Will punch excision work for my ice pick scars? (photo)

I've tried chemical peels and the E matrix laser and nothing seemes to work. My goal would be to proceed in doing the punch excision and the Cross TCA. According to my picture are either options going to make a valid difference in my acne scarring?

Doctor Answers 6

Punch excision

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Punch excision is not currently a favored treatment of mine as it has the potential to make acne scars worse.  Essentially a scar is either removed with a punch or lifted with a punch and sutured to the skin.  

Chicago Facial Plastic Surgeon
4.8 out of 5 stars 179 reviews

Ice Pick Scars

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eMatrix combined with TCA cross and fillers such as Restylane will greatly reduce the scars and improve your complexion.  PRP with microneedling will also be a great adjunct to your skin care.  Please consult an expert.  Best, Dr. Green

Acne Scarring -- Requires a Combination of Fractional Laser Resurfacing, Fillers Like Bellafill, Subcision and Eclipse Micropen

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Acne scarring needs a combination approach for improvement.  Punch excisions and TCA cross work well for ice pick scars along with lasers and needling.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Ice pick scars

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Punch excision can help ice pick acne scars.  TCA cross can also be of benefit.  Always seek help from a qualified professional.  Good luck!

Jennifer Trent, MD, FAAD
Sarasota Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Ice pick and box car scars thinking about punch excision and cross tca

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I have done punch excision and TCA cross. This might help you to a degree and that's possible. It's also possible that you may not get as much of a result from these. TCA cross can be a long recovery and sometimes it's hard to control. Sometimes you can get worsening of your scars. Punch excisions tends to leave patchiness on your face. Both approaches may require multiple treatments at different dates and points in time. Would you approach that can all be done in about 2 hours that treats all types of acne scarring with one treatment

Philip Young, MD
Bellevue Facial Plastic Surgeon

Yes, TCA is better in your skin however...

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Acne scar revision is a specialised field. For the best results, one should target the acne scar type with ideal treatments.

Looking at your pictures, I believe you primarily have box car scars, I m sure you have a few ice pick ones, but the predominant type is box car. I use a lower concentration of TCA followed by laser resurfacing a few months after. To answer your question on ice pick scars, attached a video on scar treatments. 

For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgery.

The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars.
All the best,
Dr Davin Lim
Laser, surgical & aesthetic dermatologist
Brisbane, Australia

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.