Ice pick scars are too narrow and deep for a laser pass to reach. Medical Director Dr Sin Yong treats them inside each scar with TCA CROSS or CO2 at IN Eternity Clinic on Orchard Road.
WhatsApp to Enquire →Key facts ↓Ice pick scars are narrow, deep acne scars, usually under 2 mm wide, that a laser pass across the face barely reaches. Treatment goes inside each scar: TCA CROSS or CO2 point shots, repeated every four to six weeks, then a fractional pass to blend the surface. Very deep scars may need a punch technique. They become shallower and narrower; complete removal is not promised.
Ice pick scars are the narrowest and, for their size, the deepest acne scars. At the surface they are usually less than 2 mm across, often less than 1 mm, and they run down through the dermis like a V-shaped shaft, sometimes reaching the fat below. From a normal distance they look like large open pores or tiny punctures, most often on the cheeks and temples.
They form when a deep, inflamed spot, often a cyst or nodule, breaks down a narrow column of collagen and the channel heals as a tract rather than filling in. Picking and squeezing deep spots makes this more likely. Ice pick scars rarely appear alone: most people with them also have boxcar or rolling scars, and the full mix is set out in types of acne scars.
Their shape is the whole problem. The opening is narrow, so there is little to resurface; the depth is great, so a laser pass across the face barely touches the base. Treatment therefore goes inside each scar.
| Feature | Ice pick scar | Enlarged pore |
|---|---|---|
| Edge | Sharp, often slightly irregular | Soft, round, often with a visible oily plug |
| Depth | Deep; casts a dark dot in side light | Shallow funnel |
| Pattern | Scattered where deep spots were | Evenly spread over the nose and central cheeks |
| When you stretch the skin | Stays visible | Often becomes less obvious |
| History | A deep spot or cyst in that place | Oily skin, sun damage, ageing |
| Usual first treatment | TCA CROSS or CO2 point shots | Skin care, peels, fractional or pico laser |
The distinction matters because the treatments differ. Pores respond to skin-quality treatments, covered on enlarged pores treatment; ice pick scars need focal treatment.
TCA CROSS stands for chemical reconstruction of skin scars. A high-strength trichloroacetic acid (TCA) is placed with a fine applicator into the base of each ice pick scar, and only there, until the scar frosts white. The acid creates a controlled injury inside the narrow channel. As it heals, new collagen forms along the walls, and over successive sessions the scar becomes shallower and narrower. Because the skin around the scar is not treated, the surface heals quickly.
Studies of the CROSS method, including in darker skin types, have reported improvement in ice pick scars over several sessions with few complications when the acid is confined to the scar. It is a medical procedure, not a peel, and it does little for rolling scars or flat marks. More on the procedure is on TCA CROSS in Singapore.
A CO2 laser can also be used inside the scar. With a focused setting, single deeper pulses are placed into individual pits to ablate the walls and stimulate remodelling, an approach used in the SCAR3 (S3) protocol on the DEKA Tetra Pro at IN Eternity Clinic. A lighter fractional pass is then used over the surrounding skin to blend the edges, so the scar and its surroundings are not treated as if they were the same.
CO2 point shots suit scars that are slightly wider at the opening or sit among boxcar scars that are being resurfaced in the same session. TCA CROSS suits very narrow, deep channels. Many plans use both, in different sessions. The device and its settings are explained on CO2 laser in Singapore, and the acne-scar protocol on CO2 laser for acne scars.
“An ice-pick scar is a shaft, not a dent. You treat it from the inside, one scar at a time, or you are polishing the skin around it.”
