Kare Plastic Surgery and Skin Health Center · Santa Monica
Dermatologist for Acne Scars Santa Monica
804 7th Street Santa Monica CA 90403 · (310) 998-5533
Ice pick scars, boxcar scars, and rolling scars treated with microneedling, fractional CO2 laser, subcision, and TCA CROSS by board-certified dermatologist Dr. Tiffany Sierro
Call (310) 998-5533 Schedule a Consultation
Ice Pick · Boxcar · Rolling Scars · Laser · Microneedling
TCA CROSSIce Pick Scars
CO2 LaserResurfacing
Acne Scar Dermatologist Santa Monica
Choosing the Right Treatment for Acne Scars.
Dr. Tiffany Sierro MD Board-Certified Dermatologist Acne Scars · Ice Pick · Boxcar · Rolling Scars · Microneedling · CO2 Laser · Subcision · Kare Plastic Surgery Santa Monica
Acne scars are permanent skin changes that result from the inflammatory damage of active acne. When a deep pimple or cyst destroys collagen in the dermis, the skin heals with an irregular surface that is lower, rougher, or more textured than the surrounding skin. This structural damage does not resolve with time, skincare products, or topical retinoids. Improving acne scars requires procedures that physically stimulate collagen production, release tethered scar tissue, or remodel the damaged dermal architecture.
At Kare Plastic Surgery, Dr. Tiffany Sierro MD evaluates each patient's scar pattern individually before recommending treatment.
Kare Plastic Surgery · Santa Monica · (310) 998-5533
Ready to improve your acne scars? Schedule a consultation with Dr. Sierro today.
Clinical Documentation · Kare Plastic Surgery · Dr. Tiffany Sierro
Ice Pick and Atrophic Acne Scars · Patient at Kare Plastic Surgery Santa Monica
Actual patient at Kare Plastic Surgery · Ice pick and atrophic acne scarring on the cheek · Evaluated and treated by Dr. Tiffany Sierro
Ice Pick and Atrophic Acne Scars · Dr. Sierro · Kare Plastic Surgery Santa Monica Classic pitted ice pick scars with surrounding atrophic and rolling scar pattern on the cheek · Treated with TCA CROSS and fractional microneedling protocol
What You Are Seeing
This patient presents with a pattern of ice pick scars and atrophic scarring across the cheek that is very common after moderate to severe cystic acne. The narrow deep pits are ice pick scars. The broader shallower depressions are atrophic scars with rolling scar features. This combination pattern requires a two-part treatment approach targeting both scar types separately for the best result.
Dr. Sierro's Plan
Dr. Sierro designed a staged treatment protocol for this patient. TCA CROSS was applied precisely to each ice pick scar to stimulate collagen remodeling from the base of each pore-like pit. Fractional microneedling with PRP was used across the full cheek to improve the broader atrophic scar zone. Sessions were spaced 6 weeks apart with post-treatment skin barrier support between visits.
What to Expect
Acne scar improvement is gradual. Most patients see meaningful texture improvement after 3 sessions and continue to improve for 3 to 6 months after the final treatment as new collagen matures. Patients with this combination scar pattern typically require 4 to 6 total sessions. Dr. Sierro sets realistic goals at the first consultation so every patient knows what to expect before treatment begins.
Acne Scar Types
Understanding Your Acne Scar Type
Ice Pick Scars
Deep narrow pits that extend into the dermis and sometimes the subcutaneous layer. They look like open pores or tiny puncture marks. Ice pick scars are the most difficult type to treat because of their depth. TCA CROSS is the most effective treatment, stimulating new collagen from the base of each scar upward over multiple sessions.
Boxcar Scars
Round or oval depressions with clearly defined vertical walls, like small craters. Boxcar scars vary in depth. Shallow boxcar scars respond well to fractional CO2 laser and microneedling. Deep boxcar scars may require punch elevation or a combination of subcision and laser for meaningful improvement.
Rolling Scars
Broad wave-like undulations in the skin surface caused by fibrous tissue bands tethering the skin to the deeper tissue below. Rolling scars are best treated with subcision to release the tethered bands, followed by filler or PRP to support the elevated tissue. Laser and microneedling further smooth the surface after subcision.
Atrophic Scars
Flat or slightly depressed scars without clear edges, resulting from diffuse collagen loss after inflammatory acne. Atrophic scars affect broad areas of the face and respond to fractional laser, microneedling, and dilute filler placed in the superficial dermis to restore volume and improve surface texture.
