Ice pick scars aren't effectively treated by microdermabrasion, while flat and boxcar scars respond better

Ice pick scars vs. microdermabrasion: what actually works?

If you’re at Mandalyn Academy and curious about how acne scars respond to different treatments, you’re not alone. Microdermabrasion is a go-to for many clients who want smoother skin with minimal downtime. It’s simple, it’s quick, and it often delivers noticeable results on the surface. But not every scar type is made equal when it comes to exfoliation-based therapies. Let’s keep it practical and clear, so you can explain it to clients, colleagues, or future patients without getting lost in jargon.

What microdermabrasion does, in plain terms

Microdermabrasion is basically a controlled surface scrub. It uses a stream of tiny crystals or a diamond-turbin brush to slough away the outermost dead skin cells, then suctions the debris away. The idea is to improve texture, even out minor pigment differences, and help the skin look brighter. It’s fast, it’s relatively gentle, and for many people with shallow texture issues, it does a nice job.

Because it works at the surface, microdermabrasion tends to be most effective for scars that sit relatively close to the skin’s top layer. Flat scars—smooth, level areas with minimal depth—and some shallow boxcar scars are the kind of targets that respond more readily to this approach. Think of it as giving the skin a light renewal so the surface isn’t so conspicuously uneven.

The scar lineup: why some scars behave differently

Before we drill into the “not so effective” part, it helps to know the main acne scar types you’ll hear about in clinics:

• Ice pick scars: narrow, deep V-shaped indentations that reach down into the dermis. They look like a V or a pinhole-sized canyon.

• Boxcar scars: broad, box-like depressions with steep edges. They’re usually shallower than ice pick scars, but the width makes them noticeable.

• Rolling scars: wavy, undulating surface with shallow, broad depressions. The skin doesn’t sit flat because the scar tissue turls under the surface.

• Flat scars: small, flat, a bit whitish or discolored, often less textured than the others but still visible.

It’s tempting to lump them together as “scars,” but each type behaves differently when you treat the skin. And that difference matters when you’re choosing a treatment plan or coaching a client through their options.

Why ice pick scars aren’t a great match for microdermabrasion

Here’s the crux: ice pick scars punch deep into the skin. The problem isn’t the surface texture—it’s depth. Microdermabrasion is excellent at removing the outermost layers and smoothing the topmost irregularities, but it doesn’t reach into the deeper recesses where ice pick scars hide. Picture trying to mend a long, deep crack in wood by only sanding the surface. You might reduce a bit of snags on the top, but the crack itself is still there, down in the grain.

That depth gap is why ice pick scars often don’t respond well to microdermabrasion when used as a sole treatment. You’ll see some improvement in surface texture or color, sure, but the fundamental indentation will persist because the deep channels aren’t being treated.

How other options tackle the depth problem

If the goal is to address ice pick scars effectively, clinicians usually turn to deeper or more targeted approaches. Here are a few that are commonly considered, often after a careful skin assessment and discussion of risks and downtime:

• Laser therapy: Laser resurfacing can target deeper layers of skin to stimulate collagen and encourage new, healthier tissue to fill in those tunnels. CO2 and Er:YAG lasers are examples that can be tuned for depth and recovery time. The choice depends on skin type, scar depth, and tolerance for downtime.

• Fractional lasers: These devices create tiny columns of controlled injury, leaving surrounding skin intact to speed healing. They can be effective for deeper scarring and are often better tolerated than traditional full-field lasers.

• Punch techniques: For very deep ice pick scars, a punch excision or punch graft may be used. The scar is removed or widened at the base, and the area is closed with sutures or allowed to heal with improved contour. This is more invasive but can yield dramatic changes for individual pits.

• Microneedling: By creating controlled micro-injuries, microneedling signals collagen production and can help with deeper scarring when used over several sessions. It’s often used in combination with serums or PRP (platelet-rich plasma) to boost results, depending on the clinical approach.

