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Acne is one of the most common skin conditions in the United States, affecting more than 50 million Americans throughout their lifetimes, according to the American Academy of Dermatology. When breakouts become infected with bacteria, inflammatory acne occurs, and the risk of developing acne scarring following the acne outbreak increases. One such type of acne scar is the ice pick scar, which is characterized by a deep and narrow depression that can vary in depth depending on the severity of the infection preceding it. Many patients feel frustrated and self-conscious about the appearance of ice pick scars, which are frequently on highly visible areas of the face, such as the cheeks and forehead, and are not easily covered by makeup. Unfortunately, without the help of a cosmetic procedure, these ice pick scars are permanent, leaving evidence of severe acne lesions long after the initial breakout has been resolved. Luckily, there are many effective treatment options to eliminate the appearance of ice pick scars available at Dr. Michele Green’s New York City dermatology office.

Ice pick acne scars are often challenging to treat due to the depth of the scarring that occurs. However, Dr. Green has a wide range of treatment options available for all skin types to reduce the appearance of the scar for smooth, clear-textured skin. To improve the skin texture, Dr. Green may turn to a combination approach of non-ablative laser treatments, – such as the VBeam laser for addressing hyperpigmentation, the Fraxel laser for skin surfacing, and the eMatrix laser for increasing collagen production – chemical peels, – such as the TCA cross – and dermal fillers to fill in the lost volume of the depressed scars. For particularly deep scars, Dr. Green may turn to punch excision or punch grafting to remove the scar. With so many treatment options available, it can be difficult to know which is best, which is why it is best to begin treatment with an experienced dermatologist, such as Dr. Green.

Board-certified dermatologist, Dr. Green, has been expertly treating patients in her Upper East Side New York City office for more than 25 years. Well-versed in a wide range of cosmetic and medical treatments, including laser therapy, microneedling, chemical peels, dermabrasion, dermal fillers, Botox, and many more, Dr. Green is known for generating unique and individualized treatment plans to meet her patients’ aesthetic goals. Dr. Green has been frequently voted one of the best healthcare providers in New York City by such publications as Super Doctors, Castle Connolly, and New York Magazine.

24 year old male, eMatrix and Restylane

What are ice pick acne scars?

Ice pick acne scars are characterized by narrow, deep, sharp craters found on the skin’s surface that can form following a deep infection in severe acne lesions. The name “ice pick scar” derives from how the skin scars resemble indentations made by a narrow, sharp object, such as an ice pick. Ice pick scars can range in depth and size. However, they often can extend deeper into the dermal layer of skin than the original acne cyst or nodule, depending on the body’s healing process and the amount of new collagen produced. As ice pick scars are most commonly found in highly visible areas of the face, such as the cheeks and forehead, many patients feel self-conscious about the deep scars and uneven skin texture that are characteristics of atrophic acne scars. While ice pick scars are very difficult to erase, many effective treatment options are available at Dr. Green’s dermatology office.

What are the different types of acne scars?

Two overarching types of acne scars can form due to severe acne outbreaks: atrophic acne scars and hypertrophic acne scars. Atrophic acne scars are characterized by depressions or indents in the skin’s surface that result from insufficient collagen production during the wound-healing process and can be further broken down into three subtypes: ice pick scars, boxcar scars, and rolling acne scars. Unlike ice pick scars, which are deep and narrow indentations, boxcar scars are wide, round holes that can vary in depth depending on the severity of the inflammatory acne breakout. Rolling scars create a wavy appearance on the skin’s surface, and while boxcar scars have sharp edges, rolling scars have sloping edges that further contribute to their wave-like appearance.

The second overarching type of acne scar is the hypertrophic acne scar, which forms raised scar tissue due to an overproduction of new collagen during the wound-healing process. Hypertrophic or keloid scars often look lumpy and can grow bigger in surface area than the original lesion or wound. Whether an acne scar develops into an atrophic scar or a hypertrophic scar is difficult to predict. However, studies show that those with a genetic predisposition to developing keloid scars are more likely to develop hypertrophic acne scars following a severe breakout.

Acne scars can also result in post-inflammatory hyperpigmentation, or discoloration, on the skin’s surface, making the scar tissue appear red or dark in color. Hyperpigmentation occurs when the inflammatory acne infection triggers the melanocytes to produce an excess of melanin, the pigment in the skin. During the acne scar treatment process, this redness can be targeted with such treatment options as the VBeam laser, chemical peels, microneedling, or microdermabrasion.

What causes ice pick scars?

