeks to months to fade. That is why Dr. Hwang often chooses RF microneedling or gentler laser settings for skin that darkens easily, and keeps ablative laser for cases where the extra effect is worth the recovery.

Option 1

Fractional laser

  • Light energy in microscopic columns
  • Ablative types give more change per session
  • About 5–7 days of crusting with ablative settings
  • Higher pigment risk in skin that darkens easily
  • Also improves general texture and pores
Option 2

RF microneedling

  • Radiofrequency heat delivered through needles
  • Works deeper while sparing much of the surface
  • Usually 1–3 days of redness
  • Often preferred for Asian and darker skin
  • Can be combined with TCA CROSS or subcision
✚ Hommage Women's Clinic · Gangnam, Seoul
Timeline

Boxcar scar treatment timeline: a typical six-month plan

Boxcar scar treatment is a project measured in months. Deep scars are usually treated first because those steps change their depth, and the resurfacing series follows once the skin has settled. Collagen keeps remodeling for months after each session, so the honest time to judge the outcome is 3–6 months after the last treatment, not the week after.

Boxcar scar treatment timeline and sessions schedule, Hommage Women's Clinic, Gangnam, Seoul Five stages: first visit scar map; month 1 deep scars treated with TCA CROSS or punch techniques; months 2 to 6 a resurfacing series of 3 to 5 sessions; daily sunscreen and skin care throughout; final review 3 to 6 months after the last session. BOXCAR SCAR TREATMENT TIMELINE Visit 1 Month 1 Months 2–6 Every day +3–6 mo 1 2 3 4 5 Scar map Deep scars Resurfacing SPF & care Final review Typical plan; order and timing vary HOMMAGE WOMEN'S CLINIC · GANGNAM, SEOUL
Visit 1 Scar map under angled light, photos, health check and a written, staged plan.
Month 1 Deep, sharp-edged scars treated individually with TCA CROSS or a punch technique.
Months 2–6 Fractional laser or RF microneedling, usually 3–5 sessions 4–6 weeks apart.
Every day Broad-spectrum SPF 30+ and gentle care to protect healing skin from dark marks.
+3–6 months Progress is compared with your first photos; extra rounds are discussed only if useful.
Original illustration by Hommage Women's Clinic, Gangnam, Seoul. Typical timeline; individual plans differ.
Aftercare

Aftercare for boxcar scar treatment: do's and don'ts

What you do in the first week shapes both comfort and result. The biggest avoidable risk for Asian skin is post-inflammatory hyperpigmentation, and sun exposure and picking at crusts are its main triggers. You receive written instructions for your specific treatment, and you can send photos to the clinic if something looks unexpected.

Do

  • Wash gently with lukewarm water and a mild cleanser
  • Apply the recommended moisturizer or ointment often
  • Use broad-spectrum SPF 30+ daily once the skin is closed
  • Let small crusts after TCA CROSS fall off on their own
  • Sleep on a clean pillowcase for the first nights
  • Message the clinic with photos if you are unsure

Don't

  • Pick, scrub or peel crusts and flaking skin
  • Use retinoids, acids or exfoliants until cleared
  • Sit in saunas or do hot yoga in the first days
  • Spend long periods in strong sun without protection
  • Wear heavy makeup until the surface has healed
  • Book another facial treatment without asking first
✚ Hommage Women's Clinic · Gangnam, Seoul
Woman checking her skin in a mirror during boxcar scar treatment recovery, Hommage Women's Clinic, Gangnam, Seoul Hommage · Gangnam Hommage Women's Clinic · Gangnam, Seoul

Gentle care and daily sunscreen protect your result while the skin heals. Illustrative photo.

Mixed scars

Combining methods for mixed acne scars

Boxcar scars rarely appear alone. Ice pick scars are thought to be the most common type overall, and many people also have rolling areas on the lower cheeks. A combined plan treats each type with the method that suits it, in an order that avoids undoing earlier work: tethered areas are released withsubcision, narrow deep scars are treated withTCA CROSS, and the whole area is then resurfaced withfractional laserormicroneedling.

