Best Treatment for Box Car and Ice Pick Acne Scars?

I saw a dermatologist yesterday and she classified my acne scars as "minor, box car, and ice pick." I am wondering what the best treatment would be for these types of scarring? I am considering beginning with Microdermabrasion and also Fraxel Laser, but Fraxel may be out of my price range. Any suggestions? I am not looking for a miracle, any improvement is better than none. Thanks!

Doctor Answers 4

Treatment for Boxcar and Icepick acne scars.

For your kind of scarring, I have had success with a combination of subcision and spot application of strong chemical peel solutions such as TCA or phenol. With subcision, you would expect bruising and with the spot chemical peel application, redness or pigmentation that can last for weeks to months.

Microdermabrasion would not give you significant improvement in the kinds of scars you are describing. The fractionated CO2 lasers (Fraxel repair and Deep FX) can give you significant improvement if you have the 7-10 days of available down-time.

Good luck.

San Diego Dermatologist
5.0 out of 5 stars 5 reviews

Fractional CO2 laser, Traditional CO2 laser, or dermabrasion would be your best choices

Thank you for your question.

For ice pick and box car scarring, you will need something more aggressive than Fraxel. In your case, I would consider microdermabrasion worthless as it does nothing to remodel the dermal collagen.

I would strongly consider doing fractional CO2 laser as it is the newest technology for resurfacing, with minimal downtime, that would be the best at resurfacing your type of acne scarring. In addition, you can consider the traditional CO2 laser, but there is up to 2 weeks of downtime associated with any treatment. Other options include traditional dermabrasion where the skin is sanded down manually or mechanically, however, there is also significant downtime. The last options include TCA 90% spot treatments, subcision, or excision of acne scars.

Hope this helps!

Don Mehrabi, MD
Beverly Hills Dermatologist
5.0 out of 5 stars 1 review

TCA Cross+ Erbium ...done and dusted

Yes, I agree, TCA CROSS, if you have skin type 1-2, 80-100% TCA to the ice pick, feather the box car scars with say 50-70% TCA, give this 3 months to settle, then see someone who can do erbium full resurfacing. The first procedure raises the scars up, the second (Erbium Laser) treats UNDER the scar, results will be outstanding. In Australia, part of this process of acne scar revision is covered under Medicare. 

Hope this helps, 

Dr Davin S. Lim 
Cosmetic and laser dermatologist

Davin Lim, MBBS, FACD
Brisbane Dermatologist
5.0 out of 5 stars 43 reviews

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.

Daniel Shapiro, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 92 reviews

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.