Why Are Results from Acne Scar Excision So Uncertain?

From the testimony I've read regarding excision of deep or pitted acne scars, the result tends to be extreme. They are either very pleased with the result, often stating there is absolutely no sign of the previous scar or even the "linear scar" that was supposed to replace it, or the surgery was a complete failure and they now have an even bigger scar than before. Why are the results so uncertain for this procedure? Is it the best option for ice pick or deep acne scars?

Doctor Answers 3

Excision is an important tool in Acne Scar Revision

Excision is an important tool in Acne Scar Revision. There are some scars (many of them actually) that will benefit most from excision. The results are variable depending on your genetics, the severity of your scar, location, healing, procedure preparation, etc.  One person may have more of an issue with healing because of reactions that they may have to the suture material. I have had many patients whose bodies just don't like some of the absorbable sutures that we use to close the incisions. Their bodies react to the sutures and the healing can be difficult. In this situation, I use more permanent less reactive sutures to close the incision. The skill, consideration, and experience of the surgeon / doctor can have a major impact (among many other variables). I think that people with acne tend to have healing issues more so than the general population because their skin's vascularity is compromised and hence the tissue and closure of the skin heal in a less than desirable manner. The way to combat this situation is to do fat grafting, in my opinion. Fat grafting as a procedure that starts off the whole process can really help the situation. It does this by freeing up the scars, increasing the vascularity to the skin, stretching out the skin so that the scars are not as deep, etc. Also there are stem cells in the fat that may contribute to healing the skin as well. The healthier skin after fat injections can have a significant impact in healing when future procedures are done. Frankly, there are some scars that will only respond most favorably when excision is the major method that is used.

Thanks for reading, Dr Young

Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

Acne Scars and Fraxel Re:Pair

Although ice pick type of scars on the face are more difficult to get improvement on, the Fraxel Re:Pair has demonstrated very good results for post-acne scarring. I have yet to have anyone who did not see improvement and the improvement is usually significant, but the skin is never complete smooth or level, but the area of scarring is less noticeable and with women much easier to camoflauge or cover with makeup. I will post pictures in the near future.

Theodore Katz, MD, FACS
Philadelphia Plastic Surgeon
4.8 out of 5 stars 7 reviews

Acne scar excision

Results have in part to do with location of the scar (whether it is in an area of considerable movement), an individual's tendency to heal with or without scarring, surgical technique, punch excision size, and whether dermabrasion was performed after healing of the excision to address scar texture. There is another technique that I like to use called the Cross method which involves application of a very strong chemical peeling agent into an ice-pick scar to stimulate collagen growth. You ought to consider it.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 5 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.