Punch excision and punch elevation are minor surgical techniques used to treat carefully selected deep acne scars that are unlikely to improve adequately with collagen stimulation alone. Although these procedures are appropriate for only a small percentage of acne scars, they can produce excellent improvement in properly selected patients.
During your consultation, we will determine whether punch techniques are appropriate for your scars or whether another treatment—or combination of treatments—is likely to produce a better result.
What Are Punch Techniques?
Punch excision and punch elevation are two related surgical procedures used to treat selected deep acne scars.
Punch excision removes an individual scar using a small surgical punch. The area is then carefully closed with a tiny suture, replacing the irregular acne scar with a much smaller surgical scar that often becomes far less noticeable as it heals.
Punch elevation preserves the patient’s own tissue by lifting the base of certain deep boxcar scars to the level of the surrounding skin rather than removing them completely.
The most appropriate technique depends on the type and shape of the scar being treated.
Who Is a Good Candidate?
Punch techniques are generally reserved for carefully selected deep acne scars that are unlikely to respond adequately to treatments such as subcision or TCA-CROSS alone.
Most patients require treatment of only a few individual scars rather than large numbers of scars. During your consultation, each scar is evaluated individually to determine whether a punch technique is likely to provide meaningful improvement.
Recovery and Results
Punch excision and punch elevation are performed under local anesthesia. Small sutures are typically removed approximately one week after the procedure.
As healing progresses, the tiny surgical scar gradually matures while collagen remodeling continues beneath the skin. Although additional treatments may sometimes be recommended, replacing one deep irregular scar with a fine surgical scar often produces a more favorable cosmetic result.
Our Treatment Philosophy
Punch techniques represent one of several tools available for acne scar treatment. Rather than performing these procedures routinely, we reserve them for scars that are particularly well suited to this approach. Many patients achieve the best overall improvement through a combination of punch techniques, subcision, TCA-CROSS, and fractional CO₂ laser resurfacing, with each procedure addressing a different type of scar.
Frequently Asked Questions
Which acne scars respond best to punch excision?
Punch excision is generally reserved for selected deep icepick scars and other scars that are unlikely to improve adequately with less invasive treatments.
What is the difference between punch excision and punch elevation?
Punch excision removes the scar completely and closes the area with a tiny suture. Punch elevation lifts the base of selected boxcar scars to improve the contour while preserving the patient’s own tissue.
Will I have stitches?
Yes. Tiny sutures are typically placed after punch excision or punch elevation and are usually removed approximately one week later.
Can punch techniques be combined with other acne scar treatments?
Yes. Punch techniques are often combined with subcision, TCA-CROSS, or fractional CO₂ laser resurfacing to address different scar types during an individualized treatment plan.
Will I have a scar afterward?
The goal is to replace a deep, irregular acne scar with a much finer surgical scar that typically becomes less noticeable as it heals. In carefully selected patients, this often produces a significant cosmetic improvement.
If you have deep acne scars that have not responded to other treatments, punch excision or punch elevation may be appropriate for selected scars. During your consultation, we will determine whether these techniques are likely to improve your scars or whether another treatment would be more appropriate.