Scarring from blackheads/acne. Would a punch excision help? (Photo)

Microneedling, which is best used to treat very superficial, surface texture and color irregularities and topical tretinoin had little chance of working on a deep ice pick scar. So, no surprise there. If by TCA chemical peels is meant conventional 10%-35% peels, this, too, had little to no chance of success for this type of scar. A punch-excision runs the risk in this area of developing a stretch scar and tram track stitch marks, particularly in areas, such as the forehead, subject to a great deal of static and dynamic muscular tension. However, TCA CROSS, which I have been using for treating these kind of scars and which utilizes TCA in 90-100% concentrations, applied directly down the shaft of the scar has a very long track record for both efficacy and safety. Make sure that you consult with an experienced, board certified cosmetic dermatologist with acne scar experience. Best of luck.