Options for Shallow Scarred Pores or Ice Pick Scarring?

Question

I have this scarring across both my cheeks, nose, and forehead from years of blackheads and whiteheads. What laser treatment or other options would be best?

Raffy Karamanoukian, MD, FACS · Answer

Great question.  Ice pick scars can be improved with TCA Cross or punch graft procedures.  These are hard acne scars to fix, although.

Tanuj Nakra, MD, FACS · Answer

Becky,

	There are several variables that affect the treatment options that are appropriate for acne scarring.  The most important variable is your genetic pigmentation level, measured  by the Fitzpatrick scale. (look this up on wikipedia).  In general, lighter complected patients can get away with more aggressive treatments that can be significantly more effective than the less aggressive treatments.  Darker complected patients can have severe and possibly permanent scarring and abnormal pigmentation with aggressive treatments.

	 From your picture, it is difficult to tell your skin type, but I would guess that you are a II or III.  Laser resurfacing such as a CO2 laser or dermabrasion would be the most effective (and most aggressive) way to achieve an improvement in deeper ice pick acne scars.  Fractionated lasers offer some of these benefits in a less aggressive treatment pattern, resulting in less downtime.  In addition, fractionated lasers can sometimes be utilized for darker Fitzpatrick skin types.

	The best advice for you is to have an in-person consultation with an experienced skin resurfacing surgeon who can evaluate your skin type, assess your goals and comfort level with downtime, and then suggest options.  Based on your photo and the limited information that we have about you, my guess is that fractionated lasers are going to be your best option.

	Good Luck

Daniel Shapiro, MD · Answer

Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.

Renita (Lourdhurajan) Rajan, MD, DNB · Answer

For the scars from the photo, fractional resurfacing with laser/ radiofrequency devices would be good. You can also consider TCA CROSS, from a dermatologist who offers this service near you. You can start with a small test area for CROSS, and then go on to larger areas.

Steven Wallach, MD · Answer

There are a multitude of treatments for acne, and acne scarring. I use skin care lines with retina-a and hydroquinone to clear up skin dyschromias. I use IPL lasers, and Thermascan lasers to tighten pores and clean up acne as well as sun spots and ruddy complexions. I will even to microlaserpeels to "clean up" the skin. And there are more choices.

Kari L. Colen, MD · Answer

I have had a lot of success with the Fraxel re:pair laser for treating acne scarring. It is not a 100% improvement, but can be close to 70% depending on the setting used. It also helps with skin discoloration, skin tightening and and fine lines. You have real down time for 2-3 days and then red, like a sunburn for a week or two. It is definitely worth it.

Theodore Katz, MD, FACS (retired) · Answer

There are several alternatives which may be helpful ranging from dermabrasion to laser treatments. My preferred mode at present is the Fraxel re:pair and I have had success with this form of treatment. It is a fractionally ablative laser rather than fully ablative which means that the tissues removed are on a microscopic level up to about 70%, rather than 100% for fully ablative. The fully ablative lasers (as well as dermabrasion) is 100% and has a prolo9nged healing time. The fractional lasers allow some normal tissues to remain that speed up the healing process and the actual "down" time is significantly less. Yopu may be out of commission for 2-3 days, then be red (like a sunburn) for about two weeks. I have done a lot of men as well. The healing process helps to resurface the skin and stimulates new collagen synthesis (production) which helps to fill in the depressed scars over several months and gives a more youthful glow to the skin. The skin will never be completely smooth but will be sufficiently improved that most patients are quite pleased. This is also a one time treatment. I will be posting post treatment photos in the near future.

Options for Shallow Scarred Pores or Ice Pick Scarring?

Answers (7)

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