How to Treat Ice Pick Acne Scars

Midsection Of Dermatologist Examining Man At Hospital
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An ice pick scar is a long, narrow scar that extends deep into the dermis. Ice pick scars are deep with steep sides, leaving a small, yet obvious, "hole." The skin looks as if it has been pierced by an ice pick or other sharp instrument, hence the name.

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. Some ice pick scars look like a large, open pore. Others are more obviously a scar. They can be fairly deep, extending a few millimeters into the skin.

Treating Ice Pick Scars

These types of scars won't get better with topical creams, whether they're over-the-counter or prescription. All acne scars can be tricky to treat, but with patience, it can be done. While other types of acne scars respond well to procedures like laser resurfacing or dermal fillers, ice pick scars are too deep to be treated with these.

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

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. A small scar may be left from the procedure itself, but because it's smaller and level with the surrounding skin's surface, it's much less noticeable than the original ice pick scar.

Punch grafting is done for large or very deep ice pick scars. It's similar to punch excision, except that after the scar is removed, the skin is grafted in its place elevating it to the level of the surrounding skin. The graft is taken from an inconspicuous place, like from behind the ear.

Just like with punch excision, a small scar might be visible but it's less noticeable than the ice pick scar. To help smooth out these new scars, laser resurfacing or chemical peels can be done after punch excision or punch grafting has healed. The best advice to you is to meet with a plastic surgeon who is experienced in treating acne scars to discuss your options. 

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  2. Hession MT, Graber EM. Atrophic acne scarring: a review of treatment options. J Clin Aesthet Dermatol. 2015;8(1):50-8.

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