Ice pick scars are caused when the body’s natural healing process produces insufficient collagen following an inflammatory acne breakout, leading to indentations that can extend deep into the dermis. The skin condition known commonly as acne occurs when the epidermis pores are clogged by debris such as dead skin cells, sebum, and dirt. When the pores are clogged, bacteria can become trapped and multiply, leading to inflammatory acne, manifesting as painful pimples, nodules, or cystic acne. The inflammation in the pores leads to trauma in the surrounding skin, which can cause collagen and elastin to break down and triggers the body’s natural healing process. Often, due to the trauma in the affected area, the body cannot produce the right amount of collagen to fully heal the acne lesion, which leads to the formation of depressed acne scars, such as ice pick scars. The deeper the infection in the acne lesion, the deeper the ice pick scar will be, and deep scars are much more difficult to eliminate. That is why it is imperative to seek treatment for active acne outbreaks as early as possible to avoid deep infection and potential scarring.

Do ice pick acne scars go away on their own?

Ice pick acne scars typically form after a deep infection in acne lesions, leading to narrow, deep facial scars. When severe acne is left untreated, the scarring that can develop during the wound-healing process can be deep and difficult to treat. In fact, without cosmetic intervention, ice pick acne scars can be permanent. Over-the-counter topical creams or at-home remedies may be able to reduce some of the hyperpigmentation, but to eliminate the indentation in the skin left by ice pick scars, patients should turn first to an expert dermatologist, such as Dr. Green.

CP 22 y female before after Accutane 15mo FRONT MGWatermark

Can you get rid of ice pick scars?

While ice pick scars will not go away on their own, they can be treated at a dermatologist’s office with a range of effective ice pick scar treatment options. Most often, a combination approach is best when looking to eliminate the appearance of ice pick scars, as both the indentation and the hyperpigmentation must be addressed. To improve the skin’s texture and boost collagen production, Dr. Green may recommend using chemical peels, such as the trichloroacetic acid peel, microneedling, and eMatrix radiofrequency laser treatment, or the Fraxel fractional laser treatment. To reverse signs of hyperpigmentation, the VBeam pulsed dye laser is highly effective as are chemical peels such as glycolic acid or salicylic acid peels. In some cases, when the scar is very deep, Dr. Green may turn to punch excision or punch grafting to remove the scar surgically. The first step in getting rid of ice pick scars is to schedule an initial consultation with Dr. Green to determine which treatment or series of treatments is right for you.

How to get rid of ice pick acne scars with chemical peels

Chemical peels can be used to improve skin tone and texture via the application of different kinds of acid-based solutions at varying concentrations, and are frequently used to reduce the appearance of acne scars, clear up active acne outbreaks, reduce the appearance of fine lines and brighten dark spots on the skin. One of the best ways to prevent the formation of ice pick scars in the first place is to cure acne breakouts as soon as possible and chemical peels, which work to exfoliate the skin and unclog the pores, are a highly effective solution. Typically, when addressing an active acne breakout, the chemical peels used are mild and can include 20-40% glycolic acid, salicylic acid, or lactic acid. When used to treat ice pick scars, it is best to use a high-concentration trichloroacetic acid (TCA) peel to promote skin cell turnover and boost collagen production for even-textured, healthy skin.

What is a TCA cross for ice pick scars?

The most effective type of chemical peel to be used for treating ice pick scars is the trichloroacetic acid peel, better known as the TCA cross. TCA cross uses a high concentration of trichloroacetic acid (70-100%), which is inserted directly into the indentations formed by ice pick scars. Following the application of the solution, the TCA Cross forms a “frost” over the depression, triggering an inflammatory response and the subsequent production of new collagen in the treatment area. When new collagen is produced, the depth of the scarring is reduced, creating a more even texture for the skin. Dr. Green recommends repeating TCA Cross treatments spaced 6-8 weeks apart to achieve the best results. Patients with darker skin tones are at a higher risk for hyperpigmentation as a side effect of the treatment, and, as such, Dr. Green will either recommend a different type of treatment or apply the TCA Cross at a much lower concentration. Following the TCA Cross treatment, patients should practice skincare in the form of strict sun avoidance by staying inside when the sun is at its most intense and wearing sunscreen of at least SPF 50 when going outside during those peak hours.

CG 24 female acne ematrix before after angle MGWAtermark 2

How to get rid of ice pick scars with microneedling

Microneedling with platelet-rich plasma injections, also known as collagen-induction therapy, is a highly effective treatment for rejuvenating the skin texture and tone to reduce the appearance of ice pick acne scars. The treatment works by applying tiny surgical-grade needles that pierce the skin of the treatment area and cause micro-wounds. These controlled injuries trigger the body’s natural healing response, boosting the production of the structural proteins collagen and elastin. When collagen and elastin are produced, they help fill in the deep ice pick scars to improve the skin’s texture. Platelet-rich plasma can be applied to the surface of the skin where the microneedling device has pierced the skin allowing for better absorption of the PRP, which helps with the healing process.

