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Punch Excisions followed by CO2 silktouch

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#1 Jonah

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Posted 13 October 2010 - 05:17 AM

I guess it's nine years since I've been visiting this board (and battling scars). Over those years I've tried a number of methods to diminish my scars. What follows is a brief summary of my type of scarring and the main methods I've tried to improve them, ending with the punch excisions followed by CO2 silktouch method, which I had done about 4 months ago. I've found very little testimonies about this method and hope it will be of help to this board.

Type of scarring:
My scarring is mainly icepick and boxcar type. They tend to not be too wide, but deep with sharp edges. I had over 20 of them, located mainly on my cheeks area. I also had a couple of wide (one a little less than dime size and another narrow but the length of a dime) but pretty shallow rolling type scars, also on my cheeks. But my main issue was the many icepick/boxcar scars.

Methods I've tried:
TCA -
I did this 4 or 5 times in college mainly with 100% TCA, and each treatment was an average of about 3 months apart. This method was a bit of a nightmare for a kid in college, because (assuming you're using the 100% at least) it leaves your already noticeable scars looking deeper, wider and redder for like over a month. Anyway, I had high hopes for this because of some excellent photos floating around on the internet which some of you may have seen, but it just didn't have that result for me.
Improvement: 15% at best. I prefer dermarolling/needling for better results and less redness.

Dermarolling/Needling -
Dermarolling: I did 4 or 5 times, each session an average of 1-2 months apart. I used a 2.0mm dermaroller on my whole face to get the main scars, especially the couple of rolling scars, but also in hopes of helping with generally large pores and bad texture. I also used LED lights in combination with this method, as have many others on this board.
Needling: Often at the same time I dermarolled, I also used a diabetic needle to individually needle the icepick/boxcar scars, because I felt they needed more focus than the roller provided. I had more needling sessions than dermarolling sessions, probably 6 or 7 sessions in total, each session about 1-2 months apart.
Improvement: I'd say dermarolling/needling gave me 20-25% at most. Certain scars responded well, while others did not respond at all (often the ones that bothered me most unfortunately). I found the scars that were most at odds with my skin's tension lines responded best, while the scars most in line with them responded least, to give an odd observation. Anyway it's a good method especially if you're looking for low down-time, convenience, and affordability. Needling icepicks in particular is great, because you localize the damage (you look less of a mess), and I found it was easier to perform than TCA and gave modestly better results with much less lingering redness.

Punch excisions followed by CO2 siltouch (the main event) -
Description: This is the best method I've tried. I'll quickly describe the procedure. I went to a facial plastic surgeon that had considerable experience in performing this procedure (very important I think). First, the punch excisions were performed. About 20 icepick/boxcar scars were cut out, and the resulting holes sutured up. I wore sutures for one week before they were removed.

Important: After the punch-excision step, you will look awful, even a few weeks after the sutures have been removed. The excisions will be deep and red and look so terrible that you'll wonder if you made a huge mistake, which leads me to my next point, which is that I think it's important that excisions, especially if numerous like mine, be followed up by an ablative procedure of some kind shortly thereafter, as I did. I mean, you can do excisions alone if you want, but I'll just say that it looked to me that if I left my excisions to heal without a follow up "smoothing" procedure, they would have taken a very long time to heal, and even then I would not have expected a good result.

About one month after the excisions were performed, I received CO2 laser (I believe the machine was called Silktouch, which according to my understanding is one of several providers of the traditional CO2 laser). The CO2 laser for me was mainly to help to smooth the excision sites, as my main scars had been the icepick/boxcars that had been excised. But I did in addition have a couple of mild rolling scars and bad overall texture, as described above, which I hoped the laser would also improve.

Improvement: It is now nearly 4 months since the laser (nearly 5 months since the excisions). My improvement is about 65%. Most of those very ugly excisions responded beautifully to the laser. Throughout the 2 months after the laser, I watched them slowly but surely improve and my general redness fade. However, a few excisions had failed, in that the the suture didn't properly close the wound resulting from the punch. For those failed excisions, not even the laser could be of much help. After all, as many have stated on this board, lasers alone cannot do much for deep holes/icepicks. The success of the laser is thus extremely dependent on the success of the excisions when it comes to icepicks/boxcar scars. For the successful excisions, I have great results after the laser. For the others, the laser didn't do much. But because the vast majority of my excisions were successful, I ended up with an improvement of about 65%. Most of that improvement came from the icepick/boxcar scarring, but my couple of shallow rolling scars also improved in the neighborhood of 20-25%.

