Ice Pick Scars, Excision, Pigmentation- April 7th 2025

As a skin restoration specialist, I am constantly inspired by the transformations I witness in my patients. Recently, I had the opportunity to share one of my most rewarding cases—a patient who traveled all the way from Atlanta, Georgia, to seek treatment for her severe scarring. Her journey is a testament to the effectiveness of combining multiple techniques, including subcision, laser resurfacing, TCA cross, and excision.

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Treatment Process: Subcision, Laser, TCA Cross, Excision

When this patient first came to me, she was struggling with thick, boxcar scars that weighed down her skin due to significant underlying scar tissue. Many practitioners had told her there wasn’t much they could do with subcision for such scars, but I knew differently. Subcision can be incredibly effective if done correctly, especially for patients with substantial scar tissue.

I remember vividly how we approached her case. It involved multiple steps, starting with subcision to break up the dense scar tissue. We then proceeded with ablative CO2 laser resurfacing and TCA cross treatments. Additionally, I performed excision on some of the deeper scars. The combination of these methods proved transformative. When she returned after nearly a year and a half, the improvement was remarkable. She expressed immense satisfaction with her results, which motivated her to continue further treatments.

A Comprehensive Treatment Plan

For anyone considering similar treatments, it’s essential to understand that no single method works universally. Each patient requires a tailored plan. In this particular case, the combination of subcision, laser resurfacing, and excisions delivered outstanding results. However, I also incorporated volume replacement using products like Sculptra or Radiesse, depending on the specific needs of the patient. Volume restoration plays a crucial role in achieving natural-looking outcomes.

Moreover, ongoing maintenance is key. Patients often require follow-up sessions to refine their results continually. For instance, during our recent session, I applied more TCA cross and ablative CO2 laser to areas needing further attention. This iterative process ensures steady progress toward clearer skin.

Special Considerations for Diverse Skin Types

Treating diverse skin types, particularly African-American skin, necessitates precision and careful technique. One memorable case involved an African-American patient from Atlanta with very thick scars. Despite potential risks, she opted for ablative CO2 laser treatment. After a thorough discussion about pigmentation issues, we proceeded cautiously. Remarkably, one and a half months later, she exhibited zero hyperpigmentation or hypopigmentation, thanks partly to her diligent sun protection regimen.

This underscores the importance of personalized care. While high-energy treatments might not suit everyone, certain cases demand more aggressive approaches. By being meticulous and precise, we achieve safe and effective results even for challenging scar types.

Addressing Common Concerns and Misconceptions

Many patients come to me having tried various ineffective treatments like radiofrequency microneedling (e.g., Morpheus 8). While popular, these methods often fail to deliver satisfactory results for severe scarring. Instead, manual interventions like excisions and subcision frequently yield better outcomes. For example, excising thick scar tissue provides dramatic improvements unattainable through less invasive means.

Additionally, misconceptions about treatments like TCA cross persist. Some believe it enlarges scars, but when executed precisely, it does not. Careful application ensures safe and effective outcomes without exacerbating existing scars.

Questions Answered

• Question: For scarring like this, do you recommend a peel and what type?
  Dr. Qazi: Peels can be beneficial, but caution is necessary, particularly for darker skin types prone to pigmentation issues. While phenol peels are potent, they come with considerable downtime and risk of hyperpigmentation. Lighter peels may not offer sufficient improvement. Therefore, I prefer targeted treatments like TCA cross for specific scar types.
• Question: Do you work in African-American skin?
  Dr. Qazi: Absolutely. I have extensive experience treating African-American patients. Precision and careful technique are paramount to avoid pigmentation complications. For example, a recent patient opted for ablative CO2 despite potential risks, adhering strictly to sun protection protocols, resulting in zero pigmentation issues post-treatment.
• Question: What do I think of punch excision?
  Dr. Qazi: Punch excision is highly effective for certain scar types. By physically removing scar tissue, we achieve dramatic improvements. Combining this with other techniques like laser therapy amplifies results significantly.
• Question: How much were the treatments total?
  Dr. Qazi: Costs vary, but typically range between 5,000−7,000. Financing options are available through services like Cherry, Affirm, and Alphaeon, making comprehensive care accessible.
• Question: Do lasers work?
  Dr. Qazi: Yes, lasers play a critical role, though they’re part of a broader strategy. Manual interventions like excisions and subcision often precede laser treatments to maximize effectiveness.
• Question: What does Moxy laser do?
  Dr. Qazi: The Moxy laser targets superficial pigmentation and texture issues. Its versatility makes it suitable for addressing mild imperfections without extensive downtime.
• Question: Can you use Sculptra or fillers after subcision, and if yes, how long after the procedure?
  Dr. Qazi: Yes, fillers can enhance results immediately or shortly after subcision, depending on the treatment area. Strategic placement ensures optimal support and contour correction.

