I Have Ice Pick Scarring. Will Radiesse or Other Fillers Minimize Their Appearance? (photo)

I am a mixed race male with olive skin tone and I have ice pick scarring from old acne on my forehead and cheek area. Would Radiesse and other fillers be effective in minimizing the appearance of these scars or would I have to consider subcission, laser, or some other technique?

Doctor Answers 5

Acne Scars

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Patients with a darker skin type have a higher risk of post-inflammatory hyperpigmentation after laser treatment. For this reason, I would probably avoid more aggressive laser procedures.  I would consider a series of Dermaroller medical needling procedures to break up the scar tissue and soften the scars.  This is being used more and more by physicians who specialize in the treatment of acne scars, including myself.  It is a somewhat painful procedure but it is very quick and there is minimal recovery time needed afterwards.  For ice pick scars, I would recommend a series of CROSS treatments with 100% TCA.  This has replaced punch excision and punch grafting in my practice. 

Treatment for acne scarring

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Just as there are multiple kinds of acne scars, there are multiple treatments for each variety of scar. The results of these treatments depend as much on the skill of the treating physician as it does on the treatment being used. For your type of scarring, I would recommend a series of fractionated laser treatments to soften the transition at the edge of the scars, followed by Restylane filler injections to raise any scars that are not "bound down" with scar tissue. Of all of the fillers, in my opinion Restylane gives the best results for treatment of acne scars.

Combination treatment is the best

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I have found that the best way to treat acne scars is combination treatment.  You will need about 5-7 Fraxel Repair treatments along with a filler injections.  I have found that micro-droplet silicone injections work the best.  This is a permanent filler so you do not have to worry about having to repeat it once the scar is filled in.  it is safe to use as long as your doctor uses the micro-droplet  technique.  Also, make sure your acne is under control before venturing on any corrective procedures. It doesn't make sense to do corrective work if you continue to form scars.  Good luck!

Monica Halem, MD
New York Dermatologic Surgeon

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Fillers for Acne Scars

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There are whole books written on treating acne scars because there are so many treatments and none is perfect. For your type of scars, several treatments should be combined: lasers to blunt the edges and fillers to decrease the depth of the pits. Which filler depends on a variety of characteristics that can be assessed during a visit but Radiesse, Perlane, Restylane and Sculptra have all been used.  Each has its advantages.

I would say that you will require a few different treatments for optimal outcomes.

Kenneth Beer, MD
Palm Beach Dermatologic Surgeon

Using multiple modalities for treating acne scars

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Most people who have acne scars have different types of scarring.  There are the "rolling scars" which can be distended and appear to improve when the skin is stretched.  The deeper scars such as the "boxcar" (like a wide chicken pox scar) and the "icepick" scars are more bound-down to the deeper skin layers and are more difficult to treat.  It appears from your photo that you probably have all of these types of scars including a number of the deeper ones.  If you try to put any type of filler under a boxcar or icepick scar, you may end up with a doughnut type of effect where the filler spreads to the outer portion of the scar and the deep, middle portion remains bound down.  If this happens, the scar will most likely look worse.  The best option for these scars is to do punch-excision or punch-grafting initially to replace the deep scars with a more superficial scar.  Then you can use a fractional resurfacing laser to blend and possibly subcision (breaking up deep scar tissue with a special type of needle) and/or filler for more resistant rolling scars.  As you can see, there is no magic bullet that works for all acne scars.  Multiple modalities used in combination will give you the best results.    

Nancy Samolitis, MD
West Hollywood Dermatologic Surgeon

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.