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 6

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

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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!

Beverly Hills Dermatologist

Acne scars such as ice pick scars will not be treated well by Fraxel laser nor microdermabrasion

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Microdermabrasion does not effectively treat acne scars. Icepick scars are very narrow and deep and are usually treated in my NYC practice by first doing a series of punch grafts or 100% TCA CROSS application to lift the scars and then fractional laser resurfacing is done, whether as a series of Fraxel REstore / Dual laser treatments or one more aggressvie ( and more downtime) Fraxel REpair carbon dioxide laser treatment.

Lately two new devices have shown some improvement in acne scars. Infini microneedling with radiofrequency energy and PicoSure focus laser treatments.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. 

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Treating acne scars

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Acne scars are usually harder to treat than wrinkles.  Ice pick scars, the deep, very narrow scars that look like large pores, are the most difficult.  Microdermabrasion helps skin quality, can improve acne, and can help topical medications and cosmeceuticals penetrate the skin, but it is unlikely to help deep acne scars.  Even if you treat with Fractionated laser resurfacing like the Fraxel Dual erbium laser, it will take multiple procedures.  Those procedures are usually combined with injection of filler agents to either directly treat the scars (not icepick but can help shallower scars) or via stimulating the collagen to improve the skin overall.  So you may want to save the money you would have spent on microdermabrasion and wait until you can afford a full series of Fraxel treatments.  Alternatively, ask your dermatologist about intermediate procedures like clear & brilliant (like 'baby fraxel') or  aggressive microneedling.

I hope that helps answer your question.  Best wishes.

Heidi A. Waldorf, MD
New York Dermatologist
5.0 out of 5 stars 10 reviews

TCA Cross+ Erbium ...done and dusted

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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

Fraxel For Acne Scars

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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.

Treatment for Boxcar and Icepick acne scars.

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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.

Bryan K. Chen, MD
San Diego Dermatologist

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.