Do All Plastic Surgeons Perform Punch Excision? (photo)

Question

im trying to find a doctor to do punch excision on my acne scars. Is it only plastic surgeons who perform them, should i be looking at a hospital or a clinic? Also, my doctor told me not to do a excision any reasons why?

James Wire, MD · Answer

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......

Philip Young, MD · Answer

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.

Stacey Tull, MD · Answer

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.

Dina D. Strachan, MD · Answer

Dermatologists also perform punch excisions for acne scars, however, tnis might not be the best cnoice fpr you. Before you pick a method of acne scar revision, get a consultation to be sure you have determined your best options. Also make sure that uou acne is under control. I tend to use punches only on very deep acne scars.

F. Victor Rueckl, MD (in memoriam) · Answer

I don't recommend punch excisions, actually. What happens with a punch biopsy or punch excision is that 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 customized depth and size with a regular excision, and a lot of the time a punch version is actually worse because you have to widen the margins and depth more than is actually needed. Also, derms, plastics, and other physicians can and do punch excisions. Additionally, I'm not sure why someone recommended you have a punch excision anyway; that's just going to go around the acne scar and widen and deepen it. Which will require healing and can possibly scar again. I'd recommend you get filler in the scars - a much simpler procedure with no downtime. I'd at least suggest you see another physician for a consult before going in for a punch excision - I just don't think this is the right treatment for you.

Do All Plastic Surgeons Perform Punch Excision? (photo)

Answers (5)

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