• Question: Are chemical peels a good option?
  Dr. Qazi: Chemical peels can complement other treatments, but their intensity must align with individual skin characteristics. Phenol peels provide profound changes but entail extended recovery periods.
• Question: Do you treat shallow pitted acne scars without doing subcision?
  Dr. Qazi: Certainly. Not all scars necessitate subcision. Shallow scars respond well to less invasive methods like laser therapy or topical treatments.
• Question: What about just regular hyperpigmentation; I had a chemical burn on my underarm.
  Dr. Qazi: Hyperpigmentation responds variably based on its origin. Treatments include hydroquinone, Triluma cream, or over-the-counter solutions like Eucerin anti-pigment cream. Persistent cases benefit from Pico Laser treatments.
• Question: What are your thoughts on beef tallow?
  Dr. Qazi: Beef tallow holds promise due to its vitamin content. As an experiment, I’m incorporating it into my routine to assess its impact on skin health and healing processes.
• Question: I heard the TCA cross makes the acne scars bigger. Is that true?
  Dr. Qazi: No, when executed precisely, TCA cross doesn’t enlarge scars. Careful application ensures safe and effective outcomes.
• Question: What do you suggest for ice pick scars?
  Dr. Qazi: TCA cross remains my go-to solution for ice pick scars, occasionally supplemented by excisions for deeper lesions.
• Question: Can you help with treating enlarged pores?
  Dr. Qazi: Enlarged pores relate closely to oil production. Managing sebum levels via topical retinoids, Accure laser, or other modalities addresses pore size effectively.
• Question: Thoughts on spironolactone for acne?
  Dr. Qazi: Spironolactone offers excellent benefits for women dealing with hormonal acne, excess facial hair, or scalp hair loss. Minimal side effects make it a viable choice.
• Question: What do you think of oxymetazoline for PIE?
  Dr. Qazi: Oxymetazoline provides temporary relief for persistent erythema. Long-term solutions involve azelaic acid or specialized lasers like Excel V.
• Question: What kind of scars are these?
  Dr. Qazi: These encompass boxcar, ice pick, and rolling scars, each requiring unique treatment strategies.
• Question: What about the side effects of spironolactone?
  Dr. Qazi: Side effects remain minimal for most users, offering additional cardiovascular protections alongside acne management.
• Question: How soon after being off Accutane can I go see you?
  Dr. Qazi: Timing depends on individual circumstances. Generally, treatments can commence while tapering Accutane doses, ensuring personalized plans align with healing timelines.
• Question: What inspired you to specialize in acne scars?
  Dr. Qazi: Personal struggles with acne scars fueled my passion for finding effective solutions. Witnessing inadequate treatments drove me to develop innovative, patient-centered approaches.

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Contact Qazi Cosmetic Center Today

In conclusion, treating acne scars involves a nuanced blend of techniques tailored to each individual's unique needs. Through dedication, precision, and continuous learning, I strive to empower my patients with renewed confidence and radiant skin. 

If you're interested in scheduling a consultation with me, you can call or text us at 949-336-7293 or click here to self-schedule your consultation. We would be happy to help you!