Dermabrasion Didn't Help my Ice Pick Scars

Christina,
What you are describing is a very difficult problem that we encounter in plastic surgery. As you know, options include laser, dermabrasion, or direct excision of the scars. The reason why these scars are so noticeable is because they are deep, and anything that deep on the skin will cast a shadow which is what catches the eye when you look at it. So the key to fixing this, regardless of the type of treatment, is to make the scars less deep so that there is very little shadow remaining.
For patients whose skin does not respond to lasers or dermabrasion, I will sometimes directl excise the deepest scars and then close the skin. This can be done with just a local anesthetic and with several small (a few millimeters long) incisions. I find that these scars heal very well and will look far better than most acne scars. I will usually treat a couple of the worst areas first and see if the patient likes the result, and then come back for the rest.
I hope that helps,
Dr. S

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

Dermabrasion is a good procedure for acne scarring but does have its limits. Sometimes a series of treatments is required for the best results. These  usually need to be spaced at least 6 months apart. "Ice pick" scars often need surgical excision as well.

There are many different options for managing ice pick scars:
Consider these other procedures:

Fillers or autologus fat grafting
Skin needling
Fractionated laser
Excision and puch grafting

Acne scarring is a difficult problem and realize that any improvement that achieves a 30% correction is considered maximally successful.

Microdermabrasion is not effective enough for ice pick scars. However, when the skin is pre-conditioned with prescription based skin care prior to Fraxel laser resurfacing procedures ( you will need 5-6 treatments), you will get nice improvement and great reduction in appearance of your scarring.

Acne scars come in many different forms.  Ice-pick scars (as the name suggests) are deep (crevice-like) and it is unlikely that dermabrasion will significantly help them.  They usually need excision, release of the tethering scar tissue, and re-approximation with fine sutures.  These areas can then be dermabraded later when they are flatter.  An alternative is subsision (with or without) the addition of a filler.  There are many different treatments for acne - your treatment should be tailored to YOUR scars - there isn't a single fix that works for everyone.  Other treatments can include laser, cell suspensions (ReCell), Botox, and Fillers (including fat).

Ice pick and deep pitted and crateriform scars are incredibly challenging problems to treat.  There is no perfect treatment that will completely remove these.  Dermabrasion runs the risk of leaving behind hypopigmentation and an unnatural skin texture that are tell-tale signs that someone's had dermabrasion (their skin looks waxy rather than having normal pore formation).  Fractional CO2 resurfacing is a much better and safer option.  No matter what you do, however, you need to have realistic expectations that your scars will never be gone and you may only realistically achieve 30-50% improvement after multiple treatments. 

Dermabrasion is a very effective technique to correct some scars, including acne scars. Dermabrasion works by sending down the area around a scar so that the entire surface is on the same level. For deeper scars, you may benefit from subcision or by filling the area underneath the scar with a dermal filler.

Ice pick scarring is a difficult problem to correct. There are several treatments I will use for patients with ice pick scarring. The first is to use a punch biopsy tool to elevated the skin around the scar. The incision is then allowed to heal and about 3-4 weeks later, I use either dermabrasion or dermasanding to smooth the area. Another option is a process called subcision. The basic ides is to use some type of needle to undermine the scar and then fill the area to prevent the scar from reforming. The filler can be either a temporary or permanent filler, though often even a temporary filler will produce a permanent result. The last option is direct excision. This produces excellent results and sometimes needs to be combined with dermabrasion or dermasanding.