A. Deep ice pick scars are the most difficult acne scars to improve. The pit must be ablated or surgically removed to see a change. There is a procedure called punch and float, which has been around for over 25 years. It is usually followed by dermabrasion or laser resurfacing. Punch and close is also an option, but I have found it works less reliably. I have seen the best results (but not home run results) from a combination of high concentration TCA placed with a sterile toothpick into the pit. The healing takes 1 week. The scab must be preserved because if it is picked out, there will be no change and perhaps even worsening of the scar. I usually combine it with aggressive Fraxel Restore several weeks later. 2-3 rounds of this combo may be needed and a reasonable expectation is 50-70% improvement.
Q. I have red scars on my face from acne that I think look even worse after Accutane (although I have been clear of severe acne now for over one year). What can I do to make them look better so I can be free of make-up?
A. There is no one-answer-fits- all solution to your problem. There are many questions I would ask you and I would need to see if the scars are just red, or are pitted. I would then give you options. I can make a general comment that chemical peels are quite good for most skin types having this complaint. If there is a general ruddiness to the complexion, I tend to go for a series of salicylic acid peels done monthly over 3-6 months. These peels are anti-inflammatory and very inexpensive when compared to Fraxel or Deep FX. This is a great option if you are patient (since it takes months to see the benefit) and if you do not have pitted scars.
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