Boxcar Scars - acne support

What are boxcar scars?

Boxcar scars are a common type of scarring that can occur as a result of the acne healing process. They appear as indents in the skin and tend to measure a few millimetres wide. They are defined by their sharp edges that move straight down into the skin and aren’t always the same size as the original acne lesion that caused them, as the size depends on how the skin heals.

Boxcar scars are more common in areas of the face where the skin is thicker, such as the lower cheeks and jaw.

What factors make it more likely that boxcar scars will form?

Like all acne scars, the formation of boxcar scars is largely dependent on how your skin heals. If you tend to scar easily then you are more likely to develop acne scars.

Inflammation also plays a key role in development of acne scars. The deeper that inflammation from an acne lesion reaches into the skin the more likely it is to scar upon healing. This is one of the reasons that it is important to treat acne as soon as possible, to lower the risk of deep inflammation.

Picking or squeezing acne lesions can damage the skin and lead to an increased chance of scarring. It is not advised that you pick at or squeeze your acne. However, in reality many people do this in an attempt to remove pus. If you are insistent on picking at or squeezing your acne to remove pus then please see our guide on how to lower your chances of damaging your skin here.

You are also more likely to develop acne scars if you smoke, as smoking leads to an increased risk of scarring in general.

Boxcar Scar Treatments

Treatment for boxcar scarring comes in two stages, as it does for other acne scarring. First stage treatments for boxcar scarring are designed to reduce the depth of the scar so that the skin’s surface returns to being flat. Second stage treatments for boxcar scarring are aimed at reducing skin discolouration in the newly flat scar.

It is important to remember that scar reduction treatments are not readily available on the NHS. If you are thinking about paying for a scar reduction treatment privately then be sure to research your practitioner and make certain that they are qualified to conduct the procedure, such as a Consultant Dermatologist or Plastic Surgeon. It is often advisable to use a practitioner who can carry out all of the various forms of scar reduction treatments that are discussed above, as they will be able to advise you on the best option for your skin colour and nature of scarring.

Please note that all of the treatments below have potential side effects, such as burns, skin peeling, irritation, skin bleaching and changes to skin texture. Darker skin types are at higher risk of suffering from the side effects of scar removal. Please talk to your healthcare provider to find out more about the risks involved for any treatment that you may be considering.

Stage One Treatments

Subcision

In boxcar scarring there are small fibres that tether the bottom of the scar and pull it down towards the lower layers of skin. Subcision is a treatment when an instrument is used to break the fibers that are pulling the scar down, releasing the indented skin to return back to the surface.

Punch Excision

This is where a circular tool is used to cut the scar out of the skin. The wound is then stitched shut to form a new, flat scar where the boxcar scar had been.

Punch Elavation

This is where the centre of the boxcar scar is removed and then reattached at an elevated level, bringing it up to match the height of the skin’s surface so that the scar appears flat.

Punch Grafting

This is where the scar is removed and the wound is filled with skin taken from another part of the body, such as the back of the ear.

Dermabrasion

This is where a special tool is used to remove the top layers of skin through friction, not unlike a sanding machine. As the layers of skin are removed the boxcar scar becomes shallower. This technique is generally less effective at removing deeper scarring than other methods of scar reduction and can change the colour and texture of the skin. Often 2 to 3 treatments are required for best results.

Microneedling

This treatment is sometimes known as collagen induction therapy. It works by using a special tool to create several, tiny injuries within a scar. These injuries usually heal within two days and new collagen is formed inside of the scar. Collagen is a protein that help gives our skin strength and elasticity. As the new collagen forms it reduces the scar’s depth. Multiple treatments tend to be required every four to six weeks to gain maximum benefits. You should also be aware that the depth of needling has an effect on how successful the treatment is, with deeper needles often providing better results.

TCA CROSS (Chemical Reconstruction of Skin Scars)

In this treatment, an acid known as trichloroacetic acid (TCA) is inserted into scars in high concentrations of 70%-100%. The acid generates a small inflammatory response in the skin and results in new collagen being formed, which reduces the depth of the scar. Multiple treatments tend to be required every to gain maximum benefits.

Dermal Fillers

This treatment works by injecting a substance into the skin that will physically push the skin above it upwards.

Chemical Peels

This treatment works by removing the outer layers of skin using high concentrations of glycolic or salicylic acid. This treatment is not suitable for deeper scarring as it can lead to discolouration and texture changes in the skin.

Laser Therapy

Laser therapies work in two ways. Ablative laser therapy uses high energy light to remove the outer layers of skin whilst encouraging new collagen production in the lower layers of skin. Non-ablative laser therapy uses heat to encourage new collagen production in the skin without damaging the outer layer. The removal of the outer layers and/or the production of new collagen results in a reduction in scar depth. There are multiple laser therapies that are available for the treatment of acne scarring. A consultant dermatologist will be able to determine which treatment is right for you based on your skin colour and the nature of your scarring.

Stage Two Treatments

Dermabrasion

This is where a special tool is used to remove the top layers of skin through friction, not unlike a sanding machine. As the layers of skin are removed the discolouration caused by scarring can become reduced.

Microneedling

This treatment is sometimes known as collagen induction therapy. It works by using a special tool to create several, tiny injuries within a scar. These injuries usually heal within two days and new collagen is formed inside of the scar. Collagen is a protein that help gives our skin strength and elasticity. Through this process microneedling can reduce the discolouration associated with scarring by encouraging old skin cells to shed, including skin cells that have been discoloured by excess pigment. Multiple treatments tend to be required every four-six weeks to gain maximum benefits. It is important to note that reducing skin discolouration is not microneedling’s main purpose and targeted treatments designed for treating skin discolouration may work better.

Chemical Peels

This treatment works by removing the outer layers of skin using high concentrations of glycolic or salicylic acid. In doing so, it can reduce the discolouring that is associated with scarring. This treatment should only be carried out by a qualified practitioner.

Laser Therapy

Ablative laser therapy uses high energy light to remove the outer layers of skin, which can reduce the discolouration that is associated with scarring. There are multiple laser therapies that are available for the treatment of acne scarring. A consultant dermatologist will be able to determine which treatment is right for you based on your skin colour and the nature of your scarring.