Acne can leave lasting reminders long after the active phase of spots and inflammation has subsided. Many individuals who have experienced moderate to severe acne end up with varying degrees of scarring, which can affect their self-esteem and confidence. While there are numerous treatments to tackle acne scars—from chemical peels and laser therapy to dermabrasion—one method stands out for specifically targeting deep, pitted scars: acne punch excision.

Understanding Acne Scarring

It is helpful to understand how acne scars develop in the first place. Acne scars are typically caused by the inflammation and trauma that occur during active acne. When spots, pimples, or cysts form, they can lead to tissue damage within the deeper layers of the skin. The body’s natural healing process tries to repair this damage by producing collagen. If the body produces too much or too little collagen, the resulting scar may appear raised or depressed.

Types of Acne Scars

• Ice Pick Scars: These are narrow, deep scars that extend into the dermis. They often look as though a sharp object has ‘punctured’ the skin, hence the name.

• Boxcar Scars: These are wider depressions with more defined edges. They can appear round or oval and resemble the marks left by conditions such as chickenpox.

• Rolling Scars: These scars create undulating or wave-like depressions across the skin’s surface, caused by fibrous bands of tissue pulling the skin inward.

• Hypertrophic/Keloid Scars: These are raised, thick scars that result from excessive collagen production during healing.

While certain scars can be effectively treated using surface-level interventions like microdermabrasion or superficial chemical peels, deeper scars—especially ice pick and certain boxcar scars—often respond better to more targeted interventions, such as punch excision.

What Is Acne Punch Excision?

Acne punch excision is a minor surgical procedure designed primarily to address deep, pitted acne scars, commonly referred to as ice pick or narrow boxcar scars. The concept behind this method is relatively straightforward: a specialised tool, known as a punch biopsy instrument, is used to remove the scarred area of the skin. The resulting wound is then sutured or closed, enabling the skin to heal in a more uniform manner.

In some cases, once the scar is removed, the small opening can either be closed directly or replaced with a tiny skin graft (taken from a less visible area of the body), depending on the surgeon’s assessment and the size of the defect. Punch excision can be a highly effective solution because it directly targets the area of scar tissue, removing it entirely rather than just masking or smoothing its appearance.

Who Is a Suitable Candidate for Acne Punch Excision?

Although punch excision can achieve excellent results for certain individuals, it is not suitable for all types of scars or for every patient. Below are a few factors that make someone a potentially good candidate:

1. Type of Scar: Ideal for deep, narrow scars such as ice pick or some boxcar scars. Shallower scars may respond better to resurfacing techniques, and rolling scars often improve with subcision or other methods.

2. Stable Skin Condition: The individual should not have active acne or severe skin inflammation. Punch excision is most beneficial once acne is largely under control.

3. Non-Smoker or Willing to Quit Temporarily: Smoking can impair wound healing and affect the overall results.

4. Realistic Expectations: While results can be dramatic, it is important to remember that no scar removal technique can guarantee the absolute elimination of all blemishes. Improvement in scar appearance is the key goal.

5. Overall Good Health: Being generally healthy can help ensure a smoother healing process and reduce the risk of complications.

If you have a combination of scar types—say rolling scars along with a few ice pick scars—it is common to undergo multiple complementary treatments. Our team at CLNQ can suggest a personalised treatment plan that may include punch excision alongside other procedures like laser resurfacing or subcision.

Benefits of Acne Punch Excision

Punch excision offers several advantages for those struggling with deep acne scars:

1. Targeted Removal of Scar Tissue: By directly removing problematic scar tissue, this procedure allows the skin to heal without the tethering or pitting that originally caused the depression.

2. Effectiveness for Ice Pick Scars: Among all the methods available, punch excision is particularly successful in dealing with ice pick scars—those narrow, deep depressions that many other treatments find difficult to address.

3. Minimal Downtime: While there is some healing involved, the downtime is usually less than that associated with more extensive procedures, such as deep chemical peels or ablative laser resurfacing. There may be stitches that require removal after 7-10 days.

4. Potential for Dramatic Improvement: Even though some minor scarring may remain, punch excision has the potential to significantly enhance the skin’s smoothness and overall appearance.

