Best Treatment for Ice Pick Acne Scars?

What is the best treatment for ice-pick acne scarring? I am interested in doing Fraxel Re:pair, and maybe punch excision beforehand but would like more input.

Doctor Answers 27

You have a few good options for ice-pick acne scars

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Punch excision followed by a laser such as Fraxel re:pair which is a fractionated CO2 laser device is a reasonable strategy for ice-pick type scars in Fitz type I and II (lighter) skin types. I would caution you that in darker skin types, the risk of pigmentary problems is high. Lasers alone for acne scars in general are not that helpful, and much less so for pitted acne scars. Fillers while helpful for rolling scars, spoon-shaped scars, are usually not appropriate for ice-pick scars.

You do have a couple other options as well, including:

Saline subcision which involves breaking up the scar tissue under the ice-pick scars as one method to promote collagen growth.

The "Cross" method which involves spot application of a very strong chemical peeling agent to stimulate the growth of collagen can help "fill in" the ice-pick depressions over time.

To appreciate the results of saline subcision and the "Cross" method requires patience, since the final results are not fully achieved until a year after starting treatment.

I would consult with a qualified physician to review what option(s) would be most appropriate for you.

San Diego Dermatologist

Acne scars- TCA CROSS or punch excision followed by laser

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Ice pick scar....sounds deep, and hard to treat, but they are one of the easiest acne scars to treat....and treat well. I usually use TCA CROSS  70-100% , several sessions, or 1-2 mm punch, suture, then heal. This is then followed by total or full laser resurfacing.

Ideally I use erbium, with a downtime of 8 days. One treatment and its done and dusted. This combination of treatments can improve ice pick acne scars by upto 90-95%, in some cases, we can totally remove scars all together. 

In summary, one of the easiest types of acne scars to treat, no matter what colour of skin you have. Review my before and afters on acne scarring for an idea or watch the video in the web reference. 


Dr Davin Lim
Consultant Laser Dermatologist

Ice Pick Scars and Punch Excision

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Ice pick scars are characterized by punctate deep scars that are usually caused by deep cystic acne. These scars are difficult to resurface with laser or chemical peels because the base of the scar is deep with very steep sidewalls. The most effective treatment has remained punch excision with suturing despite many advances in lasers and chemical peels over the years.

Fraxel may diffusely improve the overall quality of the skin but there is no clinical evidence to support the claim that it will improve deep punctate ice pick scars. However, Fraxel laser resurfacing may improve more superficial scarring associated with chronic acne.

If you are considering a treatment for acne scars, you should discuss options with a physician who is familiar with the use of chemical peels, lasers, subcision, and punch excision of scars.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Ice pick scar treatment

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There are a few different ways to treat ice pick scars. 

1. Punch grafting followed by laser resurfacing or dermabrasion

2. CROSS TCA--using a strong chemical peeling agent to the scars themselves.

Both of these work very well, but one should seek a very experienced surgeon to treat this type of scarring.

Robert S. Bader, MD, FAAD
Boca Raton Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Ice Pick Acne Scars and Treatment with Fraxel and eMatrix

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The gold standard for treating these ice pice acne scars is the Fraxel laser.  I have had great results with the Fraxel in treating these difficult scars.  However, if you have type III skin or darker, I reserve treatment with the eMatrix.  It is a "color blind" laser and can best treat these scars without any risk of hyper pigmentation.  Sculptra may also need to be injected to increase the collagen naturally in the skin.  PRP also has some added benefits as well.  Please consult a board certified dermatologist with expertise with these lasers and cosmetic injections and acne scars.  Best, Dr. Green

Treatment for Ice Pick Acne Scars

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There are a few options for treatment of acne scars. Small, deep acne scars can be treated with surgical excision, which will ideally trade a depressed and discolored scar for a thin, flat scar.

Other techniques to improve the base of large or numerous scars involve resurfacing the skin by intentionally traumatizing it in order to stimulate collagen production. This thickens the skin and shrinks the surface area of the scar, and color may be improved as well. The Cross technique uses a very concentration of TCA peel. Lasers and dermabrasion (surgical resurfacing) are other techniques that are used to resurface large areas. Often, several techniques are used over time to get the best result. Patience is key since the full effect is often not seen for several months, and multiple procedures are usually necessary for a significant improvement.

Risks include temporary or permanent lightening or darkening of treated skin, crusting, scabbing, scarring, reactivation of cold sores, infection, redness, acne flares, milia formation.

Dana Goldberg, MD
Jupiter Plastic Surgeon
4.9 out of 5 stars 41 reviews

TCA CROSS works for ice pick acne scars.

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For deep ice pick scars, I use TCA - CROSS, a technique which involves spot peeling with TCA 50% or 100%, applied at the base of the scar using a blunt, but fine probe. Results typically start showing around 6 to 8 weeks, with more improvement over 3 - 6 months,  and it works fine even in darker skin, which is the type I predominantly get to treat. A test area targeting say, 5 to 10 lesions, should always be treated before going onto a larger area. This technique does have a downtime of about a week, during which time the treated areas may be covered with concealer/ make up.

Treatment of ice pick acne scars

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Acne scars can be a difficult problem, but there are many options to improve them. Each patient's scars and skin tone are unique and will affect treatment options. For deep ice-pick scars, excision can often be the best option, and when followed up with a resurfacing treatment (laser, peel, dermabrasion), dramatic improvements can happen. It is important to remember that once a scar is present on the skin, there is almost nothing that can make it go away completely, but there are many things we can do to make it MUCH better.

All the best,

Matthew Richardson, MD
Frisco Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Ice pick scars

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Ice pick scars are the most difficult type to treat, and often require multiple modalities to get satisfactory correction. Which modalities are you should be custom tailored to your individual needs, which includes your skin type in the exact type of ice pick scarring that you have. 

I often employ combinations of ablative laser resurfacing, such as CO2, TCA CROSS, microneedling, injected PRP, and subcision. Subcision requires an expert to do it properly and thoroughly, as it is similar to undermining during a facelift, but is an essential aspect of the treatment plan. 

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.

Cameron Chesnut

#realself500 Physician

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 123 reviews

Acne Scars

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Thank you very much for your question. Acne scars can be one of the most difficult things to treat. We have seen some great response with a combination treatment of Profound and CO2. The profound will stimulate collagen and tighten the skin, making the scars less apparent, and the CO2 will provide a complete resurfacing. It is imperative that you find a doctor that has experience with both, before you treat this aggressively. They also need to make sure that your skin type is the right candidate for these treatments. Good luck!

Janet Allenby, DO
Delray Beach Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.