I've been told they are ice pick but i don't know if all of them are ice pick or just some of them. I have a feeling I have a mixture of ice pick and boxscar/rolling but not sure. What treatment would you suggest for the indents? Is TCA Cross something I should consider? Thanks
What Treatment Would You Recommend for Ice Pick Scars?
Doctor Answers 6
Many of the fractional lasers do a very good job, as does the eMatrix from Syneron. Find a BCAPS in your area with one of the listed technologies and have a consult.
Ice pick scars
Treatment of ice pick acne scars
I treat a lot of acne scars and have had excellent success treating scars such as yours using a combination of punch excision, subcision, dermal grafting, and skin resurfacing. In any given case it may not be necessary to use all of these treatments; only 1 or 2 may be needed. While your skin will never look as if it never had acne scars, I believe that you shouldl be able to achieve substantial improvement in the appearance of your scars.
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Acne scar treatment
Dear Hope11, the scars that show in the pictures you posted, would respond to CROSS technique, as you mentioned. Other options are punch excision, or punch grafting. Subcision can be done for more shallow scars. Any of the aforementioned procedures can be later enhanced by a resurfacing procedure such as dermabrasion, sandabrasion, chemabrasion, or fractional/ablative laser. Your dermatologist/plastic surgeon can discuss which method[s] would be best for your skin type & your work/social engagements.
Treatment of (Acne) Scars
Scars are often difficult problems to address because patients want them to be completely gone following treatment. Unfortunately, there are no medical or surgical treatments to remove scars completely. Scar treatment or revision is a very individualized procedure that depends upon the appearance, characteristics, and size of the scar(s). In general we would evaluate a scar(s), determine if some reasonable improvement could be obtained, and then discuss treatment options and expectations.
Your pictures demonstrate ice pick scarring and the textural irregularities commonly associated with acne scarring. The more severe the scarring, the more difficult it is to achieve a nice smooth result. In patients with darker skin colorations pre-operative skin care products, including retinols, skin bleachers and sunscreens, may be helpful in reducing hyperpigmentation. Continuing these skin care products after the treatment is also beneficial.
Scar excision and revision involves a surgical procedure to remove the scar and then suture the skin; followed by months of care to try to optimize the healing and maturation. Surgical scar revision of any kind does involve certain risks. These risks include changes in pigmentation possible red coloration or fine visible capillaries within a scar, infection, and surface texture changes such as a raised or depressed scar. It is important to consider these risks when evaluating a scar for possible improvement, and all of these should be discussed thoroughly during your consultation.
Many acne scars tend to be depressed compared to the surrounding skin surface. If they are small and deep, one option may be to excise them with a round punch and close them with sutures; the goal being to achieve a smoother more even skin surface.
If the scars are larger or numerous then laser resurfacing may be a better option. I recommend skin preparation prior to laser resurfacing in all patients; this improves healing and reduces risk. We have found the Fraxel Laser and the Pearl Fractional (Pearl Fusion) Laser to be beneficial for acne scarring (but certainly there are other lasers that would be effective as well). We prefer laser treatments to chemical peels and find them more consistent and effective. The specifics of these procedures should be discussed in detail during your consultation.
Pigmented scars can be difficult to treat. Some of this may respond well to skin care products and superficial laser resurfacing, while others may need deeper resurfacing. It may not be possible to remove all the pigment. Pigmented scars should be approached carefully to avoid worsening the pigmentation.
Some individuals may be require multi-modality treatment to achieve the best result. In that case surgical excision should be performed prior to laser resurfacing. It is also important to perform these treatments in the absence of active acne. If a patient is still having significant outbreaks it would be best to control those prior to pursuing scar treatments.
Combination approach is often the best for acne scars
While your scars are the appropriate subtype for CROSS technique, I would be concerned that based on the width of the scars, CROSS technique would not be ideal. This is also taking into consideration your skin color. I would agree with Dr. Biesman that a combination approach of subcision, punch excision, and resurfacing may be the best approach.