Acne scars come in more than one form, and identifying which type you have is the first step toward finding a treatment that genuinely helps. In Malta, the three most common types of acne scars are atrophic scars (including ice pick, boxcar, and rolling), hypertrophic scars, and post-inflammatory hyperpigmentation.
Acne scars come in more than one form, and identifying which type you have is the first step toward finding a treatment that genuinely helps. In Malta, the three most common types of acne scars are atrophic scars (including ice pick, boxcar, and rolling), hypertrophic scars, and post-inflammatory hyperpigmentation. Each responds differently to treatment, which is why a personalised assessment always comes first.
If you have spent time Googling “acne scar treatment” and found yourself more confused than when you started, you are not alone. Some results focus on at-home serums. Others list ten treatments without explaining which is right for your specific scar type. And most do not account for the fact that living in Malta, with its intense sun and Mediterranean climate, changes how certain types of acne markings behave on skin.
This guide is here to change that. Whether you noticed your first marks in your twenties and want to act early, you are in your thirties or forties and want to stay ahead of textural changes, or you have carried these marks for years and are finally ready to explore your options, the right starting point is understanding exactly what you are dealing with. Results may vary for each individual, but knowledge is always the foundation of a plan that works.
Why Acne Leaves Scars in the First Place
When a breakout forms, your body responds with inflammation. That inflammation is your immune system working to contain the problem, but in doing so, it can damage the surrounding collagen and skin tissue. When collagen is lost and the skin heals unevenly, you are left with a depression or indentation in the skin's surface. When the body overproduces collagen during healing, you get a raised scar instead. When pigment-producing cells are triggered by the inflammatory process, you are left with a dark or discoloured patch.
The severity of the scar depends on several factors: how deep the original lesion was, how long the inflammation lasted, whether the spot was picked or squeezed, and your individual skin biology. Genetics play a significant role. Some people heal acne with no lasting marks at all. Others are more predisposed to post-inflammatory changes regardless of how carefully they treat their skin. According to the British Association of Dermatologists' acne scarring guide, the likelihood and severity of scarring varies significantly between individuals, which is why a personalised skin assessment is so valuable.
Understanding this process matters because it explains why different scar types need different approaches. A treatment that works beautifully for surface-level pigmentation will not address a deep ice pick scar. A treatment designed to rebuild collagen in atrophic scars will not be the first choice for raised hypertrophic tissue. Getting the assessment right from the beginning saves time, money, and frustration.
The Main Types of Acne Scars Explained
Acne scars broadly divide into two categories: those where tissue is lost (atrophic scars) and those where tissue is gained (hypertrophic and keloid scars). Post-inflammatory hyperpigmentation sits in its own category entirely. Here is how to recognise each one.
Ice Pick Scars
Ice pick scars are narrow, deep channels that extend into the dermis. They look almost like a small puncture in the skin's surface, which is how they got their name. Ice pick scars account for approximately 60 to 70 percent of all atrophic acne scarring, making them the most common subtype. They tend to form after a cyst or deep papule has inflamed the skin from within and then resolved, leaving a narrow tunnel behind.
They are considered the most challenging type of atrophic scar to address because of their depth. Superficial treatments do not reach far enough to stimulate the remodelling needed. Approaches such as a technique called TCA cross (trichloroacetic acid applied precisely into each channel) or multiple sessions of microneedling at the appropriate depth are often used for ice pick scars.
Boxcar Scars
Boxcar scars are broader depressions with well-defined, almost vertical edges, giving them a box-like appearance. They account for around 20 to 30 percent of atrophic acne scars. Unlike the sharp point of an ice pick scar, a boxcar scar has a flat or slightly uneven base. They are most common on the cheeks and temples.
Because they are wider and shallower than ice pick scars, boxcar scars often respond well to treatments that stimulate collagen production across a broader surface area. Microneedling, radiofrequency microneedling, and resurfacing chemical peels are all options that can support the skin in rebuilding the lost structure.
Rolling Scars
Rolling scars create a wave-like, undulating texture across the skin. They do not have the defined edges of boxcar scars or the sharp depth of ice pick scars. Instead, they look as though the skin surface is uneven or pitted in a diffuse, irregular pattern. Rolling scars often result from fibrous bands of tissue tethering the skin to deeper structures beneath, which pulls the surface downward.
