Acne pitting is scarring that looks like like tiny ice picks have punctured the skin, leaving deep pits in their wake. These scars are also often referred to as ice pick scars. Acne pitting can be caused by all types of acne, but most especially by nodular or cystic acne. It can also be caused by aggressively picking at acne spots.
Punch Techniques
There are three different punch techniques to treat acne pitting: punch excision, punch elevation and punch graft. All three treatments are surgical procedures where a round cookie-cutter type instrument is used to "punch" the scar out of the skin. Punch excision removes the scar completely and then closes the wound to heal. Punch elevation leaves the scar tissue behind but raises it to the skin's surface to create a smooth appearance. Punch grafting also removes the scar, but then a skin graft is used to cover the wound.
Subcutaneous Incision
Subcutaneous incision is also a surgical procedure. In this procedure, a special instrument is used to separate the scar tissue from the skin. Like with punch elevation, the scar tissue is raised to the surface level of the skin to create a smooth appearance. Blood will pool and clot under the scar to help keep it raised, and may form visible bruising that can last one to two weeks.
Laser Resurfacing
Ablative laser resurfacing is a procedure where lasers are used to remove the top layers of skin while heating the layers underneath. This forces new skin growth minus the scar tissue. Acne.net reports that 158 patients who were treated with ablative lasers showed good to excellent results for ice pick scars. It is not uncommon for doctors to use a combination of punch techniques with laser resurfacing to remodel the skin and remove the scarring.
Fillers
In this type of treatment, fillers such as collagen, hyaluronic acid, polymethylmethacrylate (PMMA), body fat from the patient, or other fillers are injected into the scar. This raises the scar to the top layers of skin creating a smooth surface. Fillers are often temporary, requiring treatments every six months, although research is constantly being done to improve this. PMMA is currently the only filler that will provide a permanent solution, and taking body fat from the patient to be used as the filler can last up to three years. It is not uncommon for fillers to be used in conjunction with subcutaneous incision.
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