Preventing new boxcar scars

The best scar treatment is the one you never need. Deep, inflamed breakouts are the ones most likely to leave boxcar pits, so treating moderate or cystic acne early, and not squeezing deep spots, matters more than any device. If breakouts are still appearing, the plan starts withacne treatmentor a cortisoneacne injectionfor painful cysts. For women whose acne flares around the jaw with their cycle, a hormone check with our OB/GYN team can be arranged in the same clinic.

Microneedling on the face as part of a combined boxcar and mixed acne scar plan, Hommage Women's Clinic, Gangnam, Seoul Hommage · Gangnam Hommage Women's Clinic · Gangnam, Seoul

Mixed scars are treated in stages, each with the method that suits it. Illustrative photo.

Evidence

Does boxcar scar treatment work? What the research says

Acne scar research is useful but imperfect. Most studies are small, mix several scar types together, use different scoring scales and follow patients for months rather than years. Few report results for boxcar scars alone. With those limits in mind, the reviews below agree that meaningful improvement is common, complete clearance is not, and darkening after treatment is the side effect to plan around in Asian skin.

20–30%

Boxcar share

Estimated share of atrophic acne scars that are boxcar type; ice pick 60–70%, rolling 15–25%.

Fabbrocini et al., Dermatol Res Pract, 2010
66%

Good or excellent

Of 53 patients with atrophic acne scars after 70% TCA CROSS; 81% were satisfied.

Dermatol Surg, 2015;41(5)
34

TCA CROSS studies

Reviewed (937 patients): best for ice pick, then boxcar scars; dark marks ranged from 6.7% to over 60%.

Stratman & He, J Clin Aesthet Dermatol, 2026
7

Laser trials pooled

186 cases: ablative lasers gave stronger results, non-ablative had less pain and shorter redness.

Ke et al., meta-analysis, 2025
Honest limits. No study shows that any method erases boxcar scars, and results reported as percentages depend heavily on the scale used. Most evidence for punch techniques comes from expert reviews and case series rather than trials. Dr. Hwang uses these findings to set expectations: a realistic goal is scars that are shallower, softer at the edges and less visible in everyday light.
✚ Hommage Women's Clinic · Gangnam, Seoul
Traveling to Seoul

Boxcar scar treatment in Seoul for international patients

Because boxcar scars usually need several sessions 4–6 weeks apart, a single short trip rarely completes a plan. Many visitors use a first trip for the scar map and the first treatment, often TCA CROSS on deep scars or a first resurfacing session, then return for further sessions or continue resurfacing closer to home with the written plan.

Planning your visit

  • Send clear photos of your scars in daylight and your preferred dates by WhatsApp, KakaoTalk or the contact form.
  • Allow about a week in Seoul after stronger treatments such as ablative laser or TCA CROSS, so crusts can settle before you fly.
  • Bring your passport, a list of medicines (especially isotretinoin or retinoids) and any previous treatment records.
  • Pack a wide-brimmed hat and a broad-spectrum sunscreen for the trip home.

If you notice spreading redness, pus, blisters or fever after you return home, see a local doctor promptly and let the clinic know.

Seoul city view for international patients traveling for boxcar scar treatment at Hommage Women's Clinic, Gangnam, Seoul Hommage · Seoul Hommage Women's Clinic · Gangnam, Seoul

Seoul: the clinic is in Gangnam, a short walk from Sinnonhyeon Station. Illustrative photo.

Doctor preparing a written, staged boxcar scar treatment plan, Hommage Women's Clinic, Gangnam, Seoul Hommage · Gangnam Hommage Women's Clinic · Gangnam, Seoul

You receive a written, staged plan and quote before starting. Illustrative photo.