Because of this tethering mechanism, rolling scars sometimes respond to a procedure called subcision, where those fibrous bands are released, allowing the skin to rise back toward its natural surface level. This is often combined with other collagen-stimulating treatments for best effect.
Hypertrophic and Keloid Scars
While most acne scars are atrophic (indented), some people develop raised scars when the body overproduces collagen during healing. Hypertrophic scars stay within the original boundary of the wound, while keloid scars grow beyond it. These are more common on the chest, back, shoulders, and jawline. They can be firm, raised, and sometimes itchy or tender. Treatment typically focuses on softening and flattening the raised tissue rather than building collagen.
Post-Inflammatory Hyperpigmentation
Post-inflammatory hyperpigmentation, or PIH, is not technically a scar in the structural sense. It is a flat, darkened patch of skin left behind when inflammation triggers the overproduction of melanin. It does not involve any change to the skin's texture or structure, which means it tends to be more treatable than atrophic scarring, though it can be stubborn in certain skin types and climates.
How Malta's Climate Makes Acne Scars Harder to Fade
This is a section you will not find on most international guides about acne scars, but it is genuinely important for anyone living in Malta.
Malta averages over 3,000 hours of sunshine per year. UV radiation activates melanocytes, the cells responsible for producing pigment. When skin has previously been inflamed, those areas are more melanin-reactive than surrounding skin. That means UV exposure does not just affect new pigmentation on healed acne marks. It can actively deepen existing marks and slow down their natural fading process. For women with Mediterranean or olive skin tones, who are already more prone to post-inflammatory pigmentation, this compounds significantly.
The practical consequence is that someone managing PIH or surface-level scar discolouration in Malta faces a longer fade timeline than someone doing the same in a northern European country with lower UV intensity. This is not a reason to avoid treatment. It is a reason to pair any professional treatment for acne marks with consistent, broad-spectrum SPF 50 use year-round, not just in July and August.
It also informs treatment timing. Many collagen-stimulating treatments for acne scars require some sun avoidance during the recovery period. Planning these around Malta's quieter, lower-UV winter months can improve outcomes and reduce the risk of post-treatment pigmentation changes. A consultation with your practitioner will help you time your treatment schedule appropriately for the Maltese calendar.
Which Treatments Work Best for Each Scar Type
No single treatment addresses all types of acne scars equally well, which is why the consultation process is so important. That said, here is a practical overview of the main treatment modalities available and what they are best suited for.
Microneedling creates controlled micro-injuries in the skin using fine needles, stimulating the skin's natural collagen production response. Research consistently shows it to be effective for atrophic scars across skin tones, including the Mediterranean skin types common in Malta. A PubMed systematic review on classification and treatment of acne scars confirms that scar subtype classification is essential to selecting the most appropriate intervention, and that microneedling performs particularly well for rolling and boxcar scars. For deeper ice pick scars, it is often combined with other approaches. A typical course involves three to six sessions spaced four to six weeks apart, with ongoing improvement continuing for months as new collagen matures. You can read more about microneedling Malta on our dedicated service page.
Chemical peels use carefully selected acids to remove the outer layers of skin, encouraging cell turnover and reducing surface-level pigmentation and texture. Superficial peels are well-suited to post-inflammatory hyperpigmentation and mild texture concerns, with minimal downtime. Medium-depth peels can begin to address slightly deeper scar structure. chemical peels Malta are a particularly useful option for patients whose primary concern is discolouration rather than structural indentation.
PRP (platelet-rich plasma) uses your own growth factors to support skin repair and collagen remodelling. It is often used alongside microneedling to enhance the skin's healing response. PRP treatment Malta is particularly valued by patients who prefer a treatment approach that uses the body's own biology rather than external substances.
Dermal fillers can be used to temporarily restore volume beneath specific atrophic scars, physically elevating indented areas from beneath. This is particularly relevant for boxcar and rolling scars. dermal fillers Malta used for scar support are placed with precision and are reversible.
Most patients benefit from a combination approach tailored to the specific types of scars present, their skin tone, their timeline, and their downtime preferences.
Why Identifying Your Scar Type Matters Before Treatment
One of the most common mistakes people make when approaching acne scar treatment is choosing a treatment before identifying which type of scars they have. This matters more than most skincare content lets on.
Applying a brightening peel to a deep ice pick scar will not close the channel. It will improve surface texture and pigmentation, but the structural indentation remains untouched. Conversely, using a collagen-stimulating treatment like microneedling on raised hypertrophic scars without adjusting the protocol could theoretically worsen the raised texture. The treatment must match the scar type.
