Punch Techniques for Acne Scarring

by Marisa Amorasak

punch grafting

Mild acne, like the kind made up of comedones and non-inflammatory blemishes, recovers quickly and usually without consequence. Unfortunately, severe acne is a bit more complicated. Severe acne is characterized by cysts and nodules, which develop deep under the skin and affect the lower layers of the tissue. Once the tissue is destroyed it can no longer rebuild itself. The result is depression scarring along the surface of the skin. This type of scarring can be helped by laser skin resurfacing and chemical peels, but the most effective way to smooth out deep acne scarring is through punch techniques.

Types of Acne Scarring

Deep acne scarring from severe acne includes several different scar types including ice-pick, boxcar, pitted, and rolling scars.

Ice Pick Scars: The development of cysts and nodules disrupts the collagen located beneath the surface of the skin. When there's not enough collagen, the skin can sink into pits. The size and shape of ice pick scars can vary, ranging from small and deep to wide and shallow. They are most common on the cheeks, where the skin is fleshy so any indentations are more noticeable.

Boxcar Scars: Boxcar scars are caused by tissue that's destroyed by acne, leaving a sunken area on the skin. Unlike ice-pick scars, boxcar scars are evenly depressed so they look oval or round instead of jagged. They're usually seen on the temples and cheeks and can range from superficial to severe.

Rolling Scars: Rolling Scars occur when bands of extra tissue develop between the tissue and the skin. The result is scarring that's characterized by a wave-like appearance of shallow but numerous pits.

How Do Punch Techniques for Acne Scarring work?

There are three different types of punch techniques that are effective in the treatment of deep acne scarring: punch excision, punch grafting, and punch elevation.

Punch Excision: A punch excision uses a surgical biopsy tool that “punches” the scar out from the skin. The tool will vary in width depending on the size of the scar. After a local anesthesia is applied and the scar is removed, the wound is sewn shut using sutures. The scar left from the excision will fade over time. This is the least invasive type of punch technique.

Punch Grafting: Punch grafting is similar to punch excisions, except that instead of sewing the wound shut with sutures, a piece of skin is place over the wound and then sewn shut. The skin graft usually comes from behind the ear, where the wound won't be noticeable.

Punch Elevation: After the biopsy tool removes the scar, the scar tissue is “punched out” to elevate the texture of the scar to an even level. It's then reattached to the skin. The benefit of punch elevation is that the skin runs no chance of being a different color than the rest of the skin. Punch elevations are usually used for boxcar scars.

Costs, Risks and Side Effects of Punch Techniques for Acne Scarring

Since acne is a medical condition, some insurance providers may partially cover punch techniques. Without insurance, punch techniques cost between $250 and $750. Punch excisions will be on the cheaper end of the scale while punch elevation will be more expensive.

Punch techniques are more invasive than other in-office acne treatments like microdermabrasion or laser skin rejuvenation. But since the incision is so small, the procedure itself is very safe and virtually risk-free. After the surgery, all of the punch techniques will have some temporary scarring. Punch excisions will heal the fastest since they require the least amount of sutures. After the sutures heal, there should be no visible scarring left. Punch grafting carries a bit of a higher risk for scarring, as the graft will introduce a new bit of skin to the face. Also, the graft may not exactly match the facial skin, so some dischord between the graft and your face is possible. Punch elevation is generally very effective as long as the scar is well-elevated.

Scheduling Your Punch Technique for Acne Scarring

If nothing seems to help your deep acne scarring, punch techniques may be your answer. They level out the appearance of boxcar, ice-pick, and rolling scars the way other treatments just can't. To schedule your appointment for punch techniques for acne scarring, contact us today and we'll set you up with a qualified skincare specialist in your area.

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