Hi. I've suffered acne & acne scarring my entire life. I had severe infantile acne that left numerous small ice pick scars on my cheeks. I picked up a few more through adolescence and adulthood. I am a 40 year blond/blue male with dark, oily skin. I had 5 sessions of Fraxel Re:Pair 4 years ago and saw probably 50% improvement. Since then I have been using Tazorac 3 times a week with some additional improvement. What else should I try?
What Can Be Done to Further Treat Small Ice Pick Scars on Cheeks After Frazel and Tazorac?
Doctor Answers 6
Ice pick acne scars are tough to treat. LaViv which is using your own fibroblasts injected into the scar are has been shown to help the depressed scars.
I like the eMatrix fracitonal radiofrequency device for pitted acne scars.
We are seeing good improvement with the eMatrix radiofrequency device for the treatment of pitted acne scars. Multiple treatments at maximum energy is required. Minimal redness can be covered with makeup following treatment and lasts 5 to 7 days, no real down time. Additional Fraxel Repair treatments can also be helpful. You will have much more down time following Fraxel Repair treatment.
Additional fractional ablative laser and/or CROSS treatment with TCA could help
Additional fractional ablative laser and/or CROSS treatment with TCA could help.
You could see Dr. Kent Remington in Calgary for expert advice on your options for scar management -- he is an expert on that subject, and has done extensive teaching over the years.
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I would consider TCA CROSS method and a multilayered approach to follow
TCA can help with tight ice pick scarring. If you have a bunch of the ice pick scarring that are close together you could consider excision as an alternative. After multiple rounds with the TCA CROSS method you can then consider a multi layered approach with co2 laser resurfacing to polish the results.
What works to treat acne ice pick scars?
Other treatments for acne scarring besides the Fraxel laser and the topical medication Tazorac, which you say you have tried, include fractional C02, the dermaroller, subcisions and even possibly fillers. Depending on how it looks, even small excisions may be beneficial.
Ice Pick Scarring
Fraxel can help, like you said, for about 50% max of the scarring, but not for the very deep ice pick scars, as it cannot penetrate that deeply. I would suggest you seek consultation with a physician for filler (like Restylane) into these deeper scars. I've had great success in evening out the skin tone and scarring with this. You will have to do it every so often, maybe 1x per year since the spots are smaller and you're not trying to fill areas like the lips or nasolabial folds, but more targeted, small areas. Keep using your Tazorac as well, as it will control additional breakouts. If you do have any breakouts - don't pick or pop!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.