I Have Box Car and Ice Pick Acne Scarring on my Cheeks. My Dermatologist Recommended Radiesse.

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Doctor Answers 15

I Have Box Car and Ice Pick Acne Scarring on my Cheeks. My Dermatologist Recommended Radiesse.

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Since Radiesse is typically injected into the mid to deeper dermis I don't know that it's the best choice for this although, in all fairness, I'm not overly encouraged with the use of any non-permanent injectables for the long-term treatmennt of ice pick and acne scars.  A resurfacing treatment may be better but it is, either way, a challenge to remedy.

Dr. E

Radiesse for Acne Scars

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    Generally, restylane, juvederm, or belotero may be better for depressed acne scars.  These can be injected more superficially, which is what is needed.

Radiesse for Acne Scars?

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Hi Jilly.  Because Radiesse is typically injected into the deep dermis, it is not a good option for boxcar or ice pick acne scarring.  The only reason we can think of why your physician would recommend this is that they do not offer any laser resurfacing that can help.  We would either suggest a laser resurfacing procedure (traditional CO2, fractional CO2 or traditional Erbium) or subcision with a thinner injection product like Restylane or Juvederm that can be injected more superficially.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

NO Radiesse for acne scars...

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I agree with the other physicians... I do not recommend Radiesse for your type of acne scars.   Go see another provider for a recommendation.  Good luck.



Dr. Grant Stevens        Marina Plastic Surgery Associates          Marina del Rey, CA         The Institute



Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 152 reviews

Different Acne Scars require different treatment options

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First, I wouldn't recommend Radiesse for treatment of the acne scars that you mentioned. Ice Pick acne scars are best treated by excision followed by surgical closure. Box Car scars are treated with combination of scar subcision with filler. The filler of choice depends on the level of your acne scar. The most commonly used fillers in my practice for this indication are Juvederm and Belotero.


Best Wishes,

Stewart Wang, MD FACS

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

Combination Treatment For Acne Scars

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Combination treatment is almost always needed for scars like the ones you describe.  In my clinic, I start with subcising the scars under the surface of the skin to release the scar tissue pulling the scar down.  Then, I often do a combination chemical peel to even out the icepick scars and smooth the surface followed by a hyaluronic acid filler just as Juvederm or Restylane to the area if needed.  Laser resurfacing can also be very helpful in reducing the appearance of scars. 

Missy Clifton, MD
Bentonville Dermatologist

Filler for acne scars

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Acne scarring has to be divided into the type of scarring to determine the best treatment for your particular scarring.  Deep ice pick scars will not respond to  fillers.  Soft saucerized scars will respond the best, but often after the scar is subscised with a special needle and freed up from the deeper collagen to allow for filler or collagen stimulators to be place in that new pocket.  Using fractionated laser treatments in a series is often the best initial first step to smooth most acne scarring followed by subscision and careful placement of dermal fillers where needed.   Remember, treatment of acne scars in a process, not a single treatment.  Good luck!

Steven Swengel, MD
Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Hyaluronic acid fillers are great for ice pick acne scars

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There are numerous methods for improving the appearance of acne scars, and treatment usually requires more than one modality. For box cars and ice pick scars, I usually start with a series of FRAXEL resurfacing laser procedures. These results are long-lasting and improve the overall texture and tone of the skin. This is followed by subcision and then injection of the remaining pits with hyaluronic acid fillers. Subcision uses a special needle or cannula to loosen the underlying scars that tack down icepick scars prior to injecting the filler. Since acne scars become more prominent as we age (surrounding volume loss), filler can help address this issue as well. I favor hyaluronic acid fillers over Radiesse because it is softer and can be injected higher up in the skin.

Ramona Behshad, MD
Saint Louis Dermatologic Surgeon

Fillers Not Ideal for Box Car and Ice Pick Acne Scarring

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I completely disagree with the recommendation of injectable fillers for these type of acne scars.  They do not do well with injectable fillers, but rather with techniques that destroy the fibrous, pitted/punched out tissue of these types of scars. Such techniques would include electrosurgery, punch excision and occasionally laser and chemical peeling.  Injectable fillers work well for more broad-based, atrophic, depressed acne scars. Click on the link below to view photos of different types of acne scars treated with injectable filler (silicone) and/or electrosurgery and/or punch excision.

Channing R. Barnett, MD
Boca Raton Dermatologist
4.1 out of 5 stars 8 reviews

Acne Scars and Fillers

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Rystylane seems to work better for acne scars.  Why don't you consider having Dermabrasion as a permanent solution.  You may get tired of all those needle sticks, plus you will save money over time.  Consult with a Board Certified Plastic Surgeon, certified by the American Society of Plastic Surgeons (ASPS) for an evaluation to discuss your concerns and expectations.  Good luck to you!

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

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