Scarring from blackheads/acne. Would a punch excision help? (Photo)

Question

Backstory about 4yrs ago i had a blackhead that left a hole in my forehead and refused to close. After microneedling, tca chemical peels, tretinoin, etc. Nothing has changed I was recommended a punch biopsy by my old derm if everthing else fails but my new derm won't do it since its on a very noticible part of my face and thinks the scar from that might be worse. They refered to do cosmetic consult but appts are till the end of the year. Now I think I should just do the punch? Other recs?

Nelson Lee Novick, MD · Answer

Microneedling, which is best used to treat very superficial, surface texture and color irregularities and topical tretinoin had little chance of working on a deep ice pick scar. So, no surprise there. If by TCA chemical peels is meant conventional 10%-35% peels, this, too, had little to no chance of success for this type of scar. A punch-excision runs the risk in this area of developing a stretch scar and tram track stitch marks, particularly in areas, such as the forehead, subject to a great deal of static and dynamic muscular tension. However, TCA CROSS, which I have been using for treating these kind of scars and which utilizes TCA in 90-100% concentrations, applied directly down the shaft of the scar has a very long track record for both efficacy and safety.  Make sure that you consult with an experienced, board certified cosmetic dermatologist with acne scar experience. Best of luck.

Scarring from blackheads/acne. Would a punch excision help? (Photo)

Answers (1)