This is also why before-and-after photographs shared online need to be read with caution. A result that looks transformative for one person's rolling scars may look minimal for another person's ice pick scars, even if both patients received the same treatment. Results may vary for each individual, and the goal of a professional assessment is to set realistic expectations anchored in your specific skin, not someone else's.
For women in Malta who have spent years self-managing with skincare products, this is often the missing step. Products can support the skin between treatments and maintain results afterward, but the structural work of scar remodelling requires professional tools. A personalised consultation is the most efficient way to create a plan that targets the right scar types with the right approach in the right sequence.
Frequently Asked Questions About Types of Acne Scars in Malta
What are the main types of acne scars?
The main types of acne scars are atrophic scars (which sit below the surrounding skin surface due to collagen loss), hypertrophic and keloid scars (raised scars from collagen overproduction), and post-inflammatory hyperpigmentation (flat discolouration without structural change). Atrophic scars are the most common and are further divided into three subtypes: ice pick scars, which are deep and narrow; boxcar scars, which are wider with defined edges; and rolling scars, which create a wavy, uneven texture across the skin.
Can acne scars be removed completely?
Acne scars can be significantly improved with the right treatment, and in many cases the improvement is dramatic, but the word “removed” can be misleading. Structural indentations in the skin are addressed by stimulating collagen remodelling over a series of sessions. Most patients see a meaningful reduction in depth, visibility, and texture, but results depend on the scar type, skin tone, the treatments used, and individual healing biology. Post-inflammatory hyperpigmentation tends to respond more completely than deep atrophic scars. A professional assessment will give you a realistic picture of what improvement is achievable for your specific skin.
What is the best treatment for acne scars in Malta?
There is no single best treatment for every person. The most effective approach is determined by the type or types of scars present. Microneedling is among the most researched and widely used treatments for atrophic acne scars, with strong evidence across a range of skin tones including Mediterranean complexions common in Malta. Chemical peels are particularly effective for post-inflammatory hyperpigmentation and surface texture. Many patients benefit most from a combination protocol tailored to their scar profile. A free consultation at Carisma Aesthetics is the right first step to identifying which approach suits your skin.
Does sun exposure make acne scars worse?
Yes, particularly for post-inflammatory hyperpigmentation. Malta's high UV environment means that unprotected sun exposure can actively deepen darkened marks left by acne, slow their natural fading, and in some cases cause new pigmentation in skin that has recently been treated. Broad-spectrum SPF 50 applied daily, not just on beach days, is considered essential when managing any form of acne scarring or discolouration in a Mediterranean climate. During active treatment for atrophic scars, your practitioner will advise you on sun avoidance and post-procedure skincare to protect your results.
How many sessions does microneedling take to improve acne scars?
Most patients see visible improvement in their acne scars after a course of three to six microneedling sessions, typically spaced four to six weeks apart to allow the skin to heal and produce new collagen between appointments. The full benefit of each session continues to develop for several months as collagen matures, which means the final result is assessed three to six months after the last treatment. Ice pick scars generally require more sessions and may need to be combined with complementary techniques, while boxcar and rolling scars often respond well to a standard course. Results may vary for each individual, and your practitioner will set specific expectations for your scar type.
Is post-inflammatory hyperpigmentation the same as an acne scar?
Not exactly, though they are often spoken about together. Post-inflammatory hyperpigmentation (PIH) is a flat, dark patch left on the skin after an acne lesion heals. It involves no change to the skin's physical structure, only an increase in melanin in that area. True acne scars, by contrast, involve a change to the skin's texture or structure, either an indentation (atrophic) or a raised area (hypertrophic). PIH tends to fade over time, particularly with targeted treatment and consistent SPF use, while structural scars do not improve without collagen-stimulating intervention. Many people have both simultaneously, which is another reason a professional skin assessment is so useful.
Understanding which types of acne scars you have is not just a clinical detail. It is the starting point for a treatment plan that actually moves the needle for your skin. At Carisma Aesthetics in Malta, every treatment journey begins with a thorough assessment so that the approach we recommend is genuinely matched to your skin, your scar types, and your goals. Whether you are looking at microneedling to rebuild collagen in atrophic scars, a course of chemical peels to support surface renewal, or a combination protocol across multiple concerns, the path forward becomes clear once you know what you are working with. We would love to walk you through it.
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