Boxcar Acne Scars · Depth First · Pacific Plaza
Boxcar scars treatment depends, more than on anything else, on one measurement: the depth of the box. At Atelier, Dr Sin Yong judges each box scar under side light, then matches shallow ones to the non-ablative FSX Laser, deep ones to fractional CO2, and narrow corners to TCA CROSS.
A boxcar scar is a round or oval dip with near-vertical walls and a flat base, shaped like a U in cross-section. It forms where inflammation destroyed collagen in the dermis, and it ranges from a shallow dish to a deep well. Most cheeks with boxcar acne scars carry other types too, which is why the whole face is mapped, using the groups set out in acne scar types.
Depth is read from the shadow. Under side light, a steep wall throws a long shadow. Stretching the skin adds a second clue: a box that stays dented has a depth problem, while one that flattens is being held down from below and is treated like a rolling scar. A narrow, deep corner behaves like an ice-pick tract.
At A Glance
Your plan is written after examination. Dr Sin Yong holds a Key Opinion Leader appointment with DEKA.
Box By Box
Each box scar is sorted by what the examination shows, and the method follows. In Fitzpatrick III to V skin, the gentler option is used wherever it reaches deep enough.
| What the examination shows | Usually treated with |
|---|---|
| Short walls, short shadow, stays dented on stretch | FSX Laser, or fractional CO2 at a light setting beside deeper scars |
| Steep walls, long shadow, still a well on stretch | Fractional CO2: point shots into each box, then lighter passes so the edges blend |
| One narrow, deep corner | TCA CROSS into the corner, then laser to even the surrounding surface |
| Flattens when the skin is stretched | Subcision first, then resurfacing |
| Shallow to moderate boxes in darker skin | RF microneedling with insulated needles, or FSX |
| A small, isolated, very deep box | Assessed at Atelier; a punch technique arranged by referral where needed |
The Decision
Fractional CO2 changes more texture per session than a non-ablative laser, but healing takes longer and the risk of darkening is higher in Fitzpatrick III to V skin, so it is kept for boxes that need it. See Tetra Pro Scar³ and acne scar laser treatment.
Wait first if acne is still active, because new spots make new boxes. A fresh tan, recent isotretinoin, a history of cold sores or a tendency to keloids changes the plan. Punch excision and punch elevation are surgical; they are discussed at Atelier and arranged by referral to a plastic surgeon where needed.
On The Day
Recovery
After FSX, redness settles and fine scabs are left to shed. After fractional CO2, expect redness, swelling and warmth, then fine scabbing and peeling while the columns close; strict sun protection follows. See CO2 laser aftercare, TCA CROSS aftercare and acne scar treatment downtime.
Risks
Less common risks: prolonged redness, darker or paler patches, infection, a cold sore flare and, rarely, a new scar. No outcome is promised. Contact the clinic the same day if pain, redness or swelling increases, or pus or blisters appear.
Dr Sin Yong holds a Key Opinion Leader appointment with DEKA.
Atelier Aesthetics · Owned by AYA
9 Scotts Road, Pacific Plaza #12-01A, Singapore 228210 · +65 8023 7170
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