How to go about treating my ice pick scars via a more aggressive approach? (Photos)

Question

I am a 24-year old female. I use to have bad cystic acne and now I suffer from deep pitted scars and enlarged pores. I've tried microneedling, microdermabrasion, chemical peels, and IPL photo treatments for months at a time but nothing helps. I'm now looking into a more aggressive approach! Fraxel? Surgery?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Monica Boen, MD · Answer

Thank you for your question and I’m sorry you haven’t seen positive results to date. Treating acne scarring can be extremely challenging as every patient’s needs are going to be different. You need a customized treatment plan that addresses your specific scars with the precision necessary to achieve the best possible outcome. This requires experience and expertise from a dermatologist that is board certified. 
In my practice, we offer more than 45 different laser devices so that we can tailor treatments to the unique needs of each patient. We also perform RF microneedling, which offers more dramatic effects than standard microneedling alone. It is possible that you will need a combination of procedures to minimize the appearance of your scars. Keep in mind you may not be able to eliminate them completely, but you should be able to get very satisfying results.

Ron Shelton, MD · Answer

It is important to know that removing acne scars is not a realistic goal but often we can significantly improve scars. Some ice pick scars are best treated first by punch grafts or CROSS technique with TCA acid then after the scars improve resurfacing with laser or microneedling can be done.Infini microneedling has provided very good results in some of my NYC acne scar patients. However, this is microndeedling with radiofrequency (RF) energy (Infini) which is much more effective than at home microneedling which is not expected to make scars much better because those needles don't penetrate into the deep dermis. Furthermore, Infini fractional microneedling with radiofrequency is more effective in all likelihood than microneedling done in a medical office with a "pen" that does not use radiofrequency energy. The risk of post-inflammatory hyperpigmenation (darkening of one's own pigment) is greater with Fraxel laser and other lasers than with Infini microneedling with RF.  Usually I do three treatments once per month and then wait six months before another series is done as improvement continues without treatment as new collagen is produced as a response to the microneedling.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Manjula Jegasothy, MD · Answer

Fruit-based light acid peels, Fraxel® laser and quality skin care are great for treating brown spots, pink spots and scars. For a customized treatment please consult a board certified aesthetic dermatologist for a consultation.

Manish Khanna, MD, FRCP(C) · Answer

Hi tvnsilk, Thanks for your question and for sharing your photo. I highly recommend consulting with a dermatologist who specializes in laser treatments and has a wide range of options. It's not so much that you need agressive treatments as you need the expertise of a skilled team who can recommend the best treatment for you. There are several option that include ablative resurfacing, non-ablative resurfacing and more recently radio-frequency with microneedling. The results come from how these technologies are used on your skin and not from the devices themselves. The parameters used for treatments as well as the technique used will impact the success. Research a physician on his platform and invest in a consultation or two. Hope this helps, Manish Khanna, MD FRCPC

How to go about treating my ice pick scars via a more aggressive approach? (Photos)

Answers (7)