Choosing well

How to choose a clinic for boxcar scar treatment in Seoul

Gangnam has many clinics offering acne scar packages. Use these questions at any consultation, including ours:

  • Does a doctor grade each scar type? A plan should name which scars are boxcar, rolling or ice pick, and which are shallow or deep.
  • Is there more than one method on offer? A clinic with only one device tends to use it for every scar.
  • Are pigment risks discussed for my skin? Ask how settings are adjusted if you darken easily.
  • Will active acne be treated first? Starting scar work over active breakouts is a warning sign.
  • Are results described honestly? Improvement, not removal, is the realistic promise.
  • Do I get a written plan and quote? Including the number of sessions and follow-up schedule.
✚ Hommage Women's Clinic · Gangnam, Seoul

What affects the cost of boxcar scar treatment?

Cost depends on how many scars need individual treatment, which methods are combined (for example TCA CROSS plusRF microneedling), the number of resurfacing sessions, the size of the area and whether active acne needs treating first. Cosmetic scar treatment is not covered by Korea's National Health Insurance, and you receive a written quote for the whole plan before starting.

Your visit

What to expect at your boxcar scar consultation

01

Scar grading

The physician examines your skin under angled light and grades each boxcar scar as shallow or deep, alongside other scar types.

02

Health check

Active acne, recent isotretinoin use, cold-sore history and your skin's pigment tendency are reviewed to set timing.

03

Staged plan

You receive a written plan and quote: targeted treatment for deep scars, then a resurfacing series.

04

Follow-up

Sessions are usually 4–6 weeks apart, with progress compared and the plan adjusted at each visit.

Dr. Hwang Seonhwa, physician for skin and aesthetic treatments at Hommage Clinic
Your doctor

Dr. Hwang Seonhwa

Physician · Skin & Aesthetic Treatments

Dr. Hwang grades each boxcar scar by width and depth before choosing a method, so shallow scars are resurfaced while deep, sharp-edged ones are treated individually first. Plans are reviewed between sessions and adjusted as scars soften.

Physician for face and skin procedures, including lifting, laser and skin-improvement treatments, planned around facial proportions and skin condition.

Read Dr. Hwang Seonhwa's profile →

Boxcar scars: frequently asked questions

  • What treatment works for boxcar scars?

    It depends on depth. Shallow boxcar scars usually respond to fractional laser or RF microneedling over a series of sessions. Deep, sharp-edged ones generally need a targeted method such as TCA CROSS or a punch technique first, followed by resurfacing. Most people get the most change from a combination matched to their scar map rather than from a single treatment.

  • Can boxcar scars be removed completely?

    Boxcar scars can usually be made noticeably shallower and less visible, but no treatment reliably removes them completely. How much they improve depends on their depth and width, how many there are and how your skin heals. A scar assessment gives you a realistic idea of the change to expect before you commit to a plan.

  • Do boxcar scars go away on their own?

    No. Boxcar scars are lasting changes in the dermis caused by lost collagen, so they do not fill in by themselves. Red or brown marks left after breakouts often fade with time, but true pitted scars need treatment to improve. Starting scar treatment once acne is controlled also helps prevent new scars from forming.

  • How many sessions do boxcar scars need?

    Most people need about 3–5 resurfacing sessions spaced 4–6 weeks apart. Deep boxcar scars may also need 2–3 rounds of TCA CROSS or a punch technique. Because collagen keeps building after each session, the final result is usually judged about 3–6 months after the last treatment.

  • Does boxcar scar treatment hurt?

    Most methods are uncomfortable rather than painful. Numbing cream is applied before laser or RF microneedling, and you feel heat and prickling. TCA CROSS stings briefly as the acid is applied, and punch techniques are done under local anesthetic. Your doctor explains what each step feels like before you start.

  • Can foreigners get boxcar scar treatment in Seoul?

    Yes. International patients and foreign residents can book scar treatment at Hommage Clinic; bring your passport for registration. Because a plan usually spans several sessions 4–6 weeks apart, plan return visits or a longer stay, and allow about a week of recovery before flying after stronger treatments. Please contact us before your visit to arrange language support.

  • How can I tell if I have shallow or deep boxcar scars?

    Shallow boxcar scars are roughly 0.1–0.5 mm deep and look like soft dents that blur a little in flat light. Deep ones, about 0.5 mm or more, keep sharp shadows even in even lighting and have a clearly visible floor. Many people have both, so the most reliable answer comes from an examination under angled light rather than a mirror at home.

