Punch excision for acne scarring
Different types of acne scars respond best to specific treatments. Punch excision is a method of surgically correcting deep acne scars such as icepick and deep boxcar scars. This procedure uses a punch biopsy tool which is basically a round, sharp “cookie-cutter” tool that comes in diameters ranging from 1.5 mm to 3.5 mm. The size of the tool is matched to the size of the scar to include the walls of the scar. Under local anesthesia the punch cuts around the damaged skin, leaving a small circular would the size of the scar. The skin edges are then sutured together, usually needing only a single stitch. The newly produced linear scar eventually fades and may not be noticeable. It is less noticeable than the original acne scar and is also more amenable to correction using resurfacing techniques.
Punch Elevation for Acne Scarring
This method of surgically correcting acne scars is used on deep boxcar scars that have sharp edges and normal appearing bases. The same punch tool as above is used to excise only the base of the scar leaving the walls of the scar intact. The excised base is then elevated to the surface of the skin and kept in place with tape or steri-strips. This method lessens the risk of color or texture differences as can be seen with graft replacement, and lessens the risk of producing a visible scar as can be seen when wound edges are sutured.
Punch Excision, Punch Elevation – One week after the procedure all dressing and stitches are removed. The grafted sites may be raised at this point but are usually lasered one to two months later to smooth and merge the grafts to the surrounding skin. Make-up may then be worn.