Punch Excisions -
I've had some successful punch excisions in the past, which effectively replaced deep icepick scars with less conspicuous line scars. Recently this year, I had some more punch excisions, and well, those failed miserably. The two procedures were 4 years apart. I'm not sure what caused the second set of punch excisions to fail, but I suspect it may be related to Accutane. Let me explain. The first procedure was done pre accutane. My skin prior to accutane was always an oil slick. I had very oily skin and hair and without a doubt this contributed to my severe cystic acne. However, I think the oily skin tends to lend itself better to wound healing, in particular healing without bad scarring. This seems to make sense, because it's a known fact that scars heal better in moist environments.
Post accutane, my skin has gone from being oily to pretty dry. To me, it seems like this is a critical factor in how your skin heals after being cut. I definitely do not regret taking Accutane, because it essentially cured me of my severe cystic acne. However, the downside is that I feel it has affected my wound healing abilities. Another important factor is tension. If you get the punches done in a highly dynamic area, like the cheeks or mouth areas, the constant movement of the skin will cause excisions to stretch and fail from the tension.
Another interesting trend is that the dermatologists I have visited this past year have discouraged punch excisions. They felt it was too unpredictable and prone to bad scarring in some folks. There are others though, who get pretty decent results.
Both procedures were done by dermatologists. Perhaps if I went to a plastic surgeon it could have made a difference.