5. Combination-Friendly: Punch excision can easily be combined with other scar revision techniques for a more comprehensive approach to acne scarring.

What to Expect During the Procedure

Anaesthesia

On the day of the procedure, the treatment area will be thoroughly cleansed. A local anaesthetic is injected into the area around the scar. This numbs the region, ensuring you remain comfortable throughout the procedure.

Punch Excision

A small, cylindrical punch biopsy tool—sized to match the width of your scar—is used to cut around and beneath the scar. The goal is to completely remove the tissue that forms the depressed or ice pick scar. Depending on the scar’s depth and diameter, the punch size usually ranges from 1mm to 3mm in diameter.

Closure or Grafting

After the scar is excised, there will be a tiny hole or wound. There are two main options for closure:

1. Primary Closure: The edges of the wound are sutured together. This is usually sufficient for smaller defects and ensures a linear scar that often heals more discreetly than the original scar.

2. Skin Graft (Punch Grafting): For larger or deeper scars, we may fill the excised area with a small skin graft taken from a discreet site—often behind the ear. This technique is particularly useful if primary closure might result in tension or distortion of the surrounding skin.

Dressing and Post-Procedure

Once the excision and closure are complete, a sterile dressing or bandage is applied to protect the area. We will provide instructions on caring for the wound and may book a follow-up appointment to remove sutures and assess the healing.

Recovery and Aftercare

Initial Days After Surgery

• Mild Swelling and Redness: Some swelling, bruising, or redness around the treated site is normal. This usually subsides within a few days.

• Stitch Care: You will have a dressing covering the stitches which will be removed typically 7–10 days post-procedure.

• Pain Management: Over-the-counter painkillers like paracetamol may be recommended if you experience discomfort. Avoid medications that can thin the blood, like ibuprofen or aspirin.

Long-Term Aftercare

• Avoid Picking or Scratching: Refrain from picking at scabs or scratching the treatment site, as this can prolong healing and increase the risk of infection.

• Sun Protection: Use a broad-spectrum sunscreen (SPF 30 or higher) and limit direct sun exposure to prevent hyperpigmentation of the healing scars.

• Follow-Up Treatments: Depending on how well your skin heals, you might benefit from complementary therapies such as laser resurfacing, micro-needling, or chemical peels to refine skin texture and improve the surrounding areas.

The total recovery time for punch excision is usually a few weeks, although complete healing and final results can take a few months. This timeline may extend if additional treatments, such as skin grafting or further scar revisions, are performed.

Risks and Potential Complications

As with any invasive procedure, acne punch excision carries some risks. While complications are rare when performed by an experienced doctor, it is still important to be aware of the following:

1. Infection: If the treatment area is not kept clean, bacteria can enter the wound, leading to infection. Signs include persistent redness, swelling, and discharge.

2. Scarring: There will be a permanent scar at the site of the excision. Rarely, this could be more noticeable than desired. However, this risk is generally mitigated by careful suturing and adequate aftercare. You can use silicone scar products after suture removal to aid the healing.

3. Changes in Skin Pigmentation: Some individuals may experience temporary or, rarely, permanent hyperpigmentation (darkening) or hypopigmentation (lightening) at the treatment site.

4. Allergic Reaction: Though uncommon, patients can sometimes react to the local anaesthetic or other materials used during the procedure.

5. Wound Healing Issues: Smoking, certain health conditions (like diabetes), or inadequate aftercare can slow healing and lead to complications.

Comparisons with Other Acne Scar Treatments

While acne punch excision is ideal for specific types of scars, other treatments may also be considered based on the patient’s overall skin condition and scar characteristics. Here is a brief comparison:

Punch Excision vs. Subcision

• Subcision is a technique used mainly for rolling scars. A needle is inserted beneath the scar to release the fibrous bands pulling the skin down, allowing it to rise to the surface. Punch excision, by contrast, directly removes the scar tissue, making it more suitable for ice pick or narrower boxcar scars.

Punch Excision vs. Laser Therapy

• Laser Treatments (such as fractional laser resurfacing) help resurface the skin and stimulate collagen production. They are often used for superficial to moderate scars. Deep ice pick scars may need more direct intervention, like punch excision, for optimal improvement.

