Surgery, and this includes punch excision (which just means the cutting is done with a cookie cutter-like instrument instead of a scalpel) involves excising the scar and closing the resulting wound with stitches. Particularly in areas subject to muscular tension or movement, this can translate into the development of stretch scars and stitch tracks--in other words trading a headache for an upset stomach. On the other hand, when it comes to subcision, as the name implies, a thin needle or cannula is inserted under the skin to break up the scar tethers that hold the skin surface down, and promotes new collagen and new elastic fiber production to occur to subsequently elevate and smooth the skin. Since there is no deep cutting and stitch placement, there is no risk for the development of stretch scars or stitch tracks. Hence, subcision, which I have now been performing for more than thirty years is my go-to for treating all kinds of indented scars, including acne boxcar and rolling scars. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist. Hope this helps and best of luck.