Can ice pick scars on my nose be treated by subcision?

Question

I have some ice pick scars at the nose area, wondering whether subcision can be done or co2 laser.

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Raffy Karamanoukian
Realself100 Surgeon

Matthew Richardson, MD · Answer

Each patient is unique when it comes to treating facial scars. Some scars will respond well to resurfacing with laser, others to peels, some need more aggressive resurfacing such as dermabrasion. Fillers can often be a good option as well. Subcision is not something I perform as I simply do not think that it works very well.
An in-person consultation with a surgeon specializing in facial aesthetics can be very helpful.
All the best,

Oxana Popescu, MD · Answer

Hello and thank you for your question. 
Both treatment methods are good, but according to the location I would be inclined to use subcision.
Stay well,

Oxana Popescu MD

Michele S. Green, MD · Answer

I agree with Dr. Lim in treating these scars either with TCA or eMatrix Laser.  A photo of the scar would be helpful to evaluate the area and determine the best combination of treatments. PRP with microneedling is also very effective with superficial scars. Please consult an expert in acne scars for the best treatment.  Best, Dr. Green

Justin Harper, MD - Account Suspended · Answer

Hi Chris,
It would have been great to see photos to see what type of other scars you have and your skin color. "Some" is quite subjective. Among the treatments to consider aside from subcision and Fraxel (which you know about) are Bellafill (a dermal filler) and/or TCA CROSS (Chemical Reconstruction Of Skin Scars using trichloroacetic acid TCA). It's not the same as the peel.
Why skin color? Darker individuals have a higher tendency to form scars and PIH, in which case we may try the PRP and microneedling method if your scars aren't very deep or numerous.
It would be best to treat active acne before treating the scars. 
All the best, 
Justin Harper, M.D.

Davin Lim, MBBS, FACD - Account Suspended · Answer

A photo will be great, but best treated with TCA CROSS. If you have skin that is ethnic, then the area may temporarily darken - known as PIH. You will require 2-3 sessions. More info. in the web reference below under how to treat acne scars.  All the best, Dr Davin Lim. Brisbane. Australia.

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