Punch Excision vs. Chemical Peels

• Chemical Peels can help with surface-level improvements, pigmentation issues, and mild scarring. Deep or stubborn scars (like ice pick) often require more targeted surgical methods. Punch excision can sometimes be followed by a chemical peel once the skin has healed for additional refinement.

Punch Excision vs. Dermal Fillers

• Dermal Fillers can be used to plump depressions in the skin. While they can provide immediate improvement, the results are typically temporary, and fillers do not remove scar tissue. Punch excision removes the scar entirely, which can lead to a more permanent outcome.

Our team at CLNQ may recommend a combination approach—such as using punch excision to remove the most severe scars, followed by laser resurfacing or subcision to address the more superficial scars—for a comprehensive improvement in skin texture.

Results and Longevity

Most individuals notice a visible improvement in the appearance of their acne scars once the treated areas have fully healed. The final results can take a few months to become apparent, as the body continues to remodel collagen and the residual redness fades. Over time, the incisions and graft sites typically soften and blend with the surrounding skin.

As punch excision physically removes scar tissue, the results are generally permanent. However, the skin continues to age, and new issues such as wrinkles or pigmentation changes can appear over time. Additionally, if you experience a new bout of severe acne, you could develop fresh scarring in untreated areas.

Frequently Asked Questions

Does acne punch excision hurt?

Most people experience only mild discomfort during the procedure due to local anaesthesia. You may feel a slight pressure or tugging sensation, but you should not feel pain. After the anaesthetic wears off, you might notice some tenderness, which can typically be managed with over-the-counter pain relievers.

How long does each treatment take?

The procedure itself is relatively quick. Depending on how many scars are being treated, punch excision can take anywhere from 15 to 30 minutes.

When can I wear make-up again?

It is generally advised to avoid applying cosmetics to the treated area until the initial healing is well underway—usually around one to two weeks. Once the stitches have been removed and wound closed then you can apply make up.

Will I need time off work or daily activities?

Most patients can resume regular day-to-day tasks almost immediately after treatment, but you should avoid strenuous exercise or heavy lifting for a few days. You will have a small dressing covering the area after the procedure.

Can punch excision be combined with other scar treatments?

Yes, it is common to pair punch excision with other treatments like laser resurfacing, subcision, or micro-needling to address different scar types. This multi-modal approach often yields the best overall outcome.

How do I reduce the likelihood of new acne scars forming?

Maintaining a consistent skincare regimen, avoiding picking or squeezing spots, and using any prescription acne medications recommended by your skin doctor or specialist can help prevent new acne breakouts and subsequent scarring.

What if I have active acne?

Active acne should be brought under control before undergoing punch excision. If you have ongoing breakouts, speak to our skin experts about topical treatments, antibiotics, or hormonal therapies (if relevant) to manage your acne.

Are there any alternatives to punch excision for ice pick scars?

Although ice pick scars can be challenging to treat, some individuals opt for TCA (trichloroacetic acid) peels, dermal fillers, or laser resurfacing. However, for many patients with deep and narrow scars, punch excision remains one of the most definitive treatments.

Conclusion

Acne punch excision is a tried-and-tested technique that directly tackles the most stubborn and deep-seated acne scars, especially the notorious ice pick varieties. By physically removing scar tissue with a specialised punch biopsy tool, this procedure lays the foundation for smoother, healthier-looking skin. While it is not a universal remedy—some patients may benefit more from alternative or additional therapies—punch excision can offer significant and lasting improvement for those who are good candidates.

If you are considering this procedure, ensure you select a qualified and experienced skin doctor or plastic surgeon who will conduct a thorough evaluation of your skin. In many cases, combining punch excision with other treatments, such as laser resurfacing or subcision, can offer a more complete solution to the mosaic of acne scars.

Finally, remember that while scars may be a part of your skin’s history, they do not have to define your present or future. Advancements in cosmetic and dermatological procedures mean that significant improvements are within reach. With realistic expectations and professional guidance, acne punch excision can be an empowering step towards feeling more confident in your own skin.