Hi, this is Dr. Young. What we're doing is treating acne scarring. There's a lot of different ways to treat, in particular, ice pick scars, and that's what we're sort of concentrating on today. I'm going to talk about all the different options. I wanted to show you some of the scarring that we have here.

So these are typically what people call ice pick scars. Once they start getting bigger, you start calling them boxcar scars, and essentially how that happens is that your hair follicles actually grow really deep into your skin, and when you get infected, they cause a lot of scarring underneath your skin essentially to a degradation of the collagen through the inflammation and infection that it causes. And the tissue underneath it is essentially eaten away by the infection and inflammation. Hence, what you end up having is adhesions from the skin to the deeper structures, and that's why you get these little ice pick scars. Usually, it's around previous hair follicles that got inflamed before. There's different ways to try to improve that.

In general, acne scarring is very hard to improve, but one thing that we're doing today is what we have marked here for these big ones is we're going to do excisions. They can be improved by some other techniques, but this is what we elected to do for him, and this is what we think is the best thing for these particular scars. However, in order to allow the adhesions to come away from the deeper structures, a lot of people do subcision where they take an instrument and they go underneath it and try to cause scarring to make these little depressions and ice pick scars rise up and away from the deeper structures by creating a layer of scar tissue underneath.

Another way of going about doing that is actually grafting fat all through the layer under the skin in order to create a new layer underneath the skin that causes the skin to come away from the underlying tissue that is leading to these ice pick scars. In addition, that fat grafting can bring more vascularity to the whole area and allow the skin to real in that regards through stem cells as well as the improved vascularity and the volumizing that you get through fat grafting.

Other ways to improve these ice pick scars are to cut around it and elevate the tissue or take little punch grafts behind the ear in the same size. Punch graft this or punch the ice pick scar out and then take the tissue from behind the ear or in other places of the body that's a very common area and then graft the tissue. And a lot of times, you'll see a circular region there that is not as favorable as an outcome where you can just excise and get a better outcome.

What we're doing right here, again, is an excision of those scars. And what we're doing now is actually using a very concentrated trichloroacetic acid that's 80 percent, and this is sort of a technique that, you know, we're doing it differently. Right now, I'm using a [broke not q-tip 00:03:23], and I'm going right into the ice pick scars and adding some liquid in there. As you can see, it's turning white. That means it's undergoing a little chemical peel. This is one way to do this. As you can tell, it's turning white. We've done it over in these other areas, too. So we're going to keep doing this for all these other little depressions to try to get them to raise up.

Anyway, I wanted to show this technique of using Trichloroacetic acid to cause some of these ice pick scars to come up, and other than that, the other technique that we can consider for him is fat grafting or subcision to make them elevate the ice pick scars. Thank you.

Inside the Doctor's Office: Chemical Peel Used to Treat Acne Scarring

Dr. Philip Young uses greater than 80% TCA deep chemical peels to help improve ice pick and other depressed scars.