Bump Please help!

These scars are more of the icepick / boxcar variety and not really amenable to subcision. Subcision is really reserved for bound down, rolling scars. Icepick scars are notoriously difficult to improve because they are generally considered to be full thickness scars, meaning they extend deep down sometimes to the level of fat. Sometimes punch excisions can help, although from my own personal experience, they can be unpredictable. I've had some successful punch excisions, and some that left me with deeper scars. Generally if you have poor wound healing, excisions are a risky endeavor.

That said, your scarring does not look bad at all.

Hey Blahblah82 Thanks so much for your advice!!!! I went to a derm today and the lighting there was so bad that my scars could not look any worse haha yeah he said I should get cross instead of subcision..

These scars are more of the icepick / boxcar variety and not really amenable to subcision. Subcision is really reserved for bound down, rolling scars. Icepick scars are notoriously difficult to improve because they are generally considered to be full thickness scars, meaning they extend deep down sometimes to the level of fat. Sometimes punch excisions can help, although from my own personal experience, they can be unpredictable. I've had some successful punch excisions, and some that left me with deeper scars. Generally if you have poor wound healing, excisions are a risky endeavor.

That said, your scarring does not look bad at all.

Hey, would you care to tell more about your punch excisions? When they were successful, how does the resulting scar look like? Can you still easily see it? And the ones that failed, did the excision open up after the stitches were removed or why did they fail? Did a derm do it for you, or a plastic surgeon? I'm considering excision now too, but I want to do my best to minimize the risk of making my scars worse.

And I hope that you've seen improvement with other treatments after the failed excisions. All the best.

Fraxel Repair

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.

Thank you for clarifying. I, too, feel that the major factors determining the success of excisions are wound healing and tension. A plastic surgeon may be a safer choice, because they usually know the tricks to minimize the tension on the wound as much as possible. With excisions you do really have to know what you're doing, or alternatively go to a doctor who knows what he's doing. Ideally, the doctor should also know and be ready to say when excisions are not worth it and the outcome is likely to be worse.

But this is just based on my research, I've yet to talk to any doctor about excisions. I hope they'll be supportive and think it's a good idea instead of talking me out of it.

I would say that punch excisions may work well if the area is small, but the larger the punch the greater the tension. One other thing that I've learned is that if you do a larger excision, say on a group of scars that are close together, the edges MUST be "everted." What that means is that you can't just bring the edges together and close it with a stitch. The edges must be pulled together so that they are elevated above the surrounding skin. Why must you do this? Again, the wound edges will tend to want to pull apart due to tension. If the edges are simply brought together and stitched, the scar will look great initially but over time the tension will cause the scar to stretch and result in a depression. With everted edges, the excision will heal flat because it was slightly elevated when the wound edges were stitched together. Unfortunately, I had a rather large excision, and the derm failed to properly evert the wound edges. Initially the resultant scar from the excision looked fantastic, with only a thin linear scar that I could live with. Unfortunately over time, tension caused the thin linear scar to stretch, widen, and become depressed. I've had some success with fillers and the mixto laser to both elevate and smooth the sharp edges.

Moral of the story - larger excisions should be avoided and make sure that the proper stitching technique is used. So like you said, it may be smarter to go to a plastic surgeon.