Best Treatment for Ice Pick Scars?

I have a mixture of large pores and ice pick scars in both my cheeks. which treatment could be best? tcs cross method of punch techniques?

Doctor Answers 1

Medical Microneedling and the CROSS Technique Work Well For Acne Ice Pick Scars & Enlarged Pores

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From the px provided, it would appear that there are some depressed acne scars present in addition to ice pick scars and enlarged pores. As a result, a combination of approaches, each addressing a specific kind of scarring would be likely yield the most gratifying overall results.

There are two components to a depressed scar that must be addressed in order to achieve maximum improvement. The first is to elevate the depressed central portion so that it becomes flush with the surrounding skin. The second is to try to improve the surface texture and coloration to whatever extent possible so that the area blends as seamlessly as possible with the surrounding normal skin.

Subcision is a simple, inexpensive and tried-and-true approach for elevating all kinds of scars (e.g. surgical, traumatic, acne, chicken pox). In this procedure, following local anesthesia, a sterile needle is inserted directly under the scar and moved about in all directions in order to break up the thickened, fibrotic scar tissue collagen fibers resulting in freeing of the bound down, depressed surface of the scar allowing it to float freely to the surface. Being flush with the surface eliminates the "craters of the moon" shadowing that often accentuates the scar defect. During the ensuing four to six weeks, new, normal collagen is synthesized to replace the scar collagen and remains to buttress the surface of the scar.

Generally, two to four subcision treatment sessions are required for sufficient new collagen to be made so that the surface of the scar is at or close to the surface of the surrounding normal skin. Since all the cutting is done below the skin surface, there is essentially no surface wound healing and no wound care or activity restrictions are needed.

Often patients find the improvement or elimination of the depression to be sufficient improvement to warrant no further treatment. However, if the disparity between the surface texture of the scar and the surrounding skin remains troubling, a series of medical microneedling treatments might be considererd. Medical microneedling, which may be performed mechanically using rollers (e.g. Dermaroller) or electrically operated (Dermapen) essentially consists of going over the area with an array of needles that penetrate and break up the surface of the scar and some of the underlying abnormal fibrous tissue.

Disrupting the surface of the scar allows for the possibility healing with a smoother surface texture to the scar. In addition, the use of the needles crossing between normal and scar areas allows for the possibility of micro-auto-transplantation of pigment cells from the normal periphery into the scar area, which may help to somewhat further even out the pigmentation. Following medical microneedling, the treated area may appear sun-burned for about 12-24 hours. There is little to no downtime, however, and I permit patients to return to routine skin care and makeup the following day. To hasten the results, I frequently perform the subcision and microneedling procedures in the same treatment session.

While ice pick scars and enlarged pores typically respond favorably to medical microneedling, they may also be treated with the CROSS technique (alone or in combination with the other techniques described) that employs full strength TCA 100% inserted deeply down the ice pick scar or down the pore to shrink them and close them off. 

New York Dermatologic Surgeon
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