Best Treatment for Ice Pick Acne Scars?
- Asked by daniel in California
- 5 years ago
You have a few good options for ice-pick acne scars
Punch excision followed by a laser such as Fraxel re:pair which is a fractionated CO2 laser device is a reasonable strategy for ice-pick type scars in Fitz type I and II (lighter) skin types. I would caution you that in darker skin types, the risk of pigmentary problems is high. Lasers alone for acne scars in general are not that helpful, and much less so for pitted acne scars. Fillers while helpful for rolling scars, spoon-shaped scars, are usually not appropriate for ice-pick scars.
You do have a couple other options as well, including:
Saline subcision which involves breaking up the scar tissue under the ice-pick scars as one method to promote collagen growth.
The "Cross" method which involves spot application of a very strong chemical peeling agent to stimulate the growth of collagen can help "fill in" the ice-pick depressions over time.
To appreciate the results of saline subcision and the "Cross" method requires patience, since the final results are not fully achieved until a year after starting treatment.
I would consult with a qualified physician to review what option(s) would be most appropriate for you.
Ice Pick Scars and Punch Excision
Ice pick scars are characterized by punctate deep scars that are usually caused by deep cystic acne. These scars are difficult to resurface with laser or chemical peels because the base of the scar is deep with very steep sidewalls. The most effective treatment has remained punch excision with suturing despite many advances in lasers and chemical peels over the years.
Fraxel may diffusely improve the overall quality of the skin but there is no clinical evidence to support the claim that it will improve deep punctate ice pick scars. However, Fraxel laser resurfacing may improve more superficial scarring associated with chronic acne.
If you are considering a treatment for acne scars, you should discuss options with a physician who is familiar with the use of chemical peels, lasers, subcision, and punch excision of scars.
TCA CROSS works for ice pick acne scars.
For deep ice pick scars, I use TCA - CROSS, a technique which involves spot peeling with TCA 50% or 100%, applied at the base of the scar using a blunt, but fine probe. Results typically start showing around 6 to 8 weeks, with more improvement over 3 - 6 months, and it works fine even in darker skin, which is the type I predominantly get to treat. A test area targeting say, 5 to 10 lesions, should always be treated before going onto a larger area. This technique does have a downtime of about a week, during which time the treated areas may be covered with concealer/ make up.
Recent Acne Scars Treatment Reviews
Acne Scars Treatment Photos
Ice Pick Acne Scaring treatment with CROSS technique and fractional laser resurfacing
Ice pick acne scaring as the name implies, are deep fissures in the skin that extend well below the surface of the skin, which is why they are difficult to treat. For this reason, surface laser treatments even aggressive lasers such as CO2 lasers alone do not necessarily get to the base of the lesion to make much of an improvement. This is why excising the scar or grafting the scar has been suggested, however these approaches leave alternative scars, sometimes better but also with there own set of issues. A novel alternative is the CROSS technique where we use strong acid to burn the base of the scar creating a wound healing response that can restructure the wound in a way that lifts the base and contracts the edges. This is done over a series of treatments, often then combined with more surface laser treatments.
Fraxel For Acne Scars
Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.
Ice pick scars are hard to treat
I use a combination of subcision, laser resurfacing, deep chemical peeling to improve these scars. There are many variations with each technique that can be used to treat these scars. But you need a lot of experience and some out of the box thinking to really get the results. You can see my results on my website which represents what I can do. Below is a video showing one of our techniques.
I like Like Fraxel Repair and eMatrix for treating Ice Pick Scars.
Ice pick scars are very deep and and difficult to treat. Fraxel Repair laser and eMatrix work the best in my hands to treat ice pick scars. If you have extremely oily skin, it may be necessary to put you on isotretinoin (generic Accutane) for one week before the treatment and for one week following the treatment to to facilitate better healing without as much oil in the pores. eMatrix can be used to do touch up treatments as necessary.
Web reference: http://www.gatewaylasercenter.com/AcneScarBeforeAfter.html
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.