Post-Inflammatory Hyperpigmentation
Dark flat marks left after acne clears are not true scars. They are pigmentation changes in the upper skin layers. PIH fades over time and responds to topical retinoids, azelaic acid, vitamin C, and chemical peels. Treating active acne and using sun protection reduces the severity of PIH formation.
Hypertrophic Scars
Raised thickened scars that occur when the skin overproduces collagen during healing. More common on the chest and back than the face. Treated with intralesional corticosteroid injections, pulsed dye laser, and silicone therapy. Dr. Sierro evaluates each scar type at your consultation to confirm the correct diagnosis before recommending treatment.
Acne Scar Treatment Options with Dr. Sierro
TCA CROSS for Ice Pick Scars
TCA CROSS uses a high concentration of trichloroacetic acid applied precisely into the base of each ice pick scar with a fine toothpick applicator. The localized chemical coagulation stimulates new collagen production from within the scar, gradually filling and narrowing the pit over multiple sessions. This is the single most effective treatment for ice pick acne scars available today. Results build progressively over 4 to 6 sessions spaced 6 weeks apart. Downtime is minimal. The treated scars form a small white frost that crusts and resolves within 7 to 10 days.
Fractional CO2 Laser Resurfacing
Fractional CO2 laser delivers thousands of microscopic columns of laser energy into the skin, creating controlled micro-injuries that trigger an intense collagen remodeling response. The surrounding untreated skin speeds healing. Fractional CO2 is the most effective single treatment for improving overall skin texture, pore size, and the depth of boxcar and atrophic acne scars. Downtime is 5 to 7 days. Dr. Sierro calibrates the treatment density and energy level based on skin tone and scar depth for optimal results with the lowest risk.
Microneedling with PRP
Microneedling creates hundreds of fine channels in the skin that trigger the skin's natural wound healing response and stimulate new collagen and elastin production. Adding platelet-rich plasma from the patient's own blood amplifies the growth factor signaling and accelerates the healing response. Microneedling with PRP is ideal for patients who want meaningful improvement with less downtime than CO2 laser. Most patients are pink for 24 to 48 hours. 4 to 6 sessions spaced 4 weeks apart produce a significant improvement in acne scar depth and skin texture.
Subcision and Filler
Subcision uses a fine needle inserted beneath the skin surface to break the fibrous bands that tether rolling scars downward. Releasing these bands allows the depressed skin to rise and reduces the wave-like undulation of rolling scars. Dr. Sierro often combines subcision with dilute hyaluronic acid filler injected into the newly released scar tissue to provide scaffolding support and further elevate the corrected area. The combination of subcision and filler produces results in rolling scars that no laser or microneedling treatment alone can achieve.
Active acne must be controlled before scar treatment begins. Treating acne scars while acne is still active produces poor results and creates new scars. Dr. Sierro evaluates every acne scar patient for active acne at the first consultation and initiates acne control treatment first when needed. Once acne is fully controlled and clear for at least 3 months, scar treatment begins. This sequencing matters and is a step many providers skip. Call (310) 998-5533 to start your acne scar evaluation.
Frequently Asked Questions
What is the best treatment for acne scars in Santa Monica?
The best treatment depends on scar type. Ice pick scars need TCA CROSS. Boxcar scars respond to fractional CO2 laser. Rolling scars improve with subcision and filler. Most patients have a combination requiring a personalized multimodal plan. Dr. Sierro evaluates each patient individually at Kare Plastic Surgery. Call (310) 998-5533.
How many acne scar treatments are needed?
Most patients require 3 to 6 sessions spaced 4 to 6 weeks apart. The number depends on scar depth, scar type, and the treatments used. Dr. Sierro discusses the expected number of sessions and realistic outcomes at your first consultation at Kare Plastic Surgery in Santa Monica. Call (310) 998-5533.
Can ice pick acne scars be treated in Los Angeles?
Yes. TCA CROSS is the most effective treatment for ice pick scars and is performed by Dr. Sierro at Kare Plastic Surgery in Santa Monica. High concentration TCA is placed precisely into each scar with a fine applicator to stimulate collagen from within. Multiple sessions are typically needed. Call (310) 998-5533.
Schedule Your Acne Scar Consultation
Kare Plastic Surgery · Santa Monica · 804 7th Street
Treat Your Acne Scars with Dr. Sierro
Dr. Tiffany Sierro is a board-certified dermatologist at Kare Plastic Surgery who provides expert acne scar treatment throughout Santa Monica and Los Angeles. She evaluates every patient's scar type individually and creates a personalized treatment plan. Same-week appointments are available.