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.
Best Treatment for Ice Pick Acne Scars?
Doctor Answers 21
You have a few good options for ice-pick acne scars
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.
Ice Pick Scars and Punch Excision
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.
Ice Pick Acne Scars and Treatment with Fraxel and eMatrix
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
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Acne scars- TCA CROSS or punch excision followed by laser
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
Treatment for Ice Pick Acne Scars
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.
TCA CROSS works for ice pick acne scars.
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
i follow a simple rule that has been great for my patients.
Light skin tone: pro-fractional laser or TCA localized treatment
Darker skin: subcision surgery or fraxel
Best of luck!
Ice pick scars
Acne scar treatment with Fraxel
Ice Pick Acne Scars
My favorite treatment is a strong focal chemical peel using the “cross hatch” technique. Trichloroacetic Acid (TCA) is the peel typically used. TCA peels are considered medium-depth peels (with 100% concentration being the strongest). In the treatment, the solution is applied to the bottom of the scar with a wooden instrument (like a toothpick) pressed into the base of the pit. A white crust forms on the scar base after the procedure is complete. This superficially deconstructs the bottom of the scar to stimulate collagen neogenesis and the healing process. This can fill in the scar, decreasing scar depth ideally helping the skin “blend in”.
Always consult with a board certified dermatologist for best results catered to your specific condition.
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.