Best Laser Treatment for Ice Pick and Rolling Scars?

Question

I have some acne scars on my face, most are ice pick and rolling scars. Now I know there are 3 companies that provide laser treatment: Fraxel restore/repair, Palomar fractional laser, and Deep FX and Total FX. Which among the treatments is best for me?

Jason Emer, MD · Answer

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars. 
- Subcision for depressed, tethered scars. 
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars. 
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring. 
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

Daniel Shapiro, MD · Answer

Thank you for your question. At my practice, I use Fraxel Laser treatment. Fraxel 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.

Robert A. Weiss, MD · Answer

Acne scars can be diffficult to treat even in the most expert hands. Fractional resurfacing typically results in improvement, however improvement can range widely from 20 - 90%. A recently released XD optic for the Palomar Starlux and Palomar Icon systems was designed to deliver energy more deeply. We have seen responses on ice pick and other acne scars with this new device that have not responded to other non-ablative fractional lasers.

Steven E. Rasmussen, MD, FAAD · Answer

Treatment of acne scars is never as easy or as straight forward as we would like it to be, or as it is made out to be by some companies and some practioners. The treatment of acne scars, especially when there is a combination of fine pitting, deep ice pick scars and rolling scars usually requires many different treatment approaches.  
The easiest may be the treatment of fine pitting scars (which your picture seems to be showing). These type of scars can be dealt with various resurfacing modalities to include laser, true dermabrasion and deep chemical peeling. My personal preference is to use Total FX (combination of DeepFX and ActiveFX) because it is the only laser modality that will treat the deeper component of the skin, inducing new collagen (DeepFX) and then fractional resurfacing of the more superficial layers of the skin (ActiveFX).  
Due to the nature of acne scars, one to three treatments may be needed to get the full desired effect. As for deep ice pick scars, again, there are many ways to treat them as well to include punch raises, punch grafts, chemical acid ablation and a few other less common approaches. The goal in the treatment is to remove, raise or ablate the scar so that can be resurfaced along with the other small pitted scars. It is like filling in pot holes in the road prior to resurfacing the road. 
Lastly, rolling scars are usually addressed with subcision, which is done by inserting a needle under the skin after anesthesia is injected to cut or break up the deep scars that are tethering the overlying skin, resulting in the scar.
I hope you find this information helpful.
Good Luck!
Dr. R

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