How to get rid of ice pick scars with laser resurfacing

Laser treatment for acne scarring is a highly effective method of reducing the appearance of ice pick acne scars. There are several different types of lasers that Dr. Green employs to address different aspects of ice pick scars: the Fraxel laser for skin resurfacing, the eMatrix radiofrequency laser, and the VBeam laser for addressing hyperpigmentation.

Fraxel Laser: The Fraxel laser uses fractionated energy to target a specific area while leaving the surrounding tissue unaffected. By delivering a targeted beam of energy into the dermal layer of skin, the Fraxel laser stimulates collagen production to improve the skin’s texture and fill in the ice-pick scar. For this type of scarring, Dr. Green recommends scheduling 5-6 treatment sessions, each taking about 15 minutes, to achieve the best results.

eMatrix Laser: The eMatrix sublative laser uses radiofrequency energy to stimulate collagen production for all skin types, including those with darker skin. The radiofrequency energy heats the inner layer of the skin to trigger the body’s natural healing response and boost collagen production. Dr. Green recommends five treatment sessions for ice pick scars spaced 4-6 weeks apart.

VBeam Laser: When looking to erase signs of hyperpigmentation, the VBeam laser is the gold standard. Using pulsed dye energy, the VBeam laser targets pigmented areas of the skin, which absorb the light and destroy the pigmentation. As a result, the VBeam laser is best used on red or violaceous scars. The VBeam laser can also be used on active acne breakouts to reduce the about of acne-causing bacteria on the skin.

JL 33 yo male before and after acne treatments and VBEAM MGWatermark

How a dermatologist gets rid of ice pick scars with punch excision

When ice pick scars are particularly deep, it may be best to turn to a mild surgical treatment such as punch excision to remove the scar. Punch excision works by incision and surgically removing the scar before healing the wound with stitches or a skin graft. As there is a risk of scarring associated with any surgical procedure, Dr. Green only recommends punch excision for very deep ice pick scars that do not respond to other treatment methods.

How does punch grafting work?

Punch grafting, similar to punch excision, is a surgical treatment that takes a skin graft – usually from behind the year – to close the ice pick scar for smoother skin. The treatment works best for larger or deeper ice pick scars that are found on parts of the face that are less mobile, such as the forehead. Again, due to the surgical nature of the procedure and the risk of further scarring that can develop due to surgery, Dr. Green only recommends punch grafting for deep ice pick scars.

Why am I getting ice pick scars?

Patients are at an increased risk for developing ice pick scars when inflammatory acne is left untreated. When bacteria become trapped in pores clogged with oil and dead skin cells, inflammation and infection can occur, which causes trauma to the surrounding skin and inhibits the wound healing process. As a result, insufficient collagen is produced to adequately repair the skin, leading to an atrophic acne scar such as the ice pick scar. The deeper the infection, the deeper the acne scar may be, leading to narrow indentations that extend the dermis. Some patients are more susceptible to scarring than others, but the best way to avoid developing ice pick scars altogether is to treat active acne outbreaks as quickly as possible.

Does picking acne cause scars?

Picking, squeezing, or popping acne lesions can deepen or spread infection, which puts patients at increased risk for developing acne scars. When acne is picked, trauma to the surrounding skin increases, decreasing the body’s ability to heal the wound properly. Further, popping or squeezing pimples can force the infection down into the pores or spread the infection to other acne lesions, which can also increase the potential for scarring. Rather than picking or squeezing acne lesions, it is best to consult a board-certified dermatologist, such as Dr. Green, to treat an active breakout of any form of acne most effectively.

How can I avoid ice-pick acne scars?

The best way to avoid acne scars is to treat and prevent acne breakouts as early as possible. Several effective methods for acne treatment and prevention are available at Dr. Green’s office. To treat an already active acne outbreak, Dr. Green may recommend the use of topical antibiotics, such as erythromycin or clindamycin, or benzoyl peroxide to reduce the bacteria found on the skin and trapped in the pores, Retinoids or chemical peels to help unclog the pores, exfoliate the skin, and increase skin cell turnover, or Azelaic acid, which acts as an anti-inflammatory. To prevent further breakouts, Dr. Green may prescribe an oral antibiotic, such as minocycline or doxycycline, birth control pills to regulate the hormonal fluctuations that can increase the risk of a breakout, or Accutane for acne that has not responded to other treatments.

There are also several skincare recommendations for promoting healthy skin and decreasing the risk of developing acne scarring: To start, it is important to avoid picking, squeezing, or popping pimples as this can spread infection, which increases the risk of scarring. Dr. Green also suggests that patients avoid rubbing their faces and using cleansers that are rough on the skin. Further, patients should refrain from touching their faces throughout the day lest the oils from their hands clog the pores on their faces. Patients should also be advised always to wear sunscreen when going outside.

