Alternative to Fraxel Laser for Ice Pick Scars?

Is there another procedure besides Fraxel that can help improve or eliminate ice pick scars? A procedure that does not involve multiple visits or passes? Longer downtime is okay.

Doctor Answers (4)

Treating ice pick scars

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Ice pick scars are difficult to treat and usually require multiple modalities.

I would begin with surgical excision.

Phase two would be skin resurfacing. The best laser is CO2. I would recommend two or more Fraxel repair or a series of Fraxel restore treatments. You are better off having more treatments with less downtime and risk than an aggressive older style CO2 laser which has a greater risk of complications.

I have also found replacing lost facial volume as a tremendous benefit to acne scars. Sculptra works well to replace lost fat. Other fillers for more superficial residual scars works well such as Juvederm or Restylane.


Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 125 reviews

The best treatment for ice pick acne scar is a two stage treatment.

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There is no resurfacing method that in my opinion by itself is effective in improving ice pick acne scars. Too many physicians and other providers try to resurface them alone and this does not sufficiently improve their appearance. And I agree with you that a fraxel treatment would be a waste of your time and only give you minimal improvement.

The best initial treatment is punch excision of the ice pick scars to change them from divets or depressions to linear scars. Once the linear scars heal up from the excision, then a resurfacing procedure works the best such as CO2 laser (the gold standard) or erbium laser resurfacing. Fraxel can be used after the scar(s) are excised first, but it results in less improvement. Obviously, the more agressive treatment has a longer down-time for recovery.

I have published an article on the CO2 laser for acne scarring you might wish to google for yourself. I have done the excision of ice pick scars followed by CO2 laser resurfacing for about 15 years now with excellent results and feel that the downtime is worth the improvement. I hope this information helps.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Fraxel won't eliminate ice pick scars

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The best way to eliminate ice pick scars is by excising them.  Visit an experienced plastic surgeon or facial plastic surgeon for a consultation.  Fraxel will likely leave you disappointed. 

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 51 reviews

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Ice pick acne scars

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It may be possible to excise or punch out and directly close these scars, but it is difficult to say without seeing you directly.  Visit with an e perienced plastic or facial plastic surgeon. 

Theodore Katz, MD, FACS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 7 reviews

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