Characteristically, ice pick scars are narrow at the surface but deep. Due to its superficial nature, resurfacing techniques such as chemical peels and laser are not effective. However, punch out wedge excision has been proved to be effective to treat these lesions. The success rate of this procedure can likely increase if the patient has few scars that with well-spaced apart. A large number of scars close together are more challenging to treat.
Ice Pick Acne Scars on the Cheek
Ice pick scars are the type of acne scar that are difficult to treat without surgical intervention. The situation can be more challenging, when many scars are present in close proximity to each other. Ice pick scars are usually quite deep, making them very difficult to treat with standard resurfacing techniques such as chemical peels, micro-dermabrasion and laser resurfacing techniques, which are unlikely to have a significant impact. These techniques do not effectively penetrate deeply enough to achieve the desired treatment outcome.
Having cosmetic facial makeup can do little help as the holes are too deep to camouflage. The scar we strive for is flat and narrow. It does not cast shadow, and it can be easily covered with facial makeup. Simply, you are trading a bad scar for a better one of only 2mm. Healed 2mm scars are very hard to notice.
As ice pick scars are quite narrow in appearance, punch-out excisions are preferable, which is mildly invasive but an effective treatment technique. It is typically performed under local anesthesia in an office-based setting. Usually, one to three, human hair-like, very fine sutures are placed for wound closure. The sutures are usually removed five days after treatment. The healing process continues over many weeks until the visible redness is gone, and the final result can be seen.
Excision techniques very effective for ice pick acne scar
Biopsy punch wedge excision is regarded as the best treatment for Ice Pick acne scars. As the skin possess appreciable elasticity, the excised hole resulting from the punch out excision can be easily closed.
During the procedure, careful detailed photographs are taken and reviewed on a large monitor together with the patient. Together with Dr. Sadove’s advice, the patient decides which scars they would like to be removed. These are then marked with a marking pen. If you are allergic to lidocaine, make sure to inform Dr. Sadove before surgery.
The acne scar areas that are to be treated are then injected with local anesthesia via a tiny needle, which is similar to that used by the dentist. This step is followed by application of antibiotic prep solution onto the treatment-target skin area. For each scar excision, disposable biopsy punches of appropriate diameter are selected and used. The available, standard diameter sizes of disposable biopsy punches are 2, 3 and 5 millimeters. The scar is “punched out” in a circle shape. Dr. Sadove will ask you to smile and make various facial animations in order to determine the best orientation for the scar. These are called Langer’s lines. The circle changes its shape into an ellipse and a fine suture is used to close the excision carefully, by employing plastic surgery technique. After treatment, a dot band aid is applied onto the treated area for a day. This may be removed after a day and face washing can be done. A small amount of antibiotic ointment may be applied twice or three times a day. The fine suture can be removed after five days.
Injections should not be used for the treatment of ice pick scars. Little to no improvement of acne scar would be expected. As ice pick acne scars are too deep, peeling and laser techniques can provide little benefit.