Do All Plastic Surgeons Perform Punch Excision? (photo)

Before proceeding with any surgical treatment for acne scars it is extremely important to have covered all other possible bases of treatment.

1)  Is the acne condition under control or are you still prone to breakouts and cysts?

2)  Are you using antibiotics, topical or oral?

3)  Is the acne hormone regulated?

4)  Have you tried Accutane?

5)  What kind of skin care and exfoliants are currently utlized?

6)  Any laser treatments tried, BBL, fractional laser, ablation, etc?

Only after all these issues have been addressed would I proceed with scar revision.  "Punch" techniques are good for pock marks and small defects but can be disappointing with larger areas.  Larger excisions can be risking with the resultant scarring.  Often, less is more......

Punch excisions for acne scarring can really mean a bunch of things. One way to do it is to use a punch graft but these are usually round and won't fit your scar. Most people would use a scalpel to cut around it and elevate it and then close. Excision would be an option but you would risk the incision that would be needed and the healing from that. So you would have to choose incision scar versus the scar that you have.

In the past, we did a lot of punch excisions for deep, ice-pick acne scars.  This worked for some lesions but sometimes you just traded the acne scar for a new scar that was no better or even worse.  I the recent years, we have been treating these types of lesions with a combination of fractionated resurfacing for the more shallow scars and for overall tightening and using a very strong chemical peel applied to the inside of the deep scars to get them to seal themselves off.