Why Atrophic Scars Don’t Fill in on Their Own (And What Actually Helps)
If you’ve been hoping that your sunken acne scars will slowly fill in with time, I want to clarify something important:
Atrophic scars rarely correct themselves significantly without intervention.
They may soften slightly over the years. They may look less inflamed. But true structural filling does not typically happen on its own.
Understanding why helps you make informed decisions about treatment.
What Is an Atrophic Scar?
Atrophic scars are depressed scars caused by insufficient collagen production during healing.
When your skin is injured — whether by acne, trauma, or surgery — your body produces collagen to repair the damage. In some cases, that collagen production is inadequate. Instead of restoring the full volume of tissue, the area heals with a deficit.
The result is a depression in the skin.
Common types include:
Ice pick scars – narrow, deep pits
Boxcar scars – wider depressions with defined edges
Rolling scars – broader indentations caused by fibrous bands tethering the skin
General volume loss scars – areas that sit lower due to collagen deficiency
What all of them share is one thing:
There isn’t enough structural support beneath the surface.
Why Time Alone Doesn’t Rebuild Lost Volume
Scar healing occurs in phases: inflammation, proliferation, and remodeling.
During the active healing stage, fibroblasts produce collagen to repair the wound. Once this phase ends, collagen production slows dramatically.
In atrophic scars, the body completed healing — just with insufficient volume.
After the scar matures, your body does not naturally return to “fill in” missing tissue unless new stimulation occurs.
This is why acne scars from years ago often look very similar over time. They may soften slightly, but the depth usually remains.
Why Early Treatment Responds Better
Atrophic scars are often more responsive within the first year after formation because:
Collagen remodeling is still active
Cellular metabolism is higher
Blood supply is stronger
Tissue is more flexible
As scars mature:
Fibrosis increases
Collagen becomes more rigid
Cellular activity decreases
Surrounding skin continues aging and losing volume
This does not mean older scars cannot improve. It means they typically require more sessions and a more strategic approach.
What Actually Works for Atrophic Scars
Because the issue is structural volume loss, treatment must stimulate collagen production at the dermal level.
Professional treatments work by creating controlled stimulation that reactivates fibroblasts and promotes new collagen formation.
Depending on scar type, options may include:
Collagen induction therapies
Targeted resurfacing
Subcision for rolling scars
Regenerative protocols designed to improve dermal density
The goal is gradual collagen remodeling over time.
It is important to understand:
Atrophic scar treatment is progressive. It requires multiple sessions spaced appropriately to allow collagen formation between treatments.
Improvement typically occurs gradually over several months.
When to Consider Treatment
If your atrophic scars are:
More than several months old
Not improving visibly
Affecting your confidence
It may be time to move beyond topical products and consider structural treatment.
Creams cannot rebuild missing dermal collagen. Only targeted stimulation can encourage your skin to regenerate volume.
Atrophic scars are not a surface issue. They are a structural one.
Time may soften them slightly — but it does not replace lost tissue.
If you’re ready to actively improve your skin instead of waiting for change that isn’t coming, I can evaluate your scar type and design a protocol tailored to your tissue.
Regeneration is possible.
It just requires the right stimulus.
— Natalia Mejía
Scar Specialist | Manhattan