BonBoz Clinic

Acne Treatment

Boxcar scars

Boxcar scars are round or oval depressions, 2–4 mm in diameter, with vertical edges and a flat base, commonly found on the cheeks and temples. Compared to ice pick scars, they respond better to fractional CO2 laser, microneedling, or microneedling RF; deep boxcar scars may require additional subcision or TCA CROSS as indicated by a physician.

Medically reviewed by BS.Ths.CKI Kim Kha — BonBoz Clinic

What Do Boxcar Scars Look Like?

You will notice relatively well-defined depressions, resembling a small piece of missing skin, with a flat base rather than a pointed one. Under angled lighting, the scar edges cast distinct shadow borders. These scars typically result from widespread inflammatory acne or chickenpox, and frequently coexist with rolling scars across the cheek area.

Depth Determines the Treatment Approach

Shallow boxcar scars (less than approximately 0.5 mm) respond well to resurfacing techniques because the tissue loss is confined to the superficial to mid-dermis. Deep boxcar scars have steeper edges with a lower base, requiring deeper stimulation—such as RF microneedling, higher-energy CO2 laser, or TCA CROSS applied to the scar base. Dermatologists assess the depth through dermoscopy and palpation, rather than visual estimation alone.

Why Are Multiple Sessions Necessary?

New collagen takes several weeks to regenerate following each session. Each treatment progressively elevates the scar base, yielding cumulative results over the course of the protocol. Scheduling sessions too closely together will not speed up the process, but rather increases the risk of post-inflammatory hyperpigmentation, particularly in darker skin types.

What to Do Before Scar Treatment

Control any active inflammatory acne, avoid picking or popping lesions, and apply sun protection consistently for at least several weeks beforehand. Stable skin responds better to treatment and carries a lower risk of complications. If you are currently taking oral retinoids for acne, inform your doctor, as this affects the timing of your procedures.

The BonBoz Approach

Our dermatologists evaluate your skin using dermoscopy, count and classify the scars, assess their depth, and recommend a combination protocol: fractional CO2 laser or RF microneedling for the overall area, TCA CROSS for isolated deep scars, and subcision if coexisting rolling scars are present. You will receive clear details regarding the expected number of sessions, downtime, and aftercare; the degree of improvement depends on individual physiological response, and our doctors do not promise predetermined numbers.

Severity levels

1

Shallow, scattered

Low-edged scars with bases close to the skin surface. Typically show noticeable improvement after a few sessions of microneedling or fractional CO2 laser.

2

Moderate, clustered

Distinct sloping edges intermingled with rolling scars. Require a combination of laser/RF microneedling and subcision, along with a longer treatment course.

3

Deep, wide

Deep-set bases with large diameters. Require deep stimulation and targeted focal treatments; improvement should be expected progressively in stages rather than complete eradication.

When should you see a doctor?

  • New scars continue to form — active, inflammatory acne is not yet under control.
  • The scarred area is darkening following at-home procedures or treatments at non-physician facilities.
  • You are unsure of your scar type — a professional skin analysis is essential before choosing any treatment modality.
  • Signs of co-existing hypertrophic or keloid scars are present (raised, itchy) — requiring a completely different treatment approach from atrophic scars.

How BonBoz treats it

Fractional CO2 Laser

Resurfaces the skin and stimulates collagen—often the primary consideration for shallow to medium boxcar scars.

Learn about this method →

RF Microneedling

Dual stimulation (microneedles + RF thermal energy) delivered to deep dermal layers with minimal surface disruption—considered for deep scars or hyperpigmentation-prone skin.

Learn about this method →

Microneedling

Less invasive than lasers, well-suited for shallow scars; frequently combined within comprehensive treatment protocols.

Learn about this method →

TCA Cross / Subcision

Targeted treatment for isolated deep scars or releasing fibrous tethers in co-occurring rolling scars.

Learn about this method →

Cost guidance

Costs are calculated per session and based on the combination of techniques used; shallow boxcar scars typically require fewer sessions than deeper scars. An estimated price range is available in our cost estimator tool, with the final quote provided by the doctor following a skin analysis.

The final price follows the doctor’s recommendation after an in-person exam. A confirmed quote has no hidden extras.

Chân dung BS.Ths.CKI Kim Kha

BS.Ths.CKI Kim Kha

Aesthetic Dermatology

  • Graduated as a General Practitioner — Tay Nguyen University (2018)
  • Specialist Level I in Dermatology — Pham Ngoc Thach University of Medicine, degree awarded in 2025
  • Medical Practicing Certificate No. 009784/ĐL-CCHN — Issued by the Department of Health of Dak Lak Province on 15/10/2021
  • Over 8 years of experience in aesthetic dermatology practice (since 2018), including over 4 years of practice with an official Medical Practicing Certificate
  • Primary Specialization in Plastic and Reconstructive Surgery; Certificates in Dermatological Procedures & Minor Surgery, Microsurgery, and Lasers & Light Therapies in Dermatology
  • Certificates in Dermal Fillers, Botox, and Thread Lifts; Certificates in Emergency Resuscitation and Infection Control
  • Formerly practiced at the Aesthetic Dermatology Unit — Post and Telecommunications General Hospital (2019–2021) and Venus Sunrise Clinic (2022–2024) before joining BonBoz Clinic (2025)
  • Former lecturer in Aesthetic Dermatology Theory at Ana Aesthetic Training School (2018–2019)
  • Over 5,000 clinical dermatology cases treated
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Frequently asked questions

Can boxcar scars be completely cured?

A realistic goal is to shallow the scars, soften their edges, and create a more even skin texture so they are barely noticeable up close. Completely erasing all traces is an unrealistic expectation for atrophic acne scars in general.

Is laser or microneedling better for boxcar scars?

It depends on the scar depth and your skin type. Superficial scars may respond well to microneedling, while medium-to-deep scars typically require fractional CO2 laser or RF microneedling. The doctor will determine the best approach after a skin examination, often combining both modalities.

How long after a session will I see a difference?

The skin will be red and peel for a few days, after which it takes 3–6 weeks for new collagen to form. Noticeable improvements are typically visible after several sessions, rather than immediately after the first.

Can darker skin that is prone to hyperpigmentation undergo laser treatment?

Yes, but laser parameters must be carefully adjusted, alongside strict sun protection; doctors sometimes prefer RF microneedling due to its minimal epidermal disruption. Darker skin tones carry a higher risk of post-inflammatory hyperpigmentation (PIH).

Do I need to take time off work after the procedure?

Fractional CO2 laser generally involves 5–7 days of redness and peeling; RF microneedling and traditional microneedling are milder, taking about 2–4 days. You can return to work while your skin is still pink, provided you apply adequate sun protection.

What is the best time of year to treat atrophic scars?

There is no restricted season, but periods with less sun exposure and fewer beach trips are more ideal, as post-procedure sun protection is a critical factor.

Can I undergo treatment while taking oral acne medication?

You must inform your doctor. Certain oral retinoid medications require a specific washout period before undergoing skin resurfacing procedures.

Is maintenance required after completing the treatment plan?

No maintenance procedures are needed for the scars that have already improved, but you must keep acne under control and practice sun protection to prevent new scars or hyperpigmentation.

How is the cost calculated?

Costs are based on the number of sessions and the combination of techniques used. The doctor will provide the total estimated treatment plan cost after your consultation; the finalized quote has no hidden fees.

Are boxcar scars genetic?

They are not directly inherited; what is genetic is the predisposition to acne and the way your skin heals wounds. Avoiding acne picking is the most effective way to prevent scarring.

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