Would an elipse excision be more discrete for ice pick scars? (photo)

I have had these two ice pick scars for years on my cheek. The multiple laser treatments including fraxel have somewhat smoothed the edges after spending $$time but now they look like craters. I want them gone!

Doctor Answers 3

Options for acne scars

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I would stay far away from an elliptical excision of those type scars - location is bad and there are much better options for them. Subcision (running a needle or cannula back and forth under the scar to "release" the vertical scar fibers that hold the scar down) can be combined with filler and/or laser to fill in the defect. Probably won't look like a perfect, never scarred cheek but - especially with the laser treatments you have already had - you should get really results in terms of minimizing scar appearance. Don't make a rash or poor decision out of your frustration - time and additional treatments will improve these scars. I see it all the time! Hang in there!

Cheek scars and laser resurfacing in Los Angeles

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Subicision and laser resurfacing may be good options to reduce the visibility of the scars on your cheeks. 

Raffy Karamanoukian MD FACS
Los Angeles

Subcision & Fractional Microneedle Therapy Work Well For Acne Scars

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Subcision is an approach directed at freeing up bound-down scar tissue, such as acne scar tissue, and elevating the surface. Under local, the scar tissue is broken up and the overlying tissue freed up to float to the surface and more normal collagen production promoted in its place. The procedure requires only minutes to perform and may be repeated one or more times in order to achieve better cosmesis every six to eight weeks. 

Fractional Microneedle Therapy, aka medical microneedling, may represent a viable, minimally invasive option for improving the color and texture of the surface of such kinds of scars, since surface color is typically off-white rather than normal flesh-tone..This technique has been used successfully for years to treat all kinds of scars, including those arising from acne. Unfortunately, by contrast, I have not been impressed with the results of lasers, including the fraxels, as evidenced by your own experience with them.

Microneedling for small areas, as in this case, can be performed using a Dermastamp. The Dermastamp employs an array of needles that pierce the surface of the scar to break up the surface tissue and create microchannels. Treatment requires only the use of topical or local anesthesia and takes only a minute or so to perform. 

The microwounding of the skin allows for the triggering of a cascade of events that result in new collagen formation (collagen neogenesis), but also makes possible disruption of troublesome surface discolorations. Two to four treatment sessions are usually required at a six week intervals for optimal results. Adding a topical bleaching agent to the regimen immediately following treatment can also be helpful, as can the adjunctive use of a home Dermaroller along with a mild prescription bleaching cream. This modality is associated with little post-treatment hyperpigmentation even in people of darker flesh tones, a possibility that incidentally does pose real concern with the use of fractional lasers.

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.