Punch grafts followed by resurfacing work well for ice pick scars

Ronald Shelton, MD answers: Laser resurfacing and microdermabrasion for acne scars?

I have ice pick scars on my cheeks. I've done 5 laser resurfacing and 5 microdermabrasion treatments, but I don't see any significant improvement on my scars yet. I was told I still have 3 treatments left. Can I expect the scars to look better after 3 more treatments, or are there any other options I should be better off trying?


Ronald Shelton, MD
9 months ago

Shallow scars respond very well to the treatments you mentioned, provided that the microdermabrasion is done by a doctor and deeper than what an aesthetician would do. I typically find that punch grafts for ice pick scars work well when they are done first before the resurfacing with dermabrasion, Fraxel or Portrait plasma. The narrow but deep scars are removed surgically with a very fine instrument using local anesthesia and the new hole is plugged with a small graft of your own skin, usually taken from behind the ear so it doesn’t readily show.

After this graft is left alone, most heal in their new location filling the icepick scar. Then resurfacing is done several weeks later to improve the texture and circular incision line around the graft and the other crater scars. At times 30 – 50 punch grafts are done per session and two to three sessions might be needed before the resurfacing. This is an old time treatment and still works better than the newest technology, although the latest in lasers or plasma resurfacing is used for the final stage.

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A: Microdermabrasion or superficial laser will do nothing for ice pick scars.

George J. Beraka, MD
9 months ago

To SEEBRUCH,

Hi!  Ice pick scars are hard to treat, and "non invasive" treatments will not help.  Sometimes, "non invasive" means "non effective".

DEEP laser resurfacing with the dual modality Contour laser ( long pulse and short pulse erbium laser) can often help.  But this is done under anesthesia and has a one week recovery.

I am afraid you either have to learn to live with these annoying little scars, or you have to try something "invasive"!

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