• Chemical reconstruction: In some cases, deeper chemical peels or timed retreatment can help, especially when the goal includes color uniformity along with texture improvement. The recovery is longer than microdermabrasion, and pigment risk must be weighed, particularly for darker skin tones.

• Fillers for contour correction: In some scenarios, temporary dermal fillers can lift a particularly deep pit to better blend with the surrounding skin. This is usually part of a broader plan and not a stand-alone fix.

A careful, patient-centered way to approach treatments

What makes a real difference in practice isn’t just choosing a treatment—it's listening first. A thoughtful client assessment asks:

• Where exactly is the scar located, and how deep does it run?

• What is the patient’s skin type and tone? Some deeper procedures carry a higher risk of pigment changes in darker skin.

• How much downtime is acceptable? Some options require several days to a couple of weeks of recovery.

• What other concerns do they have—texture, color, or both?

A good clinician will explain that microdermabrasion can be part of a broader plan. For instance, you might start with surface-level improvement to refresh the skin’s appearance and prep the area for deeper procedures later. It’s not about choosing one method forever; it’s about sequencing the steps to achieve the best overall result.

What this means for students and future practitioners

If you’re learning in a setting like Mandalyn Academy and you’re studying to meet state board expectations, here’s the practical takeaway you can carry into conversations with clients and colleagues:

• Know your scar types. Being able to identify ice pick, boxcar, rolling, and flat scars helps you quickly assess which treatments may be needed and which options are less likely to pedal results.

• Explain depth in simple terms. Clients get why a surface scrub isn’t enough when you describe the difference between a shallow scrape and a deep canyon in the skin. A clear explanation builds trust.

• Emphasize safety and downtime. Deeper treatments can bring more dramatic changes, but they also come with more downtime and a different set of risks. Shared decision-making matters.

• Avoid one-size-fits-all promises. Scar treatment is rarely a single-step revolution. Expect a plan that might combine modalities over several months to maximize results.

A few practical pointers for learners

• When you’re observing a case, sketch the scar’s depth on a whiteboard or in notes. A simple visual aid helps you compare how a surface treatment might affect the outer zone versus a deeper approach.

• In patient counseling, use relatable analogies. “Surface treatments refresh the skin’s coat; deeper therapies repair the internal structure.” It sticks better than clinical jargon alone.

• Consider downtime and pigment risk for different skin types. This is a real-world factor that clients care about—especially when the aesthetic goal is natural, even skin tone.

• If you’re unsure, consult a dermatologist or experienced practitioner. Deeper scarring often benefits from a multidisciplinary plan, and learning to know when to refer is part of professional growth.

A quick recap you can hold in your pocket

• Microdermabrasion works best for surface-level concerns. Flat scars and some shallow boxcar scars may respond with noticeable improvements.

• Ice pick scars are not effectively treated by microdermabrasion alone because the problem runs deep into the skin’s layers.

• For ice pick scars, deeper approaches—such as laser resurfacing, fractional lasers, punch techniques, microneedling, or a combination—are typically considered.

• A thoughtful assessment, patient education, and a staged plan lead to the best outcomes. And that’s the heart of good aesthetic care.

The bigger picture

Skin care, especially when acne scars are involved, isn’t just about a single procedure. It’s about matching the right tool to the right problem, timing each step, and keeping the patient informed and comfortable throughout the journey. If you’re studying in a program that covers skin therapies and board-level expectations, you’re building a foundation that helps you weigh options, discuss them clearly with clients, and design practical treatment paths.

So next time a client asks whether microdermabrasion will fix every scar, you’ll have a grounded, honest answer. You’ll explain that it’s a helpful surface treatment for some scars, but for deep ice pick scars, you’ll outline the deeper options and the role each could play in a comprehensive plan. That clarity—not hype, not guesswork—wins trust and delivers real results.

If you’re curious to dig deeper into this topic, you’ll find that the science behind collagen stimulation, wound healing, and skin texture is a fascinating thread to follow. It’s a reminder that the skin isn’t just a canvas; it’s a living, changing work of tissue—and understanding its language is what makes a great clinician stand apart.