One approach is to punch out the scar surgically and either float the scar up or put a little punch graft in, he said.
Another approach that he uses for ice pick scars is to lightly apply 90% trichloroacetic acid to the base of the scar with a toothpick. This causes an inflammatory reaction that destroys the scar and raises it up, making it distensible and resurfaceable, he said.
Ice pick scars, as well as boxcar scars, divot scars, and hypertrophic scars, need to be refined during the treatment process.
Also keep in mind that patients lose volume as they age, which can cause acne scars to become more prominent. Sometimes a patient will come in with old scars that never bothered them before, and suddenly the scars are much more visible.
“If you volume-fill the face, you’ll improve the scars,” he said, describing one 48-year-old woman who was treated successfully with three sessions of Sculptra, topped off with a little bit of Radiesse.
Dr. Monheit has consulted or performed contracted research for Allergan, Contura, Dermik Laboratories, Galderma Laboratories, Ipsen/Medicis, Kythera Biopharmaceuticals, MELA Sciences, Merz Pharmaceuticals, MyoScience, and Revance Therapeutics.