How to Treat and Prevent Ice Pick Scars

Severe acne breakouts can leave pitted scars on your skin, especially if the pimples were picked or popped. Types of acne scars vary by size and shape. Rolling scars are wide and shallow (like depressions on the skin), boxcar scars are more wide than deep, and ice pick scars are deep with steep sides.

Ice pick scars are caused by an inflammatory breakout, such as a deep papule or cyst, that has damaged the skin's structures. They are most common on the cheeks. These scars extend—sometimes by a few millimeters—into the second layer of the skin (the dermis). The skin looks like it was pierced by an ice pick or other sharp instrument, hence the name.

Read on to learn more about how ice pick acne scars can be treated.

Dermatologist performing treatment on patient
Nikola Ilic / EyeEm / Getty Images

Causes

There are different types of acne, but all acne begins with a clogged pore. When pores are deeply clogged, acne can become inflamed and infected with bacteria. Skin tissue is destroyed as the pimple heals. Inflammatory acne breakouts—including cystic acne—are more likely to leave ice pick scars.

In the case of a deep pimple, the body may not make enough proteins, like collagen, to fill in the injury to the skin. This creates an indented scar.

Treatment Options

Acne scars can be tricky to treat, but with patience, it can be done. Pitted acne scars won't get better with topical creams (over-the-counter or prescription). Ice pick scars are too deep for treatments such as laser resurfacing or dermal fillers that work for other types of scars. They won't completely remove the scar.

For ice pick scars, punch excision and punch grafting are the most effective choices. Both procedures are commonly done by facial plastic surgeons under local anesthesia (so you'll be wide awake, just numbed for the procedure).

Punch Excision

During punch excision, a small cookie-cutter-like tool is used to cut out the scar. The opening is then sutured or glued together and allowed to heal. 

The procedure may leave a small scar. However, because it's smaller and level with the surrounding skin, it's less noticeable than the original ice pick scar.

Punch Grafting

Punch grafting is a treatment for large or very deep ice pick scars. This procedure is similar to punch excision. The scar is removed, but instead of closing the opening with stitches or glue, a skin graft is used. This raises the level of the scar to that of the surrounding skin. The skin for the graft is taken from an inconspicuous place (like behind the ear).

Like punch excision, punch grafting can also leave a scar, but it is less noticeable than the original.

Microneedling

This type of treatment is also called collagen induction therapy. To perform microneedling, a doctor rolls a tool covered in tiny needles over the skin. The needles create microscopic holes in the skin, and the body reacts by releasing collagen, which can fill in some types of acne scars.

Most patients undergo multiple microneedling treatments spread out over a period of time. Changes to the skin are gradual, and improvement may not be seen right away.

Microneedling may have a small effect on ice pick scars, but it is not as effective as other treatments.

Hyaluronic Acid Injections

Hyaluronic acid is a substance that is produced naturally by the body and helps tissues retain water and stay hydrated. Dermatologists use hyaluronic acid as a filler for wrinkles and fine lines. In recent years, hyaluronic acid has proven to be safe and effective in treating pitted acne scars, such as ice pick scars.

For this treatment, a series of hyaluronic acid injections are given over multiple sessions that are spaced apart. It can be an effective treatment but isn't permanent. The effects of hyaluronic injections wear off in about a year.

Laser Resurfacing

Laser resurfacing is a common treatment for scars, including deep ice pick scars. The procedure involves using a laser to remove layers of skin. This stimulates the production of collagen and elastin (another protein) as the skin layers regrow.

This treatment requires multiple sessions, typically about a month apart. Results can typically be seen after a few treatments.

Studies have shown that laser resurfacing for ice pick scars has fair results, but that other treatments are more effective.

Microdermabrasion

This resurfacing treatment also removes the top layer of the epidermis (the outermost layer of skin). Your doctor may use a tool with a rough surface or an instrument that sprays sand-like particles to remove the layer of skin.

Like other resurfacing procedures, microdermabrasion works best on shallow scars, not deep ones. It may not be a good option for ice pick scars.

Chemical Peels

As its cells grow and mature, our skin goes through a natural process of exfoliation (shedding of older, dead cells). Chemical peels speed up this process, which helps new skin to grow. This can minimize the appearance of pitted scars, including ice pick scars.

There are different types of chemical peels. Some penetrate the skin more deeply than others based on which chemicals are used. Your doctor will be able to tell you whether a chemical peel is an option to treat your ice pick scar.

Radiofrequency

A newer treatment for acne scars is radiofrequency, a treatment that tightens the skin. As the skin tightens, it stretches, which can make deep scars less visible.

Like other treatments, this one also requires multiple treatments to achieve optimal results. It has, however, been shown to be effective for ice pick scars.

Accutane

Accutane (isotretinoin) is a strong drug used to treat cases of severe acne. The drug has powerful side effects and is often used after other treatments have failed.

Accutane does not make scars go away; rather, it helps clear breakouts that can lead to further scars, and it prevents future breakouts.

A course of treatment with Accutane is different for each person. On average, it takes an average of four to five months. Some people see results in a few weeks, but for others, it can take longer.

At-Home Treatment and Remedies

Many at-home treatments or over-the-counter products will not work to treat ice pick scars. They are simply too deep. However, some at-home therapies can be helpful in improving your skin's health, which is a first step in preventing the breakouts that can cause scars.

Some steps you can take at home include:

Eat a healthy diet: One of the many benefits of an anti-inflammatory diet is that it can also give your skin a boost. In addition to keeping the rest of your body healthy, foods rich in antioxidants and omega-3 fatty acids can help clear your skin, minimizing inflammatory acne that can leave deep scars.

Apply tea tree oil to pimples: Research has shown that tea tree oil can reduce inflammation and fight bacteria. Applying diluted tea tree oil to your pimples can help clear your breakout.

DIY facials: In addition to putting more anti-inflammatory foods into your body, you can also put some of them on your body too. Honey and cinnamon have anti-inflammatory and antibacterial properties. For instance, using a cinnamon-honey mask on your skin can be soothing and helpful.

Prevention

The best way to prevent ice pick scars is to treat the inflammatory acne that causes them. Good first steps to avoid scarring include:

  • Maintaining a healthy skin care regimen
  • Talking to your doctor about your breakouts

If you have a breakout, it is important to avoid picking at or popping pimples. This can cause infection and make existing breakouts worse.

Frequently Asked Questions

What is an ice pick scar?

An ice pick scar is a specific type of acne scar that remains after a deep, inflamed pimple has healed. It appears like a large pore, or a pierce in the skin.

How do you minimize ice pick scars?

The most effective procedures are punch excision and punch grafting. Non-surgical treatments are also available, but they vary in results and may not completely remove the scar.

How do you know if you have an ice pick scar?

Acne scars vary in size and depth. Two types of scars (boxcar and rolling scars) are shallow (more wide than deep). Ice pick scars, on the other hand, are more deep than wide. They appear like holes in the skin.

How much laser surgery does it take to get rid of ice pick scars?

Laser surgery can be helpful for ice pick scars. Depending on the size of your scar, you may need more than one treatment. Your doctor may combine laser surgery with other treatments to minimize the appearance of your scar.

How do you smooth shallow ice pick scars?

By definition, ice pick scars are not shallow. However, the deeper the scar, the more difficult it is to treat. The shallower your scar is, the more likely it could be made less visible through the use of resurfacing or other less-invasive treatments.

A Word From Verywell

If you have deep acne scars, you're not alone. The good news is that you don't have to live with them. Even ice pick scars are treatable. Talk to your doctor about your concerns. They will be able to refer you to a dermatologist or surgeon who can work with you to treat your scars.

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