Treatment for ice picked acne scars? Subcision, microneedling, what do you recommend? (Photos)

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best,
Dr. Raffy Karamanoukian
Realself100 Surgeon

Ice pick scars are the most difficult to improve and they do not respond to many treatments. I am a microneedling expert and can tell you microneedling would not be helpful for you. I know you have tried many treatments but I would consult with a physician experienced in fractional CO2 laser because  I feel that it can really help. You need a very deep laser and it might need to be repeated many times. 
Good luck.

See a scar specialist, I know you have tried TCA CROSS but was this done properly by a specialist using 100% 2-3 sessions. I would still explore RF Microneedling and PRP, with TCA CROSS, then subcision with or with out fillers. You will require 5-8 sessions to improve by up to 70%. Dr Davin Lim. Brisbane. Australia.  Acne scar specialist. 

Hi neversatisfiedinusa,I know you have tried TCA Cross but have you done this with Bellafill? I've seen good results with injecting a filler after the TCA Cross.I'm not sure whether you have tried Microneedling with PRP? It's not instant and would take about 3 sessions before you see effects. Microneedling with Vitamin C is also effective if you have hyperpigmentation. All the best,Justin Harper, M.D.