  • Is fractional laser or RF microneedling better for boxcar scars?

    Both can help shallow boxcar scars. Ablative fractional laser tends to give more change per session with more downtime, while RF microneedling and non-ablative lasers cause less pain and shorter redness. For skin that darkens easily, Dr. Hwang often favors RF microneedling or gentler fractional laser settings to lower the risk of dark marks.

  • Will dermal fillers fix boxcar scars?

    Fillers lift soft, wide depressions better than sharp-edged pits. Because a boxcar scar has steep walls, filler alone usually leaves the edge visible. Fillers or collagen stimulators may be added for broad, sloping areas, but they are a supporting step, not the main treatment for boxcar scars.

  • Can boxcar scar treatment cause dark spots?

    Yes, temporary darkening called post-inflammatory hyperpigmentation can follow any scar treatment and is more common in Asian and darker skin. Reviews of TCA CROSS report it in anywhere from about 7% to over 60% of patients across studies, usually fading over weeks to months. Gentler settings, spacing sessions, daily sunscreen and not picking crusts all lower the risk.

  • Can I treat boxcar scars while I still have acne?

    It is usually better to control active acne first. New breakouts can form new scars and make healing less predictable, and some treatments are postponed over inflamed skin. Dr. Hwang may start with acne treatment and begin scar work once breakouts have been quiet for a few months.

  • How soon after isotretinoin can I treat boxcar scars?

    Timing after isotretinoin (Roaccutane) is decided individually, because the drug affects how skin heals and recommendations have changed over time. Tell your doctor exactly when you took your last dose, and the plan will be timed to suit the methods chosen, often starting with the gentlest options.

  • How long do boxcar scar results last?

    Collagen remodeling from treatment is long-lasting, so improvement in scar depth generally holds. Natural aging and collagen loss can make scars look a little more visible again over many years, and new acne can form new scars. Daily sunscreen and good acne control help protect the result.

References

Sources used for this page, reviewed by Dr. Hwang Seonhwa. Read our editorial and medical review policy.

  1. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001;45(1):109–117.
  2. Fabbrocini G, Annunziata MC, D'Arco V, et al. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract. 2010;2010:893080.
  3. Therapeutic response of 70% trichloroacetic acid CROSS in atrophic acne scars. Dermatol Surg. 2015;41(5):597–604. PubMed
  4. Stratman S, He H. The use of chemical reconstruction of skin scars (CROSS) method with trichloroacetic acid (TCA) for atrophic scars: a comprehensive review. J Clin Aesthet Dermatol. 2026;19(6):52–67.
  5. Ke R, Cai B, Ni X, et al. Efficacy and safety of non-ablative vs. ablative lasers for acne scarring: a meta-analysis. 2025. doi:10.1111/ddg.15651.

This page is general information and does not replace a personal consultation. Illustrations are original works of Hommage Women's Clinic, Gangnam, Seoul; photos marked illustrative are not of patients.

Related acne scar treatments

Ice Pick Scar Treatment

Narrow, deep scars that need focused methods such as TCA CROSS or punch techniques.

Rolling Scar Treatment

Wide, wave-like scars pulled down by fibrous bands, usually treated with subcision first.

Fractional Laser for Acne Scars

Ablative and non-ablative laser resurfacing for shallow boxcar scars and texture.

TCA CROSS Treatment

High-strength acid applied to the base of narrow, deep scars to build collagen from below.

RF Microneedling for Scars

Radiofrequency heat through fine needles, with lower pigment risk for darker skin.

Subcision for Acne Scars

Releases the fibrous bands that tether scars to deeper tissue.

Find out how deep your boxcar scars are

Book an appointment with Dr. Hwang Seonhwa in Gangnam to have each scar graded and receive a written, staged plan matched to its depth.

Hommage Clinic · 4F, Building A, 509 Gangnam-daero, Seoul (near Sinnonhyeon Station) · Mon & Fri 10:00–20:00 · Tue–Thu 10:00–19:00 · Sat 10:00–15:00