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 26
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.
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
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.
You might also like...
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
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.
Ice pick scar treatment
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.
Ice pick scars
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.
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!
Treatment of ice pick acne scars
Thank you for the question. The best result would be obtained from excising the scar and suturing it closed. You can follow this with a fractionated CO2 laser though I think microneedling for 5-6 sessions gets a better result. Also consider bellafill injections into the scars that are not ice pick scars at time of excision of the scars to improve other scars if present.