How to Identify and Treat Acne Scars: A Guide for Estheticians

Not all acne scars are created equal, and treating them successfully starts with knowing exactly what you’re looking at. 

As estheticians, we’re often the first stop for clients hoping to fade the marks left behind by years of breakouts. But to create an effective plan, we need to do two things really well:

1. Identify the type of scarring 

2. Choose the right combination of treatments and ingredients 

Let’s break it down step-by-step. 

How to Spot the Different Types of Acne Scars 

1. Ice Pick Scars 

• What they look like: Deep, narrow indentations that look like tiny holes or punctures.

• Cause: Inflammation that destroys collagen in a vertical pattern. 

• How to treat: These are the most difficult to treat and often require multiple modalities. RF microneedling, TCA CROSS, or deep skin resurfacing can help. Combine with collagen-supporting topicals to improve skin quality over time. 

2. Boxcar Scars 

• What they look like: Round or oval depressions with defined edges, like little craters.

• Cause: Loss of tissue in a broad area, usually from long-term cystic acne.

• How to treat: Microneedling or microchanneling works well here, especially when paired with growth factors, peptides, or NAD+ serums. Chemical peels can also help soften edges and improve skin tone. 

3. Rolling Scars 

• What they look like: Wavelike undulations in the skin, usually on cheeks or jawline.

• Cause: Fibrous bands pulling down the skin beneath the surface. 

• How to treat: These often need subcision or RF microneedling to break up the tethering. Collagen-building topicals are crucial between treatments to support dermal remodeling. 

4. Post-Inflammatory Hyperpigmentation (PIH)

- Technically not a scar, but your clients probably think it is.

• What it looks like: Flat dark spots left behind after a breakout, often mistaken for scarring.

• Cause: Melanin overproduction due to inflammation. 

• How to treat: This isn’t technically a scar, but it’s what clients most often complain about. Brightening agents (like arbutin, vitamin C, and mushroom extract), combined with calming ingredients like Centella Asiatica, are key. 

Pro tip: Take photos and chart scar types during consultations. This helps track progress and build trust as you customize treatment. 

Treatment Options That Work 

There is no single solution for acne scars, but there is a smart way to layer treatments for better results. 

1. Microneedling / Microchanneling 

• Stimulates natural collagen production 

• Ideal for boxcar, rolling, and shallow ice pick scars 

• Pair with actives like peptides, growth factors, or NAD+ for enhanced results

2. Chemical Peels 

• Excellent for textural smoothing and pigment improvement 

• Great as a prep or maintenance treatment 

• CMCA (monochloroacetic acid), TCA( trichloroacetic acid), glycolic, or mandelic peels are promising options depending on scar type and skin tone 

3. LED Therapy 

• Red light reduces inflammation and supports healing post-treatment 

• Blue light can help manage active acne if breakouts are still present 

4. Skin-Barrier Recovery + Post-Care 

• Don’t skip this! Post-treatment healing is where results really come together.

• Use calming, hydrating ingredients like panthenol, Centella Asiatica, and squalane to minimize downtime and support collagen remodeling. 

Key Ingredients That Support Scar Revision 

Here are some ingredients every acne-scar-focused esthetician should have in their arsenal:

• NAD+ (Nicotinamide Adenine Dinucleotide)

  • What it does: Energizes cells, supports DNA repair, and boosts  collagen production

  • Ideal for: All scar types

• Copper Peptides

  • What it does: Promotes skin regeneration and wound healing

  • Ideal for: Boxcar, rolling, and post-treatment repair

• Growth Factors

  • What it does: Stimulates fibroblasts and collagen synthesis

  • Ideal for: Supporting dermal regeneration and scar softening

• Centella Asiatica

  • What it does: Reduces inflammation and supports tissue repair

  • Ideal for: Rolling scars, PIH, and sensitive skin

• Arbutin + Vitamin C

  • What it does: Brightens pigment, evens tone, and supports skin clarity

  • Ideal for: PIH and uneven tone post-acne

• Squalane + Panthenol

  • What it does: Strengthen the skin barrier, reduce inflammation, and support healing

  • Ideal for: Essential for pre- and post-treatment recovery, all scar types

Want to learn more about the science behind great skin results? Let’s connect. 

Follow me on Instagram @slateandserum for real-world education, skin science, and practical tools for estheticians and skincare pros. 

At Slate and Serum, we’re building a space where professionals can grow with confidence, integrity, and evidence-based knowledge without the fluff. 

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About the Author 

Karla Pelaez-Barrick is a licensed aesthetic professional, educator, and skincare innovator with over 20 years of experience in the health and beauty industry. Known for her expertise in advanced skin revision techniques, she is dedicated to helping fellow professionals elevate their practice through science-backed treatments and ongoing education. Her work bridges clinical insight with practical application, empowering estheticians to deliver results-driven care with confidence.