What is the best treatment for ice-pick acne scarring? I am interested in doing Fraxel Re:pair, and maybe punch excision beforehand but would like more input.
Best Treatment for Ice Pick Acne Scars?
Doctor Answers (11)
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.
Treatment for Ice Pick Acne Scars
There are a few options for treatment of acne scars. Small, deep acne scars can be treated with surgical excision, which will ideally trade a depressed and discolored scar for a thin, flat scar.
Other techniques to improve the base of large or numerous scars involve resurfacing the skin by intentionally traumatizing it in order to stimulate collagen production. This thickens the skin and shrinks the surface area of the scar, and color may be improved as well. The Cross technique uses a very concentration of TCA peel. Lasers and dermabrasion (surgical resurfacing) are other techniques that are used to resurface large areas. Often, several techniques are used over time to get the best result. Patience is key since the full effect is often not seen for several months, and multiple procedures are usually necessary for a significant improvement.
Risks include temporary or permanent lightening or darkening of treated skin, crusting, scabbing, scarring, reactivation of cold sores, infection, redness, acne flares, milia formation.
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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.
TCA CROSS or punch excision followed by laser
Ideally I use erbium, with a downtime of 8 days. One treatment and its done and dusted. This combination of treatments can improve ice pick acne scars by upto 90-95%, in some cases, we can totally remove scars all together.
In summary, one of the easiest types of acne scars to treat, no matter what colour of skin you have.
Dr Davin Lim
Consultant Laser Dermatologist
Ice Pick Scars
The Focal Acne Scar Treatment (F.A.S.T.) procedure, which combines two different fractional CO2 lasers and delivers outstanding results in a short period of time. There is also the new platelet rich fibrin matrix (also known as PRP treatment or vampire facial), which promotes the growth of healthy skin and new collagen formation in and around the area of acne scars by introducing your body’s own growth factors deep into the dermis. This new acne star treatment is best used in combination with laser procedures and produces results that are very impressive.
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
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.