Punch excision is a specialised excision method to treat a specific type of acne scarring called ice pick scars. Acne scarring can present in different forms that we dermatologists classify as a subtype. These include rolling, boxcar, and ice pick subtypes. A patient can present with one or several subtypes of scars at once and therefore the treatment for acne scarring can involve more than one method as each subtype of scarring is treated in a specific way.

 Ice pick scars are a variant that present with very narrow but deep openings and can affect any part of the face but often found in the cheeks and temples. They give the appearance of “ice pick” hence the term used. The severity and extent may vary from mild with few scars visible to severe with many scars present and sometimes involving many areas of the face such as the cheeks, forehead and temples. These types of acne scars are often difficult to treat but punch excision is a very effective method for many of these scars. Depending on the severity this may be done in one or more treatment sessions.

Punch excision is a technique using a specific tool that is often used for taking a sample of the skin which is a procedure called biopsy. The tool is called a punch biopsy tool and is a circular sharp apple core-like tool which excises (meaning cut out) the deep ice pick scar under local anaesthetic injection. The subsequent very small wound (usually 2 to 3 mm in diameter) will then be closed with very fine suturing. The procedure does not take long and can be performed in a single visit. These sutures will then be removed after a week. The whole purpose of punch excision is to change the type of acne scar from a narrow deep one to a very fine superficial surgical scar which is much easier to improve using subsequent laser treatments.

Dr. Firas Al-Niaimi is a highly trained dermatologic surgeon who has performed hundreds of complex surgical procedures on the face and is very experienced in punch excision method for ice pick acne scars.