Ice Pick Scars

Atrophic scars, cause form acne, are the most common type of acne scars, which results from loss of tissue. They appear as depressions or indentations in the skin. There are three primary types of atrophic scars:

  • Ice Pick Scars
  • Boxcar Scars
  • Rolling Scars

Ice pick scars are characterized by their deep, narrow, and pitted appearance, resembling the punctures made by an ice pick. These scars are often a result of comedonal acne or severe acne but can also arise from other skin conditions or injuries. Due to their depth and narrow width, they can be particularly challenging to treat. Understanding the causes of ice pick scars and the available treatment options is essential for individuals seeking to improve their skin’s appearance and regain confidence.

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Door No. 8-2-293/82/A/725/A, Beside FMS
Hitech City Rd, near Daspalla Hotel, CBI Colony,
Jubilee Hills, Hyderabad, Telangana 500033

Here at FMS Skin and Hair Clinics, after the thorough examination by the dermatologist, we offer a customized treatment depending on the extent and the severity of the scars.

Ice Pick Scars Treatment


A combination of procedures is usually advised. Ice-pick scar treatment is started with TCA CROSS, where 100% TCA is applied, which leads to coagulation of the skin leading to new skin formation. Few sessions may be required. It is followed by MNRF and Fractional lasers along with bio stimulators for a better result.

Characteristics of Ice-Pick Scars:

Appearance: They are tiny craters, which resemble the letter V. They are narrow deep scars, which have a wide opening and a narrow base. They are <2mm in size.

Location: These scars are often found on the upper cheeks, forehead, and T zone area, where there is more oil production.

Causes of Ice Pick Scars:

  1. Severe Acne: The primary cause of ice pick scars is comedonal acne or  inflammatory acne, which are not properly treated. The body’s healing process involves inflammation and the destruction of tissue, which can lead to the formation of deep, narrow scars. They can cause significant damage to the skin tissue.
  2. Infections: Skin infections that cause significant inflammation and damage to the dermal layer can also result in ice pick scars. Conditions like bacterial infections or viral infections can also leave behind these deep scars.
  3. Injuries and Trauma: Physical injuries to the skin, such as puncture wounds or deep cuts, can heal with ice pick-like scars if the damage extends into the deeper layers of the skin. Inadequate wound care can exacerbate the scarring.
  4. Genetic Factors: Genetics play a significant role in how an individual’s skin heals. Some people are more prone to developing severe scarring due to genetic predispositions which affects collagen production and the healing process.


Treatments for Ice Pick Scars

Treating ice pick scars requires a multifaceted approach, often combining several treatments to achieve the best results. Here are some of the most effective treatments available:

Topical Treatments – 

  1. Topical Retinoids— Retinoids, are derivatives from Vitamin A. They promote cell turnover and collagen production, helping to improve skin texture, reduce scarring and decreases sebum production.
  2. Alpha Hydroxy Acids (AHAs)— Chemical exfoliants which help to remove dead skin cells and stimulate new cell growth along with increased cell production. Commonly used is Glycolic acid. This helps to improve the skin texture and reduce the appearance of pigmentation and also the scars.
  3. Vitamin C Serums— An antioxidant in nature, which usually helps to  brighten the skin, sun protection, reduce hyperpigmentation and also helps to boost collagen production. Applying Vitamin C serum daily basis helps to lighten PIH and improve overall skin tone.
  4. Beta Hydraoxy Acid (BHA) – Salicylic acid, commonly used ingredient to decrease the sebum production, with indirect decrease in comedones formation and scar formation. 
  5. Others— willow bark extract, centella etc. are other ingredients which improve acne scars.


  1. Chemical Peels: Deep Chemical peels using trichloroacetic acid (TCA) or phenol can help reduce the appearance of ice pick scars by removing the top layers of skin and promoting new skin growth. TCA CROSS is a specific technique where high-concentration (100%) TCA is applied directly to the scar, promoting collagen production and filling in the depressed area over time.
  2. Microneedling: Microneedling, also known as collagen induction therapy, uses fine needles to create micro-injuries in the skin. This stimulates the body’s natural wound healing response, boosting collagen and elastin production. Over multiple sessions, microneedling can improve the texture and depth of ice pick scars, making them less noticeable. One of the type, Micro Needling Radio Frequency (MNRF) which delivers radiofrequency energy during the creation of micro-injuries into the skin, thereby reaching deeper layer and also by increasing the amount of collagen production. 
  3. Laser Treatments: Fractional Laser Resurfacing – Fractional lasers, such as Fotona, Tribeam etc., can target microscopic columns of skin, promoting collagen production and skin regeneration allowing new, healthier skin to form. This treatment is effective for ice-pick scars as it can reach deeper skin layers without excessive surface damage.
  4. Punch Excision: This surgical procedure involves removing the ice pick scar with a small, cookie-cutter-like tool. The resulting wound is then closed with stitches or left to heal naturally. Punch excision is particularly effective for isolated, deep ice pick scars.
  5. Dermabrasion and Microdermabrasion: Dermabrasion –This procedure involves sanding down the top layer of skin to promote the growth of new, smoother skin. It’s more aggressive and can be effective for superficial ice pick scars but requires significant downtime.  Microdermabrasion: A less invasive procedure that exfoliates the skin using tiny crystals. While less effective for deep ice pick scars, it can improve the overall texture of the skin and be used in conjunction with other treatments.
  6. Bio Remodelling Therapy: PRP/GFC therapy involves using a concentration of the patient’s own platelets to promote healing and collagen production. These can be injected directly into the scar or they can be also applied on the surface of skin after microneedling to enhance the results.

Ice pick scars, with their characteristic deep and narrow depressions, can be particularly challenging to treat. However, advancements in dermatological treatments offer a variety of options to improve their appearance. From chemical peels and laser treatments to surgical interventions like punch excision and subcision, multiple approaches can be tailored to the individual’s needs and skin type. A combination of treatments often yields the best results, and consulting with a dermatologist is crucial to developing an effective, personalized treatment plan. With the right approach, individuals can significantly reduce the appearance of ice pick scars and achieve smoother, more even skin.