Rolling scars: Symptoms, Causes and Treatment

by Dr Wan Chee Kwang
September 21, 2023

Acne, though temporary, can leave behind lasting scars. Among them are rolling scars. For those who have battled acne and now contend with the aftermath of these deep, uneven depressions on the skin, removing them can seem like an uphill struggle.

In this blog post, we explain more about rolling scars, their symptoms, and a range of treatments you could explore to help you achieve a smoother complexion.

Rollings scars and their symptoms

Rolling scars manifest as depressions beneath the skin's surface. They are a type of atrophic scar, often caused by inflammation from acne, and they form below the layer of skin tissue. 

Unlike the temporary redness and swelling of active acne, these scars leave a lasting mark on your complexion. To understand and treat rolling scars, you must first recognise their symptoms.

Uneven texture

The most apparent symptom of rolling scars is the uneven texture they create on the skin. These depressions vary in size and depth.

Distorted contours

The natural contours of your skin can become distorted due to rolling scars. An uneven surface can lead to a lack of smoothness and symmetry, often causing distress and impacting self-confidence.


Under certain lighting conditions, rolling scars can cast shadows that further highlight their presence, making them more pronounced and apparent.

Causes of rolling scars

Rolling scars mostly happen because of acne and skin inflammation. When your skin tries to heal after these issues, it can sometimes make bands of scar tissue under the surface, known as dermal tethering. There is also a loss of volume in the skin and deeper tissues which leads to an uneven skin texture with bumps and indentations once the healing is done.

Only some get these scars, depending on how well their bodies can produce collagen in response to inflammation. Rolling scars appear when your body struggles to create the right amount of collagen during healing.

Why are some people more susceptible to rolling scars

The development of rolling scars is a complex interplay of various factors, and it's essential to recognise that not everyone's skin responds the same way to acne-related injury. 

Certain individuals are more susceptible to forming rolling scars due to a combination of intrinsic and extrinsic factors. Here, we explore why some people are more prone to experiencing them.

1. Genetic predisposition

Some people inherit a tendency for their skin to heal with less effective collagen production, making them more prone to forming scars after experiencing inflammation or trauma. 

2. Immune response

Some individuals have a more robust and efficient immune response, which can help prevent excessive scar tissue formation. Others may experience an exaggerated inflammatory response that contributes to the development of deeper scars.

3. Hormonal factors

Higher levels of certain hormones, such as androgens, can increase sebum production and more significant inflammation, making acne lesions more likely to become profoundly inflamed and result in scarring. 

4. Age

The age at which acne occurs can influence scarring tendencies. The skin at a younger age may heal more rapidly and effectively than matured skin, making adults more prone to lasting scars.

6. Acne severity

Those who experience severe acne are at a higher risk of developing rolling scars. The inflammation caused by severe acne, such as cystic acne, is more damaging, going deeper into the skin tissues.

How to treat rolling scars

Removing rolling scars requires a multifaceted approach that considers both the depth of the acne scars and the skin's characteristics. Here, we explore some of the techniques that are promising in rolling scar treatment.

1. Fractional energy devices

Fractional energy devices are effective acne scar removal methods that can improve the appearance of rolling scars. Treatments like fractional lasers, fractional radiofrequency and fractional microneedling radiofrequency harness controlled energy to stimulate the skin's natural healing processes. 

  • Fractional lasers: A study found that fractional laser treatment improved acne scar severity by 25% in patients with atrophic scars. This method uses fractional lasers to trigger the body's healing mechanisms, promoting collagen synthesis and skin remodelling. Its precision targets scars, improving skin texture. 
  • Fractional radiofrequency: Controlled heat energy stimulates collagen production beneath the skin, reducing rolling scars by triggering the natural healing response.
  • Fractional microneedling radiofrequency: This approach combines microneedling and radiofrequency to maximise collagen production and skin rejuvenation, making it a powerful acne scar removal treatment for rolling scars. Results from fractional microneedling radiofrequency are progressive and can continue to improve several months after treatment.

2. Subcision

Subcision is a simple procedure that releases the scar tissue's hold on your skin, allowing it to bounce back and become smoother. A fine needle or a specialised instrument is used to gently release the fibrous bands or tethers that are anchoring the scar tissue to the deeper layers of skin.

It is inserted under the skin through a tiny incision at the scar site. By carefully manoeuvring beneath the scar, the tethers are disrupted or cut. This process allows the skin to lift and fill in the depressed area, gradually smoothing out the scar's surface.

Subcision also encourages your skin to make new collagen, improving the scar's appearance. Multiple sessions might be needed, but the procedure is minimally invasive and requires little downtime.

3. Fillers

Fillers can be an effective acne scar removal treatment option for rolling scars, helping to improve their appearance by filling in the depressions and creating a smoother skin surface. 

Fillers, typically made of collagen-stimulating substances or hyaluronic acid, are injected into these depressions. The filler material acts as a cushion, lifting the depressed area and bringing it closer to the surrounding skin level.

As soon as the filler is injected, you'll notice a visible improvement in the appearance of the rolling scar. The skin becomes more even, and the scar's depth is reduced.

4. Fat graft

Fat grafting is a cosmetic procedure often used to improve the appearance of rolling scars. It involves transferring a person's fat from one part of their body to another.

Fat is removed from a donor site on the patient's body, typically areas with excess fat like the abdomen or thighs. This fat is collected through gentle liposuction and harvested to obtain pure, healthy fat cells.

The processed fat is injected beneath the scarred skin to fill the depressions and improve the overall texture.

Acne scar removal in Singapore

Each person's skin is unique, and the approach to treating rolling scars should be tailored to your needs. 1Aesthetics provides individualised recommendations and advice that can set you on the path to smoother skin.

Dr Wan will assess your skin's condition, understand your goals, and craft a custom treatment plan that aligns with your aspirations. You can look forward to a more even complexion with the proper support and treatments.

Book a consultation today!


  1. Marcus G Tan, Christine E Jo. (2021). Radiofrequency Microneedling: A Comprehensive and Critical Review. PubMed
  2. Wong Suk Chae, Jun Young Seong. (2015). Comparative study on efficacy and safety of 1550 nm Er:Glass fractional laser. PubMed

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