Punch techniques are small surgical procedures for scars too deep or too wide-walled for chemical or laser treatment alone. A circular blade of a size matched to the scar is used under local anaesthetic.
| Technique | What is done | Suits | Trade-off |
|---|---|---|---|
| Punch excision | The scar is cut out and the edges are closed with a fine stitch | Deep ice pick scars, narrow deep boxcar scars | Leaves a fine line scar instead of a pit; stitches for about a week |
| Punch elevation | The scar floor is cut free and lifted level with the surrounding skin | Boxcar scars with a normal-looking flat floor | The edge can still show; often followed by resurfacing |
| Punch grafting | The scar is removed and replaced by a small plug of skin, usually from behind the ear | Very deep ice pick scars | Colour or texture mismatch is possible; resurfacing later blends it |
Punch techniques trade a deep pit for a flatter, finer mark, and the area is usually resurfaced weeks later to blend it. They are considered when a scar is unlikely to respond enough to TCA CROSS or CO2 point shots. At IN Eternity Clinic punch excision, elevation and grafting are all offered. Nowadays, though, Dr Sin Yong more often treats deep ice pick scars with S3 (SCAR3) resurfacing on the DEKA Tetra Pro CO2 alongside TCA CROSS, because in his experience it usually gives a smoother, more even result without stitches. A punch technique is still used where a particular scar calls for it.
Where ice pick scars sit among rolling and boxcar scars, they become one part of a wider plan with subcision and resurfacing, described on acne scar treatment in Singapore and, for mixed scarring, in the 4D Scar Reconstruction protocol.
Ice pick scars can usually be made shallower and narrower, so they cast less shadow and look more like fine pores than pits. Very deep scars may improve only partly and may need punch techniques. Change builds for months after each session, as collagen keeps forming in the treated channels.
| Scar depth | Typical sessions | Realistic aim |
|---|---|---|
| Shallow ice pick scars | About 2–4 | Much less visible in normal light |
| Moderate depth | About 3–5 | Shallower and narrower; some still visible in side light |
| Very deep or wide-walled | About 4–6, sometimes with a punch technique | Partial improvement; a fine mark may remain |
General clinical observations used at consultation; they describe what is checked, not any individual result.
Most small pits on the cheeks are acne scars or pores. A few need a different diagnosis.
Where any of these apply, the first step is a diagnosis.
Cost depends on how many scars are treated, the method (TCA CROSS, CO2 point shots or a punch technique), how many sessions are needed and whether other scar types are treated in the same plan. Other Singapore clinics publish TCA CROSS at S$300 to S$600 per session and fractional CO2 at S$380 to S$600 per session (read 20 October 2026; sources in acne scar removal cost in Singapore). At IN Eternity Clinic the plan is quoted after assessment; the consultation fee is S$120, waived with any medical treatment.
Treatment usually goes inside the scar: TCA CROSS or CO2 point shots over several sessions, followed by a fractional pass to blend the surface. Very deep scars may need a punch technique. The choice follows the width and depth of each scar.
Usually not completely. They can be made shallower and narrower so they cast less shadow. Very deep scars may improve only partly, and a fine mark can remain after a punch technique.
Commonly three to six sessions, spaced four to six weeks apart. Deeper scars usually need more, and progress is judged on photographs in the same light.
A laser pass across the face reaches the base of an ice pick scar poorly. Focused CO2 point shots placed into each pit can help, usually alongside TCA CROSS and followed by a fractional pass.
Because only the scar is treated, TCA CROSS is often well suited to Asian skin. Temporary darkening around treated scars can occur, so sun protection and spacing are planned and darkening is treated early if it appears.
Each treated scar shows a white dot, then a small dark crust that sheds in about a week. Make-up can usually cover it after a day or two.
Other Singapore clinics publish TCA CROSS at S$300 to S$600 per session (read 20 October 2026). The total depends on the number of scars, methods and sessions. At IN Eternity Clinic the plan is quoted after assessment; the consultation fee is S$120, waived with any medical treatment.
IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, Singapore 228210. By appointment with Medical Director Dr Sin Yong. Monday to Saturday, 11am to 8pm. WhatsApp or call +65 8815 3008. The consultation fee is waived with any medical treatment.
These sources describe mechanisms and general evidence. They are not a promise of any individual result; suitability is decided at an in-person assessment.