According to DermaNetwork, a cosmetic-surgery website overseen by a medical board of advisers, "Ice pick scars are deep pitted scars with steep edges." Atrophic scars are also pitted, but not as deep and sharp. Treatments for these lesions vary based on a number of factors like skin color, severity of condition, and type of skin.
Punch Grafts
A punch graft is a surgical procedure done by a dermatologist or cosmetic surgeon. It entails using a circular tool to cut (or punch) a hole in the skin and remove the scarred tissue. Using a healthy piece of skin taken from another part of the body, like behind the ear, the hole is plugged and sealed with surgical tape for five to seven days. The skin that surfaces following the period of healing will be smoother than the pitted appearance of the skin. There's still a possibility of some scarring with punch grafts, but it will not be as noticeable as before.
Punch Excisions
Similar to a punch graft, the excision uses sutures to close the wound after the scar tissue is removed.The stitches are taken out after five to seven days.
The American Academy of Dermatology (AAD) reports that the punch graft and excision are the best treatments for pitted acne scars.
Soft Tissue Filler
During a soft tissue filling procedure, your doctor will use collagen, hyaluronic acid or fat injections to elevate deep and indented scars. The AAD indicates that the improvement can be seen immediately, but won't be permanent. This is a procedure that needs about four or five treatments before the results endure.
The fillers used for this process include bovine and human collagen, hyaluronic acid, and your own fat. You and your doctor can discuss which filler is best for you based on the severity of your scar, your skin type, hue and sensitivity.
Soft tissue filler treatment can be used on both atrophic and ice pick scars.
Dermabrasion
Dermabrasion is a surgical procedure that mechanically resurfaces the outer layers of skin (known as the epidermis) with an abrasive tool. Deep dermabrasion will remove the epidermis and part of the dermis (the lower layers of skin). Deep dermabrasion is an effective treatment for pitted acne scars but requires several weeks of recovery, and healing could last several months.
There are also risks for complications, reports DermaNetwork. This technique will likely produce better results for atrophic scars while ice pick scars show less significant improvement. People with a dark complexion are not good candidates for dermabrasion because they are more prone to darkening of the skin.
Subcision
A newer method of treating atrophic scars, subcision "has been tested in recent studies and shown to be effective," according to DermaNetwork. While sedated, your doctor will insert a needle into the scar and reshape the hard, fibrous tissue by releasing the bands that bind damaged skin to fat. Subcision may take several rounds before improvement is achieved. At Acne.org, people who have had this treatment report subcision does work well for some types of acne scars. Other patients choose to have complementary procedures, like laser resurfacing, to get the results they hoped for (see Resources).
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