Downtime: The month immediately after the excisions and before the laser was 100% downtime for me because the excisions looked so awful. The month immediately after the laser was also 100% downtime, because you're generally incredibly red and raw, especially in the first week. That's two months of solid downtime. FYI, I'm male and so don't have the makeup option, but I was also told that men typically heal faster than women from the procedure. Anyway, the third month I was still pretty red, but could at some point go out and feign sunburn. In summary, you're talking about 2-3 months in which I don't think any guy could go to work, unless perhaps it's a burger joint and the customers can't see you. But anyone familiar with corporate culture would understand, you simply could not go. I had to quit my job to do this, which took a great deal of planning and saving.

Doctor's skill: I want to emphasize a point. This method, to me, seems very dependent on the doctor's skill. Don't listen to doctors who don't have much experience with punch excisions, but say "punch-excisions are simple blablabla". My doctor had considerable experience doing them, yet 2 or 3 of my excisions still failed seemingly because the sutures either tore through or were too loose. Among the failures, one scar is about 3x worse than it was before the procedure. Thankfully, it was one of the smaller scars to begin with, so now it just looks really bad, but not horrible. Among the other failures, one of them still managed to come out with mild improvement after the laser compared to the original scar, and the other is about the same as it was before. I don't even blame my doctor for the couple of failures, because of just how difficult it seems to me to punch-excise a single scar so as to prevent anything from going wrong with the result, much less 20 of them! Overall, after 9 years of scar treatment methods that took years to give little result, he gave me about 65% in 4-5 months. That is nothing less than incredible on his part. As for the operation of the laser, the importance of the doctor's skill should go without saying; it's also critical!

Risk: One more important point to make: If you've researched this method like I did before doing it, you have probably got the impression that it's a risky procedure. In case you hadn't noticed, my experience substantiated to me that it is. Most of my scars got much better, but a couple stayed the same or got slightly worse, and one got much worse; but because the amount improved vastly outweighed the amount worsened, I had a great overall result. I would bet that this favorable ratio holds true (and that the procedure is worth getting) for most sufferers of significant icepick/boxcar scarring, so long as they go to a facial plastic surgeon very experienced with this procedure; but of course I can't even say that for sure.

Moreover, I haven't even addressed the risks of laser, among which involve pigmentation. I'm a bit dark skinned (fitzpatrick III I believe); I tan well, but will burn before too long. Well, my skin on my face is definitely lighter than before the procedure, considerably so, and yet only enough to be noticeable to me. I hope I will darken back a bit over time, but who knows maybe I will not (pick your poison). I don't know if this is a genuine change in color, just a removal of years of sun exposure, or what; but if need be I can live with it and would consider it more than fair trade for the improvement I received to my scarring. In short, so far I have not had a serious pigmentation problem, but they can come up well over a year after the procedure. The point is it's another one of the risks of this procedure, and I'm sure there are many others which I have not mentioned.

I will also mention that the doctor offered me less risky and invasive lasers, including Fraxel and others, but stressed that for my scarring and punch-excisions, CO2 would give the best result because among other reasons it simply goes deeper, including deeper than Fraxel. I chose to take that risk.

To illustrate the risk by comparison, procedures like needling or dermarolling seem miles away less risky, as they appear much less likely to ever make scars worse or affect pigmentation, where as punch-excisions/CO2 really might (and to a certain extent, did in my case). But those less risky procedures, in my experience, also seem to me to have less potential reward.

Things to watch out for:
Excisions: If you get punch excisions and need to have sutures for a week or thereabouts, be very careful. I tried not to move my face much, not to laugh, or even yawn, etc. Consider eating soft foods at first to avoid all the contortion of your face that comes with chewing. Of course, take precautions so you do not scratch your face by accident or in your sleep (at least, wear sock gloves). Doctors may not warn you against that kind of stuff, but use your brain. You have tight sutures in your face for goodness sake that have the potential of becoming too loose or pulling through. I tried to do these precautions myself, and as I said 2 or 3 of mine still failed. It's just 5 to 7 days, so better safe than sorry I say.
Laser: Laser carries a lot of risks, including the pigmentation risks I briefly referred to above. One other thing I want to mention though is that for the first 2-3 months at least (and especially the 1st month) after you get the procedure, your skin will be extremely fragile, and it seemed to me, very prone to scarring. You will get pimples and other skin issues during this time - you have to handle them very carefully, so as not to scar your hopefully nicer new skin. It's 4 months post-op for me now, and I feel like my skin is only recently finally beginning to toughen up and become less scar-prone; but it is still much more fragile than before the procedure. Also, be very clear with your doc regarding the appropriate post-op regimen (e.g., of how to cleanse the face, wear aquafor, dressings, etc.) Post-op care is very important.

I need to give the typical disclaimer. Obviously the methods above could have totally different results for different people. The results above were just my experience.

Conclusion: Punch excisions followed by CO2 (silktouch) is the best method I've tried for my icepick/boxcar scars, yielding overall improvement of about 65%. It worked much better for me than dermarolling/needling, TCA, and the other methods I've tried. If you consider it, you should vet facial plastic surgeons who have experience performing it as I feel that doctor skill is critical. Furthermore, you should be aware of the risks that exist even when in the best doctor's hands. Also, be prepared for the discomfort and downtime the procedure involves.

