Would fractional CO2 laser offer any improvement on ice pick scars on my nose? No physicians do TCA cross in my region (Photo)

Question

I have had two ice pick scars excised on the bridge of my nose which actually created bigger scars, and I have also completed 6 sessions of microneedling with Rejuvapen with little results. The only other option in my area is fractional co2 laser (specifically CO2RE laser). Would this offer any improvement? There seems to be many differing opinions about the efficacy of these lasers in this type of scarring. Thanks for any and all help!

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Cameron Chesnut, MD, FAAD, FACMS · Answer

Ice pick scars are the most difficult type to treat, and often require multiple modalities to get satisfactory correction. Which modalities are used should be custom tailored to your individual needs, which includes your skin type and 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 on the nose is significantly different than in other parts of your face, and requires an expert to do it properly, but can be an important aspect of the treatment plan.  All these together are designed to achieve significant results with one treatment, which does allow people to travel in and achieve their goals in one trip. 
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

Jason Emer, MD · Answer

nothing helps ice pick scarring except for TCA cross and  microneedling RF like intensif.  Pores will not improve with either as these are genetic and need long term skin care, lasers/RF, microneedling.  I suggest you see an expert.  Best, Dr. Emer.

J. Kevin Duplechain, MD, FACS · Answer

Your photos were very helpful.  both TCA Cross and C02 resurfacing would be helpful in improving your problem.  Because the skin of the nose is relatively thick, and also because there is no subcutaneous fat here, I would recommend a more fully ablative c02 treatment, and also recommend dermabrasion in this area.  Dermabrasion is still an excellent choice for these  types of conditions, and is very capable of providing great results.

P. Daniel Ward, MD · Answer

Without question, fractional CO2 laser resurfacing can help improve ice pick scars. We use both CROSS techniques and fractional CO2 resurfacing and have used both with good success.

Would fractional CO2 laser offer any improvement on ice pick scars on my nose? No physicians do TCA cross in my region (Photo)

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Would fractional CO2 laser offer any improvement on ice pick scars on my nose? No physicians do TCA cross in my region (Photo)

Answers (6)

Answer: Fractional C02 for acne scars

Answer: Fractional C02 for acne scars

Answer: Ice pick scars

Answer: Ice pick scars

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Recommended reading

Everything you need to know about CO2 Laser

Our mission is to create a world where every investment in modern beauty is Worth It.