Punch excision is a surgical procedure that’s usually used for scar revision. It uses a sharp, cookie-cutter-like punch tool to "punch" around a scar and ultimately remove it. The remaining hole is then closed with a tiny suture.Â
The procedure can treat acne scarring, as well as some marks left by mole removal or other indented or atrophic scars. It works best for deep icepick or boxcar scars smaller than 3 millimeters. Anything bigger, such as a keloid or birthmark, probably won’t have a good outcome with punch excision.Â
“If the scar is approximately the size of a pencil eraser and is located in a high-tension area like the forehead, a punch excision is likely to yield a scar that will ultimately stretch again to about the same size of the original scar,” says Dr. Nelson Lee Novick, a New York City-based dermatologist.
Some doctors on RealSelf caution that punch excision can be less precise than other methods. “The depth can be too deep, which actually results in too much being taken out. Usually, physicians who aren’t comfortable with scalpels and excisions use a punch technique, but I’ve found you can actually customize depth and size with a regular excision. A lot of the time, a punch is actually worse because you have to widen the margins and depth more than is actually needed,” says Dr. F. Victor Rueckl, a dermatologist in Las Vegas.
A doctor with extensive experience in scar removal and skin resurfacing can create a tailored plan for your skin. “The majority of patients will have a collection of different scar types,” says Dr. Davin Lim, a dermatologist in Brisbane, Australia, in a RealSelf Q&A. “Careful examination, especially under angled lighting with scar mapping, will give you an understanding of the best options for your scars.”
RealSelf Tip: This procedure is sometimes referred to as punch biopsy, a technique used to remove some types of skin cancer. Learn more about skin cancer treatment options.
