Acne scars fall under two categories: hypertrophic scars and atrophic scars. Hypertrophic scars are raised scars that grow due to excess tissue growth, atrophic scars are depressed acne scars that grow due to loss of tissue. Icepick scars fall under the latter category.
Icepicks scars are characterised by their narrow and deep pitted look with sharp borders — some say they look like dilated pores. They are usually a result of the loss of skin tissue and collagen damage caused by deep cystic acne. Not treating your inflamed acne early can lead to icepick scars — this inflammation penetrates deep into the skin, damaging underlying tissues. Due to their narrow impressions and depth, icepick scars are often considered the most difficult type of acne scar.
The severity of icepick scars make them extremely difficult or otherwise impossible to treat at home. Over-the-counter and natural remedies will not be strong enough to work as they cannot get rid of the leftover deep pits that characterise icepick scars. Simply put, patients who wish to treat their icepick scars must seek treatment from a professional.
What treatment options are there available?
While traditional treatment options usually consist of surgery or resurfacing procedures, today, there are many types of procedures available to help improve the appearance of your icepick scars and skin texture.
There are usually two stages in ice pick scar treatments. The first stage involves reducing the depth of the scar so it evens out with the rest of the skin, and the second stage involves blending in the scar and reducing skin discolouration. Hence, treating ice pick scars often require combining different types of treatments for optimal results. Of course, your options will depend on the severity of your scar and skin condition.
The effectiveness also highly depends on your skin type and condition. Your doctor will best be able to advise you.
Icepick scars are caused by depression on the skin fibres. As mentioned above, the first stage of icepick scar treatment is to reduce the depth of the scar and even it out with the skin’s surface.
As icepick scars are pitted and depressed, the first course of action is to improve their depth. One way is by encouraging collagen production around the scar. TCA CROSS uses trichloroacetic acid, a medium-deep peeling agent to penetrate the epidermis and dermis while coagulating proteins. Small amounts of TCA at high concentrations are deposited into the depths of the scar — this bridges the scar and causes an intense inflammatory reaction stimulating the development of new collagen fibres at the base of the scar.
After the procedure, your scars might look a little more damaged, but this is normal. The point of damaging and inflaming your scar tissues is to signal the skin’s natural healing process. To reduce infection, your doctor will apply an antibiotic ointment.
Patients who undergo TCA Cross can expect about a 10-40% improvement in their icepick scars after one treatment, depending on the severity of the scar.
Small narrow icepick scars can be excised using ablative laser and sutured flat. This removes the entire scar leaving a flat thin linear scar which can then be blended into the surrounding skin
Slightly wider icepick scars can be treated through subcision where a special, hypodermic needle is moved back and forth in a fanning pattern to break and release the fibrotic tissues that cause depression on the skin. This releases tension and allows new and healthier tissues to form.
Once the scars are levelled with the rest of the skin’s surface, fillers are injected in small amounts to increase the volume of any pitted areas and stimulate collagen synthesis. As a result, skin heals a lot faster. Some patients have reported that their skin seems to appear a lot healthier — this is due to the rejuvenating properties of hyaluronic acid in fillers.
Subcision is an excellent way to treat deep, pitted scars like icepick scars. This is because subcision is able to target icepick scars from deep into the layers, which other treatment methods can’t. However, subcision cannot be performed on individuals prone to keloidal and hypertrophic scars or have skin infections.
Fractional Microneedling Radiofrequency
Fractional microneedling radiofrequency skin resurfacing treatments (such as INFINI, Explore) address not just severe acne scars but wrinkles and sagging skin too. Radiofrequency is delivered deep into the skin to trigger collagen production, which tightens scar tissues, reduces the depth of scars and improves skin texture.
This technique uses gold-plated microneedles that can reach as deep as 4mm into the acne scar and skin. This effectively heats the targeted area and boosts elastin and collagen production.
Patients who undergo Fractional Microneedling Radiofrequency essentially treat their acne scars with radiofrequency and microneedling technologies. It is suitable for all skin types. If there are many icepick scars, it may be worthwhile to use Fractional Microneedling Radiofrequency as a field treatment first followed by targeted treatment of the stubborn scars that remain.
Treating icepick scars may be difficult, but it is not impossible. Finding the right doctor and treatment methods can prove wondrous results. I encourage patients to always seek treatment early even for their acne to avoid dealing with potential acne scars later down the road.
Xu, Y., & Deng, Y. (2018). Ablative Fractional CO2 Laser for Facial Atrophic Acne Scars. Facial plastic surgery : FPS, 34(2), 205–219. https://doi.org/10.1055/s-0037-1606096
Bahl, A., O’Connor, K., & Chung, H. J. (2020). Treatment of atrophic acne scars with combination therapy of chemical reconstruction of skin scars method and fractionated nonablative laser: A retrospective analysis. Journal of cosmetic dermatology, 10.1111/jocd.13514. Advance online publication. https://doi.org/10.1111/jocd.13514