Characteristically, ice pick scars are narrow at the surface but deep. The image is that of a microscopic view of the skin in cross section. There is a protein on the surface of the skin called keratin. The first layer of living cells is called the epidermis. These cells originate from what is called the basal membrane. New cells are continually forming at the basal layer and move to the top after new cells are formed below. The dermis is deep to this basement membrane and is made of collagen and hyaluronic acid.Ice pick scars penetrate down into this dermis. These scars are vertically straight and pointed at the bottom.
Due to its deep nature, resurfacing techniques such as chemical peels and laser are not effective. However, punch out wedge excision has been proved to be very effective to treat these lesions. The success rate of this procedure is increased if the patient has some normal skin surrounding the scar. Ideally, there should be some space between the scar to be removed and any surrounding scar. A large number of scars close together are more challenging to treat. These scars may be located on all areas of the face, but are often seen on the cheeks and forehead.
Ice pick scars are the type of acne scar that are difficult to treat without surgical intervention. In general, laser and chemical peels do not effectively penetrate deeply enough to achieve the desired treatment outcome. There are situations where very thin or superficial ice pick-like scars can be improved with an ablative laser peel. These are very shallow scars. Ablative is a term that basically means that it is a deeper peel. Fillers alone are not effective.
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