should I try punch excision again? I had an enlarged pore that my Derm said he could fix with no visible scarring. (Photo)

Question

It will be one year in May since I had the procedure done. He recommended trying it again. Should I try again or will it cause a larger pot?

Rohit Seth, MD, MRCS(Ed), PhD · Answer

Hi Jfh2001
Thank you for your question and the photograph.
My initial thought on reading the question was no visible scar with an excision is not possible. I wanted to check what exactly you had done as a procedure. 
If it was a punchy biopsy excision, even if this was a small punch - this would still leave a scar. This would require a stitch to close the defect otherwise the scar will stretch and leave a wide and indented scar. 
If this was a shave excision, then no stitch is required but the scar will be flat and of the diameter of the original lesion/ scar. 
With many acne scars, the pitting is quite deep. I see it with many face-lifts in patients with acne. Not only is the scarring reaching the SMAS layer that is deep to the skin, but in areas of active acne, these pores are quite deep. Therefore a superficial punch biopsy might not be enough. 
For the area you are showing, whether you repeat the punch biopsy or have it formally excised as a small elipse - the resulting scar will be a small straight line. This will be less evident then the current area as there will be no indentation and therefore no shadowing on the skin which highlights the area of concern
I hope this helps 
Best wishes
Rohit Seth
Plastic, Reconstructive, Aesthetic and Hair transplant surgery
Bella Vou Cosmetic Clinic

Michele S. Green, MD · Answer

A punch excision may still leave a scar. I would recommend first trying a filler into the scar and see if that makes a nice improvement.  I like Restylane for these types of scars and I have great results. Please consult an expert in scars.  Best, Dr. Green

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