Most importantly: If you do get a life-changing result from this or another procedure, please don't forget the unfairness of facial scarring. Don't become superficial. Be compassionate, judge people for only what of themselves they can control, and work hard and sacrifice at least a bit of yourself to help those who deserve it.

I'll check back on this post and edit/respond as necessary to answer any questions. As you can see by the unforgivable length of the post, I tried to minimize questions by covering a lot. I'm not sure when I'll respond to questions, could be tomorrow or a couple of months, but I definitely will.

Edited by Jonah, 13 October 2010 - 12:09 PM.


#2 Tevez

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Posted 13 October 2010 - 05:57 AM

Great commitment quitting your job to get rid of scars smile.gif

#3 Tevez

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Posted 13 October 2010 - 06:00 AM

To illustrate the risk by comparison, procedures like needling or dermarolling strike me as much less risky in that they seem quite to actually make scars worse or affect pigmentation, where as this procedure really might. But those procedures, in my experience, also seem to me to have less potential reward.
So your saying needling and dermarolling could of made your scars worse? i dont get it maybe its to late eusa_think.gif

#4 Mr President

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Posted 13 October 2010 - 06:19 AM

QUOTE (Jonah @ Oct 13 2010, 10:17 PM) <{POST_SNAPBACK}>
I guess it's nine years since I've been visiting this board (and battling scars). Over those years I've tried a number of methods to diminish my scars. What follows is a brief summary of my type of scarring and the main methods I've tried to improve them, ending with the punch excisions followed by CO2 silktouch method, which I had done about 4 months ago. I've found very little testimonies about this method and hope it will be of help to this board.

Type of scarring:
My scarring is mainly icepick and boxcar type. They tend to not be too wide, but deep with sharp edges. I had over 20 of them, located mainly on my cheeks area. I also had a couple of wide (one a little less than dime size and another narrow but the length of a dime) but pretty shallow rolling type scars, also on my cheeks. But my main issue was the many icepick/boxcar scars.

Methods I've tried:
TCA -
I did this 4 or 5 times in college mainly with 100% TCA, and each treatment was an average of about 3 months apart. This method was a bit of a nightmare for a kid in college, because (assuming you're using the 100% at least) it leaves your already noticeable scars looking deeper, wider and redder for like over a month. Anyway, I had high hopes for this because of some excellent photos floating around on the internet which some of you may have seen, but it just didn't have that result for me.
Improvement: 15% at best. I prefer dermarolling/needling for better results and less redness.

Dermarolling/Needling -
Dermarolling: I did 4 or 5 times, each session an average of 1-2 months apart. I used a 2.0mm dermaroller on my whole face to get the main scars, especially the couple of rolling scars, but also in hopes of helping with generally large pores and bad texture. I also used LED lights in combination with this method, as have many others on this board.
Needling: Often at the same time I dermarolled, I also used a diabetic needle to individually needle the icepick/boxcar scars, because I felt they needed more focus than the roller provided. I had more needling sessions than dermarolling sessions, probably 6 or 7 sessions in total, each session about 1-2 months apart.
Improvement: I'd say dermarolling/needling gave me 20-25% at most. Certain scars responded well, while others did not respond at all (often the ones that bothered me most unfortunately). I found the scars that were most at odds with my skin's tension lines responded best, while the scars most in line with them responded least, to give an odd observation. Anyway it's a good method especially if you're looking for low down-time, convenience, and affordability. Needling icepicks in particular is great, because you localize the damage (you look less of a mess), and I found it was easier to perform than TCA and gave modestly better results with much less lingering redness.

Punch excisions followed by CO2 siltouch (the main event) -
Description: This is the best method I've tried. I'll quickly describe the procedure. I went to a facial plastic surgeon that had considerable experience in performing this procedure (very important I think). First, the punch excisions were performed. About 20 icepick/boxcar scars were cut out, and the resulting holes sutured up. I wore sutures for one week before they were removed.

Important: After the punch-excision step, you will look awful, even a few weeks after the sutures have been removed. The excisions will be deep and red and look so terrible that you'll wonder if you made a huge mistake, which leads me to my next point, which is that I think it's important that excisions, especially if numerous like mine, be followed up by an ablative procedure of some kind shortly thereafter, as I did. I mean, you can do excisions alone if you want, but I'll just say that it looked to me that if I left my excisions to heal without a follow up "smoothing" procedure, they would have taken a very long time to heal, and even then I would not have expected a good result.

