Which acne scars can be cut out rather than resurfaced?
A small number of deep acne scars can be removed surgically rather than resurfaced. Punch excision uses a small circular device to remove the scar completely, and the resulting wound is carefully closed with sutures. This converts a pit into a longer fine line, which is usually less noticeable. It is an excellent option where there are a small number of deep scars but is not suitable for large numbers of scars.
Under local anaesthetic a circular core of skin containing the scar is removed and one or two sutures are placed. The wound heals over one to two weeks and leaves a linear scar which continues to fade over several months.
The reason this approach cannot simply be applied to every scar is that each excision leaves its own line, and the arithmetic ceases to work quickly. Removing five deep scars exchanges five pits for five fine lines, which is generally a favourable trade. Removing fifty exchanges fifty pits for fifty lines across a face already under tension, which is not. Punch excision is therefore best used selectively, on those few scars too deep for any other treatment, as part of a wider plan.
Skin grafts are not used for acne scarring. Grafted skin rarely matches the surrounding colour and texture and creates a second wound at the donor site, so the result is usually more conspicuous than the scarring it was intended to replace. Where there is a single localised area of severe scarring, surgical excision of that area can occasionally be worthwhile, although this applies to a small minority of cases.
Generally punch excision is best performed early within a treatment plan, before resurfacing, so that the lines it creates can subsequently be softened by laser. It combines particularly well with subcision at the same visit.
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