Laser Resurfacing and Microdermabrasion for Acne Scars?

I have ice pick scars on my cheeks. I've done 5 laser resurfacing and 5 microdermabrasion treatments, but I don't see any significant improvement on my scars yet. I was told I still have 3 treatments left. Can I expect the scars to look better after 3 more treatments, or are there any other options I should be better off trying?

Doctor Answers 9

Punch grafts followed by resurfacing work well for ice pick scars

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Shallow scars respond very well to the treatments you mentioned, provided that the microdermabrasion is done by a doctor and deeper than what an aesthetician would do. I typically find that punch grafts for ice pick scars work well when they are done first before the resurfacing with dermabrasion, Fraxel or Portrait plasma. The narrow but deep scars are removed surgically with a very fine instrument using local anesthesia and the new hole is plugged with a small graft of your own skin, usually taken from behind the ear so it doesn’t readily show.

After this graft is left alone, most heal in their new location filling the icepick scar. Then resurfacing is done several weeks later to improve the texture and circular incision line around the graft and the other crater scars. At times 30 – 50 punch grafts are done per session and two to three sessions might be needed before the resurfacing. This is an old time treatment and still works better than the newest technology, although the latest in lasers or plasma resurfacing is used for the final stage.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Deep non-ablative fractional laser resurfacing plus ablative fractional is best for deep acne scars

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Deep ice pick acne scars are very difficult to treat. Surface laser resurfacing and microdermabrasion do not go deep enough into the dermis (deep layer) of the skin to promote new collagen to plump the scars.

Newer fractional non ablative resurfacing (Satrlux 1540) for 4 treatments followed by a deep ablative fractional laser resurfacing (Starlux 2940) produces the best laser results for acne scars.

It is important that an experieced laser doctor supervise or do your treatments. For effective results the laser power needs to be set at high. Many new laser users are not comfortable using the higher power settings required to effectively treat acne scars.

While microdrmabrasion is helpful for acne control, microdermabrasion alone will have no effect on deep acne scars.

Another very effective treatment is surgical. The ice pick scar is loosened with a surgical punch, which allows the scar to elevate and protude above the skin. Two to three weeks later, the laser is used to plane down the protruding skin and smooth the surface.

This technique unequivocally produces the best results for removal of ice pick scars.

Punch excision or TCA CROSS

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Ice pick scars lie deep in the dermis, and even though they may seem difficult to treat, they are one of the easiest scars to improve. I usually use a combination of TCA CROSS ( percentage of TCA depends on skin type), or punch excision with a 1-2 mm punch, then resurface with Erbium laser....expect 70-90% improvement with combination treatments. 


Dr Davin Lim 
Dermatologist, Laser and Cosmetic. 

Fraxel For Acne Scars

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Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel. This treatment 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.

Acne scars are difficult to treat

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The treatment is multimodality, including resurfacing (peels, (micro)dermabrasion, CO2 and erbium laser), fillers (HAs, radiesse, sculptra), and excisional surgery as with limited ice pick scar excision or skin lifting as with mini-lifting.

Of course, your skin condition should be as stable as possible under the regular care of a dermatologist or trained esthetician under the supervision of a physician.

Acne scars are difficult to treat! Be patient.

David J. Levens, MD
Coral Springs Plastic Surgeon
5.0 out of 5 stars 78 reviews

Ice pick scars need deep and full thickness treatment

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Laser resurfacing and dermabrasion generally treat surface irregularities.

Ice pick scars are essesntially holes in the skin that usually traverse the enitre thickness of the skin. The best treatment is to punch (cut) them out and then perform a resurfacing procedure to soften the resulting scar.

If I can provide an example to illustrate the point. IF you have a piece of wood that has a knot or worm hole that completely traverses the entire thickness of the wood plank, you can sand, buff, polish, plane and burr the wood plank all you want but you will never eliminate the "defect" unless you completely burr all the way through the wood.

If you do this in skin you will create a scar (3rd degree type wound).

Therefore, consider having the worst ice pick scars cut out and then dermabrasion or laser to eliminate the surface irregularity.

I hope this helps!

You will need fillers

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The laser tx will improve your skin to some degree. Fraxel been very effective since it penetrates deep and rebuilds your tissue. The acne starts from deep layers and skin tx do not penetrate deep enough to remove acne. Fillers and fat injection will work better.

Please discuss this with you doctor. If you have very deep acne you wil have better results from fat injection

Results depend on depth of resurfacing

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it is difficult to evaluate your situation without photos and laser settings. Ice pick scars sometimes need excision as well. Current thinking is that acne scars respond best to fractional ablative laser resurfacing either with erbium or carbon dioxide lasers. best advice is to see a practicioner with significant experience.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 45 reviews

Microdermabrasion or superficial laser will do nothing for ice pick scars.

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Hi! Ice pick scars are hard to treat, and "non invasive" treatments will not help. Sometimes, "non invasive" means "non effective".

DEEP laser resurfacing with the dual modality Contour laser ( long pulse and short pulse erbium laser) can often help. But this is done under anesthesia and has a one week recovery.

I am afraid you either have to learn to live with these annoying little scars, or you have to try something "invasive"!

George J. Beraka, MD (retired)
Manhattan Plastic 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.