About one month after the excisions were performed, I received CO2 laser (I believe the machine was called Silktouch, which according to my understanding is one of several providers of the traditional CO2 laser). The CO2 laser for me was mainly to help to smooth the excision sites, as my main scars had been the icepick/boxcars that had been excised. But I did in addition have a couple of mild rolling scars and bad overall texture, as described above, which I hoped the laser would also improve.

Improvement: It is now nearly 4 months since the laser (nearly 5 months since the excisions). My improvement is about 65%. Most of those very ugly excisions responded beautifully to the laser. Throughout the 2 months after the laser, I watched them slowly but surely improve and my general redness fade. However, a few excisions had failed, in that the the suture didn't properly close the wound resulting from the punch. For those failed excisions, not even the laser could be of much help. After all, as many have stated on this board, lasers alone cannot do much for deep holes/icepicks. The success of the laser is thus extremely dependent on the success of the excisions when it comes to icepicks/boxcar scars. For the successful excisions, I have great results after the laser. For the others, the laser didn't do much. But because the vast majority of my excisions were successful, I ended up with an improvement of about 65%. Most of that improvement came from the icepick/boxcar scarring, but my couple of shallow rolling scars also improved in the neighborhood of 20-25%.

Downtime: The month immediately after the excisions and before the laser was 100% downtime for me because the excisions looked so awful. The month immediately after the laser was also 100% downtime, because you're generally incredibly red and raw, especially in the first week. That's two months of solid downtime. FYI, I'm male and so don't have the makeup option, but I was also told that men typically heal faster than women from the procedure. Anyway, the third month I was still pretty red, but could at some point go out and feign sunburn. In summary, you're talking about 2-3 months in which I don't think any guy could go to work, unless perhaps it's a burger joint and the customers can't see you. But anyone familiar with corporate culture would understand, you simply could not go. I had to quit my job to do this, which took a great deal of planning and saving.

Doctor's skill: I want to emphasize a point. This method, to me, seems very dependent on the doctor's skill. Don't listen to doctors who don't have much experience with punch excisions, but say "punch-excisions are simple blablabla". My doctor had considerable experience doing them, yet 2 or 3 of my excisions still failed seemingly because the sutures either tore through or were too loose. Among the failures, one scar is about 3x worse than it was before the procedure. Thankfully, it was one of the smaller scars to begin with, so now it just looks really bad, but not horrible. Among the other failures, one of them still managed to come out with mild improvement after the laser compared to the original scar, and the other is about the same as it was before. I don't even blame my doctor for the couple of failures, because of just how difficult it seems to me to punch-excise a single scar so as to prevent anything from going wrong with the result, much less 20 of them! Overall, after 9 years of scar treatment methods that took years to give little result, he gave me about 65% in 4-5 months. That is nothing less than incredible on his part. As for the operation of the laser, the importance of the doctor's skill should go without saying; it's also critical!

Risk: One more important point to make: If you've researched this method like I did before doing it, you have probably got the impression that it's a risky procedure. In case you hadn't noticed, my experience substantiated to me that it is. Most of my scars got much better, but a couple stayed the same or got slightly worse, and one got much worse; but because the amount improved vastly outweighed the amount worsened, I had a great overall result. I would bet that this favorable ratio holds true (and that the procedure is worth getting) for most icepick/boxcar sufferers, so long as they go to a facial plastic surgeon very experienced with this procedure; but of course I can't even say that for sure.

Moreover, I haven't even addressed the risks of laser, among which involve pigmentation. I'm a bit dark skinned (fitzpatrick III I believe); I tan well, but will burn before too long. Well, my skin on my face is definitely lighter than before the procedure, considerably so, and yet only enough to be noticeable to me. I hope I will darken back a bit over time, but who knows maybe I will not (pick your poison). I don't know if this is a genuine change in color, just a removal of years of sun exposure, or what, but if need be I can live with it and it's a great trade for the improvement. In short, so far I have not had a serious pigmentation problem, but they can come up well over a year after the procedure. The point is, it's another one of the risks of this procedure, and I'm sure there are many others which I have not mentioned. I will also mention that the doctor offered me less risky and invasive lasers, including Fraxel and others, but stressed that for my scarring and punch-excisions, CO2 would give the best result because among other reasons it simply goes deeper, including deeper than Fraxel. I chose to take that risk.

To illustrate the risk by comparison, procedures like needling or dermarolling seem miles away less risky as they appear much less likely to ever make scars worse or affect pigmentation, where as punch-excisions/CO2 really might. But those less risky procedures, in my experience, also seem to me to have less potential reward.

