Deep Acne Scar on Forehead? (photo)

I have deep ice pick and rolling scars on my forehead I have had 3 fraxels done and no significant change what are my next best option will punch graft work?

Doctor Answers 5

Treatment of Acne Scars On Forehead

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Based on the picture, it seems you have mostly depressed/rolling acne scars with a few more ice-pick type scars on the forehead. I think laser is a waste of time for these kind of scars. Injectable filler works very well for the depressed/rolling/atrophic scars and punch excision, TCA Cross or electrosurgery works well for the more ice-pick and pitted scars. Click on the link below for some before and after pictures of patients with acne scars treating with injectable silicone (a permanent filler that is great for acne scarring) and/or electrosurgery. 

Deep ice pick acne scars on forehead

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One question is what were the settings of the fractional laser treatment.  How deep and how close together?  Also, many times acne scarring requires an ablative treatment that will deal with the surface of the scars as well.

My concern about punch grafting is the number of scars that will need to be excised.  I would consider another fractional treatment combined with the ablative laser peel. 

For the more narrow scars, you may also consider the CROSS technique.  All of these procedures need a high level of expertise.  Please consult a board certified dermatologist or plastic surgeon with proper training and experience in these procedures.


Emily Altman, MD
Short Hills Dermatologic Surgeon

Acne Scar Resurfacing with EMATRIX

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Deep ice picked scars typically respond well to ablative laser treatments such as a CO2 fractionated laser. Punch graft acne surgery would work very well on the really deep scars, followed by an additional resurfacing procedure. We are seeing great results with doing a combination of punch acne surgery with E-Matrix. This procedure is safe, with little to no downtime. It directs energy into the dermis of the skin to increase the elastin and collagen and to fill in the deep scars. A typical acne patient needs 4-6 sessions, which last only 15 minutes. No topicals anesthesia is needed. Consider this treatment. We are more than happy to assist you if you have any further questions.   

Diane Walder, MD
Miami Dermatologist

Acne Scarring

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I would suggest you consider a type of chemical peel called a CROSS chemical peel to improve the worst of the scars.  It may take a few treatments to get improvement.  Once that is done, there may be 2 or 3 areas that could be improved with a punch graft.  Once that is all done, you will probably benefit by having 3 or 4 more Fraxel laser treatments done.  From your picture it looks like you have darker skin so a more ablative fractional treatment may not be in your best interest but should be at least considered.  Hope this helps.


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The options you have for your acne scars are Laser treatment, as Profractional laser or even a mini face lift to stretch out the skin and get rid of the scars. Fillers are not long lasting results. You should look into laser. Good luck


Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

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