Ice Pick Acne Scars in Edmonton: Classification, Treatments, Aftercare and More

Ice pick scars fall under the category of atrophic acne scars, meaning they result from a loss of tissue. Unlike rolling or boxcar scars, which are wider and shallower, ice pick scars are narrow (often less than 2 millimetres across) but extend deep into the skin. They have sharp, steep walls and taper to a point, giving them a V‑shaped cross‑section. These scars most commonly appear on the cheeks and can also affect the forehead, temples and nose. Because of their depth, they do not flatten out when the skin is stretched.

Why Do Ice Pick Scars Form?

Severe inflammatory acne, especially cystic or nodular breakouts, damages the skin’s structure. When the body attempts to heal a deep pimple, it sometimes lacks enough collagen to fill the void, leaving a narrow channel. Popping or picking at cysts increases trauma and the risk of scarring. Genetics, delayed acne treatment and chronic inflammation can also contribute. Once formed, ice pick scars rarely improve on their own because the tethered tissue prevents the skin from regenerating normally.

Treatments for Ice Pick Scars

Because ice pick scars are deep and narrow, they often require targeted procedures to excise or fill the scar. Topical creams and over‑the‑counter products cannot reach far enough into the skin to have a significant effect. Effective treatments include:

• Punch excision: A small, cookie‑cutter–like tool removes the scar and its surrounding tissue. The wound is closed with sutures or surgical glue, leaving a thinner, more shallow scar that blends better with the skin.
• Punch grafting: For larger or deeper ice pick scars, the scar is excised and the hole is filled with a tiny skin graft taken from a discreet area (such as behind the ear). This raises the level of the scar to match the surrounding skin.
• CROSS (Chemical Reconstruction Of Skin Scars): High‑concentration trichloroacetic acid (TCA) is applied to the base of each scar using a fine applicator. The acid causes controlled damage that triggers new collagen formation and gradually elevates the scar floor.
• Laser resurfacing: Ablative or fractional lasers remove layers of scarred tissue and stimulate collagen and elastin production as the skin heals. Multiple sessions spaced a month apart are typically needed.
• Microneedling: A device with tiny needles creates micro‑channels in the skin to promote collagen production. Although it helps shallower scars more, microneedling can soften the edges of ice pick scars when combined with other therapies.
• Dermal fillers: Hyaluronic acid injections can temporarily fill some pitted scars, making them less noticeable for several months to a year. This option is often used alongside other treatments.
• Radiofrequency and microdermabrasion: Radiofrequency energy tightens the skin, which may slightly improve deep scars, while microdermabrasion removes the outer layer of skin but is most effective on shallow scars.
• Isotretinoin and at‑home care: Oral isotretinoin treats severe acne and prevents new scars but does not remove existing scars. A balanced diet, gentle skincare and avoiding picking at pimples help prevent further damage.

During your consultation, we will assess your scars and recommend a personalised plan. Combination therapy often yields the best results, since no single treatment can address every aspect of ice pick scarring.