Deep ice pick scars, hyperpigmentation and enlarged pores. Can I treat this with Fraxel then TCA? (Photo)

Question

I have deep ice pick scars and some hyperpigmentation and enlarged pores, getting 4 Fraxel laser treatments. I read that TCA peels give best results for ice pick scars, and then Fraxel laser afterwards for better results. Can i get Fraxel first then TCA or is it better to get TCA first then Fraxel, results wise. I was also told by dermatologist that the Fraxel treatment will shrink pores permanently, but infor online about this being a genetics thing and therefore cant shrink them permanently.

Nelson Lee Novick, MD · Answer

TCA CROSS works well for treating ice pick scars and dilated pores. This quick and relatively inexpensive procedure has more than a twenty year history of proven efficacy and safety in all skin types.  Once this is done, if still deemed necessary or desired, professional microneedling can be performed to help better blend any residual superficial color or textural irregularities that may be present. Be very cautious in falling prey to the heavy marketing for this or that relatively expensive fraxel laser or other energy devices since the hard science to support the use of these "bells and whistles" lags well behind the marketing hype. It would be wise to keep in mind that simple solutions are often the best. Hope this helps.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

at home peels like cosmelan, enlighten and aerify along with dermarolling (Emerageskin roller with anteage MD AERIFY ampules weekly) should be started now (see link to emeragecosmetics).

if you have post inflammatory hyperpigmentation/melasma/discoloration that needs cosmelan or enlighten peels at home which we can do virtually and send to your home along with aerify peels regularly, vivatia foam, restorsea 10x, faith essence serum, and cosmelan 2 cream.

Acne scar treatment needs a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, halo, maxi, pro fractional laser/erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif or fractora microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we already pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments.  Best, Dr. Emer.

Deep ice pick scars, hyperpigmentation and enlarged pores. Can I treat this with Fraxel then TCA? (Photo)

Answers (3)

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