Things to watch out for:
Excisions: If you get punch excisions and need to have sutures for a week or thereabouts, be very careful. I tried not to move my face much, not to laugh, or yawn too much, etc. Consider eating soft foods at first to avoid having to do all that contortion of your face that comes with chewing. Of course, take precautions so you don't scratch your face by accident/in your sleep. Doctors may not warn you against that kind of stuff, but use your brain. You have tight sutures in your face for goodness sake that have the potential of becoming too loose or pulling through. I tried to do these precautions mentioned, and as I said 2 or 3 of mine still failed. It's just 5-7 days, so better safe than sorry I say.
Laser: Laser carries a lot of risks, including the pigmentation risks I briefly referred to above. One other thing I went to mention though is that for the first 2-3 months at least (and especially the 1st month) after you get the procedure, your skin will be extremely fragile, and it seemed to me, very prone to scarring. You will get pimples and other skin issues during this time - you have to handle them very carefully, so as not to scar your hopefully nicer new skin. Also, be very clear with your doc regarding the appropriate post-op regimen (of wiping the face, wearing aquafor, etc.) Post-op care is very important.

I need to give the typical disclaimer. Obviously the methods above could have totally different results for different people. This results above were just my experience.

Conclusion: Punch excisions followed by CO2 (silktouch) is the best method I've tried for my icepick/boxcar scars. It worked much better for me than dermarolling/needling, TCA, and the other methods I've tried. If you consider it, you should vet facial plastic surgeons who have experience performing it as I feel that doctor skill is critical. Furthermore, you should be aware of the risks that exist even when in the best doctor's hands. Also, be prepared for the discomfort and downtime the procedure involves.

Most importantly: If you do get a life-changing result from this or another procedure, please don't forget the unfairness of facial scarring. Don't become superficial. Be compassionate, judge people for their actions, and work hard and sacrifice at least a bit of yourself to help those who deserve it.

I'll check back on this post and edit/respond as necessary to answer questions. I'm not sure when I'll respond, could be tomorrow, could be a couple months, but I definitely will.


i love this post and thanks for putting it together. i found your excision story rather interesting. it does appear to be very easy to make the scarrign worse and that sounds rather aweful! at the same time, i suppose you could simply do those scars again and all would be good smile.gif

facial scarrng is unfair, but ive come to accept it, like a lot of people here. its definitely made me less superficial. so maybe in some ways, its a blessing? just in a weird way, shape and form.

#5 Jonah

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Posted 13 October 2010 - 06:48 AM

QUOTE (Tevez @ Oct 13 2010, 06:00 AM) <{POST_SNAPBACK}>
To illustrate the risk by comparison, procedures like needling or dermarolling strike me as much less risky in that they seem quite to actually make scars worse or affect pigmentation, where as this procedure really might. But those procedures, in my experience, also seem to me to have less potential reward.
So your saying needling and dermarolling could of made your scars worse? i dont get it maybe its to late eusa_think.gif


Sorry that was a typo. I spent some time editing the post and hope it is error free now. Thanks.

#6 Mr.Don

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Posted 13 October 2010 - 03:45 PM

thx for sharing your experiences with us.

btw, silktouch is very funny name for an ablative co2 laser biggrin.gif

#7 Jonah

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Posted 16 October 2010 - 04:39 AM

QUOTE (gimme gimme gimme @ Oct 13 2010, 06:19 AM) <{POST_SNAPBACK}>
i love this post and thanks for putting it together. i found your excision story rather interesting. it does appear to be very easy to make the scarrign worse and that sounds rather aweful! at the same time, i suppose you could simply do those scars again and all would be good smile.gif

It is an awful thought yeah; and so this is a relatively risky procedure in my opinion that people who are relatively not too risk averse may be interested in. But if you have many scars to excise, then I suppose in theory it might become a tiny bit less risky, since you're sort of diversifying? eusa_think.gif But keep in mind, it's the same Doctor doing every scar, so if the doctor's not good.. eusa_doh.gif


QUOTE (gimme gimme gimme @ Oct 13 2010, 06:19 AM) <{POST_SNAPBACK}>
facial scarrng is unfair, but ive come to accept it, like a lot of people here. its definitely made me less superficial. so maybe in some ways, its a blessing? just in a weird way, shape and form.

I never accepted it that's why i shelled out several thousand $ for a risky procedure biggrin.gif . But I totally agree with you that it does also come with a blessing, which whether they cure their scars or not I hope people accept and remember like you!

#8 Jonah

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Posted 16 October 2010 - 04:43 AM

QUOTE (Mr.Don @ Oct 13 2010, 03:45 PM) <{POST_SNAPBACK}>
thx for sharing your experiences with us.

btw, silktouch is very funny name for an ablative co2 laser biggrin.gif

Misnomer of the century yea, luckily I was under anesthesia while they were burning my face off, i mean touching me with the silk..

#9 no_hope

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Posted 16 June 2011 - 08:41 PM

QUOTE (Jonah @ Oct 13 2010, 06:17 AM) <{POST_SNAPBACK}>
I guess it's nine years since I've been visiting this board (and battling scars). Over those years I've tried a number of methods to diminish my scars. What follows is a brief summary of my type of scarring and the main methods I've tried to improve them, ending with the punch excisions followed by CO2 silktouch method, which I had done about 4 months ago. I've found very little testimonies about this method and hope it will be of help to this board.

