Although not as common as ice pick scars, nor as pronounced, box car scars are a familiar type of acne scar, most frequently found after an inflammatory acne breakout. In comparison with ice pick scars, box car scars are a good deal wider and though not quite as deep as ice pick scars they do give the skin a somewhat pitted appearance. Usually a box car scar will be round or oval in shape and have steep sides. They are recognisable for the amount of tissue that is removed to make them.
The box car scar is created when an inflammatory breakout of acne strikes, destroying some of the collagen which gives facial skin its rubbery, flexible texture. Where the tissue is effectively burned away by the inflammation, the skin is left without support and develops a sunken look. There is no set level of severity for a box car scar, and it is recognised purely by its shape. They can consequently be fairly superficial or very severe depending on the severity of the breakout and the amount of tissue destroyed.
To treat a box car scar, it is possible to use punch excision, although the nature of that form of surgery is more suited to ice pick scars. Instead, punch elevation is a more frequent choice for surgeons. This style of surgery involves cutting out the base of the scar and lifting (or elevating) it to a point where it is level with the surrounding skin. It is then held in place using surgical sutures until it heals, leaving the skin looking much less pitted.
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