Are ice pick scars permanent?

Ice pick scars form due to severe inflammatory acne, which leaves deep, narrow indentations on the skin’s surface. Without proper treatment, these scars can remain permanently, providing patients with an unfortunate reminder o past acne outbreaks. Due to the permanent nature of the scarring and the often highly visible placement, many patients opt to receive cosmetic treatment to reduce the appearance of ice pick acne scars on the face.

AZ 29yo female before and after acne and acne scar treatments 1 year apart ANGLE LEFT MGWatermark

What are rolling acne scars?

Rolling acne scars are another type of atrophic acne scar that forms when an insufficient amount of collagen is produced during the wound-healing process, causing depressions on the skin’s surface. Rolling acne scars are characterized by a wavy appearance to the skin’s surface with sloping-edged intendants and an uneven texture. Rolling acne scars may be bigger than the original acne lesion and often form on areas of the face where the skin is thicker, such as the jaw and lower cheeks. Rolling acne scars can be treated with many of the same treatment methods as ice pick scars, including laser resurfacing, chemical peels, microneedling, and VBeam laser therapy. For some cases of rolling acne scars, subcision is the best treatment to break up the fibrous bands under the skin that pull on the epidermis, causing the wavy appearance.

How do you get rid of ice pick scars naturally?

Unfortunately, ice pick scars tend to be permanent when not treated cosmetically and, therefore, will not go away naturally or on their own. For patients who would prefer to reduce the appearance of acne scarring at home, topical ointments can be good for mild scarring, particularly scarring that has caused discoloration. For ice pick scars, which tend to be deep craters on the skin, brightening the skin is only part of the problem, and therefore, to fully get rid of ice pick acne scars, it is best to consult with Dr. Green on the best treatment method, such as chemical peels, laser therapy, microneedling, or punch excision.

How long does it take for ice pick scars to go away?

The time it takes for ice pick scars to go away depends on the treatment being used. Some treatments, such as Fraxel laser resurfacing, the eMatrix radiofrequency laser, chemical peels, and microneedling, reduce the appearance of ice pick scars by boosting the body’s natural collagen and elastin production. As a result, the effects of the treatment become visible over time as the new collagen helps to fill in the indentations on the skin’s surface. Typically, these procedures require multiple sessions for the best results, and the full effects of the treatment will become visible in 3-6 months. Surgical procedures, such as punch excision and punch grafting, have more immediate results. However, the recovery time required is more significant than the non-surgical treatments.

What are the best treatments for ice pick acne scars?

There are many effective treatments for the elimination of ice pick acne scars, and because of that, the best first step is to consult with an expert, board-certified dermatologist, such as Dr. Green. No one treatment is inherently “better” than another; rather, the most important thing is to determine which treatment will be best for each patient’s unique needs. For mild scarring, Dr. Green may use a chemical peel or microneedling to promote collagen production and skin cell turnover for smoother, even-textured skin. Dr. Green will often pair chemical peels with laser treatments, such as the Fraxel laser or eMatrix laser. To address any post-inflammatory hyperpigmentation associated with the scarring, Dr. Green will turn to the VBeam pulsed dye laser or chemical peels to target dark spots on the skin. When ice pick scars are particularly deep, a mild surgical procedure, such as punch excision or punch grafting, is often the best choice. When you have your initial consultation with Dr. Green, she will help to decide about the series of treatments that will be best for you.

How do I get started with these treatment options today?

Ice pick acne scars are deep, narrow depressions that develop when inflammatory acne causes irreparable damage to the underlying skin tissue. Successfully and safely improving the appearance of ice pick acne scars requires the expertise of an experienced board-certified dermatologist, like Dr. Michele Green in NYC. Many non-invasive acne scar treatment options are available at Dr. Green’s private dermatology office in Manhattan’s Upper East Side, from laser resurfacing and chemical peels to microneedling and punch excision.

Dr. Michele Green in NYC is an internationally renowned board-certified cosmetic dermatologist with over two and a half decades of experience providing her patients from around the world with the best non-invasive treatment options available, including for acne scars. Castle Connolly, New York Magazine, Super Doctors, and the New York Times consistently identify Dr. Green as one of New York’s best dermatologists for her dedication to her patients and expertise. Dr. Green takes a holistic approach to acne scar treatment, customizing each patient’s plan to suit best their skin type, skin tone, the types of acne scars present, and their unique aesthetic goals. When you consult with Dr. Green at her private dermatology office in the Upper East Side neighborhood of Manhattan, she will work with you to create a personalized acne scar treatment plan that leaves you with a smooth, clear, beautiful complexion that lasts. To get started with your acne scar treatment and schedule a consultation with Dr. Green, call the NYC office at 212-535-3088 or contact us online today.

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