Type of scarring:
My scarring is mainly icepick and boxcar type. They tend to not be too wide, but deep with sharp edges. I had over 20 of them, located mainly on my cheeks area. I also had a couple of wide (one a little less than dime size and another narrow but the length of a dime) but pretty shallow rolling type scars, also on my cheeks. But my main issue was the many icepick/boxcar scars.

Methods I've tried:
TCA -
I did this 4 or 5 times in college mainly with 100% TCA, and each treatment was an average of about 3 months apart. This method was a bit of a nightmare for a kid in college, because (assuming you're using the 100% at least) it leaves your already noticeable scars looking deeper, wider and redder for like over a month. Anyway, I had high hopes for this because of some excellent photos floating around on the internet which some of you may have seen, but it just didn't have that result for me.
Improvement: 15% at best. I prefer dermarolling/needling for better results and less redness.

Dermarolling/Needling -
Dermarolling: I did 4 or 5 times, each session an average of 1-2 months apart. I used a 2.0mm dermaroller on my whole face to get the main scars, especially the couple of rolling scars, but also in hopes of helping with generally large pores and bad texture. I also used LED lights in combination with this method, as have many others on this board.
Needling: Often at the same time I dermarolled, I also used a diabetic needle to individually needle the icepick/boxcar scars, because I felt they needed more focus than the roller provided. I had more needling sessions than dermarolling sessions, probably 6 or 7 sessions in total, each session about 1-2 months apart.
Improvement: I'd say dermarolling/needling gave me 20-25% at most. Certain scars responded well, while others did not respond at all (often the ones that bothered me most unfortunately). I found the scars that were most at odds with my skin's tension lines responded best, while the scars most in line with them responded least, to give an odd observation. Anyway it's a good method especially if you're looking for low down-time, convenience, and affordability. Needling icepicks in particular is great, because you localize the damage (you look less of a mess), and I found it was easier to perform than TCA and gave modestly better results with much less lingering redness.

Punch excisions followed by CO2 siltouch (the main event) -
Description: This is the best method I've tried. I'll quickly describe the procedure. I went to a facial plastic surgeon that had considerable experience in performing this procedure (very important I think). First, the punch excisions were performed. About 20 icepick/boxcar scars were cut out, and the resulting holes sutured up. I wore sutures for one week before they were removed.

Important: After the punch-excision step, you will look awful, even a few weeks after the sutures have been removed. The excisions will be deep and red and look so terrible that you'll wonder if you made a huge mistake, which leads me to my next point, which is that I think it's important that excisions, especially if numerous like mine, be followed up by an ablative procedure of some kind shortly thereafter, as I did. I mean, you can do excisions alone if you want, but I'll just say that it looked to me that if I left my excisions to heal without a follow up "smoothing" procedure, they would have taken a very long time to heal, and even then I would not have expected a good result.

About one month after the excisions were performed, I received CO2 laser (I believe the machine was called Silktouch, which according to my understanding is one of several providers of the traditional CO2 laser). The CO2 laser for me was mainly to help to smooth the excision sites, as my main scars had been the icepick/boxcars that had been excised. But I did in addition have a couple of mild rolling scars and bad overall texture, as described above, which I hoped the laser would also improve.

Improvement: It is now nearly 4 months since the laser (nearly 5 months since the excisions). My improvement is about 65%. Most of those very ugly excisions responded beautifully to the laser. Throughout the 2 months after the laser, I watched them slowly but surely improve and my general redness fade. However, a few excisions had failed, in that the the suture didn't properly close the wound resulting from the punch. For those failed excisions, not even the laser could be of much help. After all, as many have stated on this board, lasers alone cannot do much for deep holes/icepicks. The success of the laser is thus extremely dependent on the success of the excisions when it comes to icepicks/boxcar scars. For the successful excisions, I have great results after the laser. For the others, the laser didn't do much. But because the vast majority of my excisions were successful, I ended up with an improvement of about 65%. Most of that improvement came from the icepick/boxcar scarring, but my couple of shallow rolling scars also improved in the neighborhood of 20-25%.

Downtime: The month immediately after the excisions and before the laser was 100% downtime for me because the excisions looked so awful. The month immediately after the laser was also 100% downtime, because you're generally incredibly red and raw, especially in the first week. That's two months of solid downtime. FYI, I'm male and so don't have the makeup option, but I was also told that men typically heal faster than women from the procedure. Anyway, the third month I was still pretty red, but could at some point go out and feign sunburn. In summary, you're talking about 2-3 months in which I don't think any guy could go to work, unless perhaps it's a burger joint and the customers can't see you. But anyone familiar with corporate culture would understand, you simply could not go. I had to quit my job to do this, which took a great deal of planning and saving.

