Small ice pick scars that aren't improving- TCA cross or other procedures? (Photo)

Question

I have small ice pick scars all over my cheeks that haven't really responded to microneedling and fractional co2. Would I be a good candidate for TCA cross or alternatively what procedures might help with these ice pick scars? Also I'm not sure if I have scarring or large pores around my nose area? Thank you!

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

TCA CROSS, WHICH I HAVE BEEN USING FOR TWENTY-FIVE YEARS, UNLIKE SO MANY OF THE EXPENSIVE LIGHT AND ENERGYBASED GIZMOS OUT THERE (AS YOU HAVE LEARNED THE HARD WAY), HAS A PROVEN TRACK RECORD FOR SAFETY AND EFFICACY FOR TREATING ICE PICK SCARS AND DILATED PORES. 
MICRONEEDLING IS BEST RESERVED FOR TREATING SUPERFICIAL, SURFACE TEXTURE AND COLOR ISSUES. SO, NO SURPRISES AGAIN ABOUT THE LACK OF BENEFIT WITH THIS APPROACH. 
YOU WOULD BE WISE TO SEEK CONSULTATION WITH A BOARD CERTIFIED COSMETIC DERMATOLOGIST ACNE SCAR TREATMENT SPECIALIST. HOPE THIS HELPS AND BEST OF LUCK.

Zoran Potparic, MD · Answer

A traditional dermoabrasion is a gold standard for acne scars. In many patients it has to be repeated or combined with other techniques to achieve satisfactory improvement. Good luck.

Small ice pick scars that aren't improving- TCA cross or other procedures? (Photo)

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