Doctor's skill: I want to emphasize a point. This method, to me, seems very dependent on the doctor's skill. Don't listen to doctors who don't have much experience with punch excisions, but say "punch-excisions are simple blablabla". My doctor had considerable experience doing them, yet 2 or 3 of my excisions still failed seemingly because the sutures either tore through or were too loose. Among the failures, one scar is about 3x worse than it was before the procedure. Thankfully, it was one of the smaller scars to begin with, so now it just looks really bad, but not horrible. Among the other failures, one of them still managed to come out with mild improvement after the laser compared to the original scar, and the other is about the same as it was before. I don't even blame my doctor for the couple of failures, because of just how difficult it seems to me to punch-excise a single scar so as to prevent anything from going wrong with the result, much less 20 of them! Overall, after 9 years of scar treatment methods that took years to give little result, he gave me about 65% in 4-5 months. That is nothing less than incredible on his part. As for the operation of the laser, the importance of the doctor's skill should go without saying; it's also critical!

Risk: One more important point to make: If you've researched this method like I did before doing it, you have probably got the impression that it's a risky procedure. In case you hadn't noticed, my experience substantiated to me that it is. Most of my scars got much better, but a couple stayed the same or got slightly worse, and one got much worse; but because the amount improved vastly outweighed the amount worsened, I had a great overall result. I would bet that this favorable ratio holds true (and that the procedure is worth getting) for most sufferers of significant icepick/boxcar scarring, so long as they go to a facial plastic surgeon very experienced with this procedure; but of course I can't even say that for sure.

Moreover, I haven't even addressed the risks of laser, among which involve pigmentation. I'm a bit dark skinned (fitzpatrick III I believe); I tan well, but will burn before too long. Well, my skin on my face is definitely lighter than before the procedure, considerably so, and yet only enough to be noticeable to me. I hope I will darken back a bit over time, but who knows maybe I will not (pick your poison). I don't know if this is a genuine change in color, just a removal of years of sun exposure, or what; but if need be I can live with it and would consider it more than fair trade for the improvement I received to my scarring. In short, so far I have not had a serious pigmentation problem, but they can come up well over a year after the procedure. The point is it's another one of the risks of this procedure, and I'm sure there are many others which I have not mentioned.

I will also mention that the doctor offered me less risky and invasive lasers, including Fraxel and others, but stressed that for my scarring and punch-excisions, CO2 would give the best result because among other reasons it simply goes deeper, including deeper than Fraxel. I chose to take that risk.

To illustrate the risk by comparison, procedures like needling or dermarolling seem miles away less risky, as they appear much less likely to ever make scars worse or affect pigmentation, where as punch-excisions/CO2 really might (and to a certain extent, did in my case). But those less risky procedures, in my experience, also seem to me to have less potential reward.

Things to watch out for:
Excisions: If you get punch excisions and need to have sutures for a week or thereabouts, be very careful. I tried not to move my face much, not to laugh, or even yawn, etc. Consider eating soft foods at first to avoid all the contortion of your face that comes with chewing. Of course, take precautions so you do not scratch your face by accident or in your sleep (at least, wear sock gloves). Doctors may not warn you against that kind of stuff, but use your brain. You have tight sutures in your face for goodness sake that have the potential of becoming too loose or pulling through. I tried to do these precautions myself, and as I said 2 or 3 of mine still failed. It's just 5 to 7 days, so better safe than sorry I say.
Laser: Laser carries a lot of risks, including the pigmentation risks I briefly referred to above. One other thing I want to mention though is that for the first 2-3 months at least (and especially the 1st month) after you get the procedure, your skin will be extremely fragile, and it seemed to me, very prone to scarring. You will get pimples and other skin issues during this time - you have to handle them very carefully, so as not to scar your hopefully nicer new skin. It's 4 months post-op for me now, and I feel like my skin is only recently finally beginning to toughen up and become less scar-prone; but it is still much more fragile than before the procedure. Also, be very clear with your doc regarding the appropriate post-op regimen (e.g., of how to cleanse the face, wear aquafor, dressings, etc.) Post-op care is very important.

I need to give the typical disclaimer. Obviously the methods above could have totally different results for different people. The results above were just my experience.

Conclusion: Punch excisions followed by CO2 (silktouch) is the best method I've tried for my icepick/boxcar scars, yielding overall improvement of about 65%. It worked much better for me than dermarolling/needling, TCA, and the other methods I've tried. If you consider it, you should vet facial plastic surgeons who have experience performing it as I feel that doctor skill is critical. Furthermore, you should be aware of the risks that exist even when in the best doctor's hands. Also, be prepared for the discomfort and downtime the procedure involves.

Most importantly: If you do get a life-changing result from this or another procedure, please don't forget the unfairness of facial scarring. Don't become superficial. Be compassionate, judge people for only what of themselves they can control, and work hard and sacrifice at least a bit of yourself to help those who deserve it.

I'll check back on this post and edit/respond as necessary to answer any questions. As you can see by the unforgivable length of the post, I tried to minimize questions by covering a lot. I'm not sure when I'll respond to questions, could be tomorrow or a couple of months, but I definitely will.

FANTASTIC POST!!! these are the types of storys that give hope for fellow acne scar sufferers!
i admire ur desire to become scar freee. my hats off to u !

#10 PaulyD

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Posted 16 June 2011 - 09:30 PM

well in

#11 miramar

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Posted 17 June 2011 - 02:01 AM

great find! lots of useful info. I feel his overall success rate could've been vastly improved by including the below items in my opinion...

- scalpel instead of punch excision

- taping the area

- spread the 20+ scars out into 4 session of 5 scars each

- re-excised the failed ones

Edited by miramar, 17 June 2011 - 03:25 AM.


#12 Jonah

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Posted 01 December 2011 - 10:11 PM

great find! lots of useful info. I feel his overall success rate could've been vastly improved by including the below items in my opinion...

- scalpel instead of punch excision

- taping the area

- spread the 20+ scars out into 4 session of 5 scars each

- re-excised the failed ones


Great suggestions.

I could see the scalpel being preferable in many cases, though perhaps if the scars are very narrow and rather circular already, the punch tool may be the way to go. I'm not knowledgeable enough to say. I will say that in my case every punch site where the sutures did not fail turned out hardly noticeable after the laser.

Great suggestion on taping the area. As mentioned some of my excisions failed due to the sutures pulling through or not being tight enough to close the wound. Maybe tape would have prevented those failures. It may be tricky to use tape if you have many scars close together (as was my case), but it's definitely something to bring up to your doctor.

If you can spread out the excision sessions, I definitely agree you should do it. I think that one of the factors that lead certain excision sites to fail is the tension put on them by nearby sites pulling the skin a different direction. Of course, excisions can also fail due simply to the natural tension of the face, but if you can break up the sessions, why not? In my case, my doctor said it would not make a difference (who knows if he was right), and I did not want to give up the extra weeks that would be required to wait for the first session's sites to close strongly enough to withstand the tension of the second session without sutures.

Only problem with a re-excision of the failed ones is, as I mentioned in the first post, it seemed to me that the results of an excision would not be good without a follow up invasive procedure, such as laser, to smooth them over. If that's the case, then re-excision may require re-laser too. I'm not ruling out ever making the downtime to do that again, but it would have to be a while from now.

Anyway, those are excellent suggestions. I also wanted to bump this thread for new members in case they benefit from the info.

#13 DainBramaged

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Posted 02 December 2011 - 09:24 AM

very interesting information. I had two excisions, one and three months ago, and the scars are indented. Could explain how laser could help? Is it worth?

#14 dayman

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Posted 04 December 2011 - 12:34 AM

Brilliant post!
Im going to see my doctor in a few days for a consultation, really wish I can stop smoking. Whats the price you paid for the laser and excisions if you dont mind me asking. cheers bud

#15 no_hope

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Posted 03 July 2012 - 06:14 PM

Bump! =) fantastic read for new comers

#16 Rob_X_22

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Posted 03 July 2012 - 08:35 PM

punch exision is different then subcision correct? and do you have b4 after pics?

#17 *Inspired*

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Posted 03 July 2012 - 08:39 PM

Before and after pictures would be helpful.

Considering he had traditional Co2 laser on fitzpatrick type III and a few of the excisions failed with one scar turning out worse, I wonder how his skin really looks now. Was it worth it?

#18 no_hope

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Posted 03 July 2012 - 09:06 PM

like he said the pros out weighed the cons. there fore the results were worth it to him and prolly worth it to us if we was in his shoes. the kind of courage he had to deal with his issue is the exact same courage im gonna need to pull it all offf. for now its saving and a matter of time

#19 *Inspired*

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Posted 03 July 2012 - 09:14 PM

It does take courage to treat your scars. I've felt completely empowered ever since my Deep FX treatment. It's been a long journey and I'm not nearly at the end, but I understand how you feel and determined to win in the end. I wish you the best of luck.

#20 no_hope

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Posted 03 July 2012 - 10:01 PM

It does take courage to treat your scars. I've felt completely empowered ever since my Deep FX treatment. It's been a long journey and I'm not nearly at the end, but I understand how you feel and determined to win in the end. I wish you the best of luck.

Thanx i rly appreciate it. i wish you the best of luck also. as long as we keep our eyes on the horizon and never loose faith, we are sure to win this battle against acne scarring once and for alll!