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Is punch excision good or bad?

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I had my second treatment of fraxel at the beginning of this month but it did improve the edge of my scars just a BIT!! I am feeling depressed and starting to lose hope again. I think that if I get another two treatment and it won't work, I will go for punch excision. Anyone who did it please advise whether it is good or bad to do it. And whether it works or not. Thanks a lot!!

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I recently had 4 punch excisions done...I think 2 will come out really well, one just ok, and the last one has been made bigger.

In researching punch excisions, it seems like there is about a 50% chance you take when you decide to do this. So I would make your decision based on that average.

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I had a huge punch excision done a while back. It took a full 3 months to completely heal, and 6 months to blend in normally with the rest of the skin. At first it looked really bad because it was so large and red. I actually thought it was a complete failure. However, I spoke with a PS (because a derm performed my punch excision) to get his opinion on it and he says considering the size it turned out well. Sure enough, once the redness has faded and the stitch marks are gone it looked a lot better. It is a slight bit larger than my old chickenpox pit, but a lot more shallow so I can now cover it up with makeup which wasn't possible with the original scar since it was so deep. Some ppl have had horrible experiences with it though. I would say...mentally prepare yourself because unless you're one of the lucky ones (everything looks great once stitches come off for these ppl) it will look pretty sucky for quite a long time. But it does get better with time, and pray that you don't end up worse than when you started. Also, if you decide to get it done, afterwards leave the wound alone! Don't apply anything harsh to it (retinoids, copper peptides), nothing. Maybe a bit of aloe vera to moisturize but that's all. You may think that applying all those ointments and creams will help the healing, but the harsh stuff might aggravate the wound --> more scar tissue formation. Your body is really amazing; it is capable of healing itself nicely on its own so don't disrupt nature's process. Just eat/drink healthy and take good care of yourself. Good luck.

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Mine turned out badly because I had a bad surgeon ( a derm) who did not use underlayer stitching and did it on large scars, leading to scar separation. This technique is best reseverd for small scars (they can be deep, but not wide). Many have reported great results with this but not all scars are good candidates.

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Thank you everyone for your precious advises

Emily88- I would like to ask you something. From your suggestion, it means that it took almost one year for the stitch marks and the redness to recover, right? And nowadays do you still see obvious stitch marks or just the faded ones? Are you happy with the result? Do the stitch marks look better than the depressed scars? Thank you!!

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Oh no, it doesn't take a whole entire year. I got the punch excision done June of last year and by September it looked a whole lot letter but still pinkish and the stitch marks were still visible. Then nearing 6 months the stitch marks have faded 90% and now they're not visible anymore. I think it will keep healing little by little for a couple more months. I'm happy with the results now, but for a long time I wasn't. And also I was in constant fear the wound would rip apart--from reading up on other ppl's experiences, some came undone even several months after. The stitch marks make the wound look worse than it does. I'm actually surprised my stitch marks faded at all, since the derm didn't take them out until 9 days later (which is way too long for outer facial stitches).

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Emily88-I would like to ask something more pleaseee. According to the experiences of people who did the excision, there is a chance that the wound will be apart. How long does it take to guarantee that the wound will not change anymore (It means that there is no risk of ripping apart of the wound and the results are stable.)?

Thanks a lot!!

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I had a very bad experience with it, but I had a terrible surgeon. I truly hope you do better..

I've been reading enough in here to figure out just how badly this guy sucked.

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I have read every single post on scar excision on this site, and it isn't common. I think if your wound is large, there would be more strain and it'll be more likely to rip apart. It depends on the doctor performing it too...some don't pull the stitches tight enough or they're careless so the wound doesn't close completely. For other people it was because their scars weren't right for it, or it's on an area of the face that gets moved/disturbed often (near the mouth) so it's harder for it to heal, or because the stitches were removed too early. I think in the long long long main excision thread with 20+ pages there was a girl whose scar came apart about 3 months later due to irritation or something. According to doctors that I've asked, scar tissue is never as strong as normal tissue but at around 6 months it is pretty much 80% in strength so you are in the clear (maybe 3 months for small pinprick ones). I would say do your best to take care of it, but don't stress out because it's really not too common. Good luck!

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Does anyone know whether the stitch mark will turn out to be a raised scar (keloid). Is there any chance?

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Emily88,

I am truly happy that yours have turned out well. I am in the dilemma whether I should do it or not. Do you think my 2mm icepick is too wide or it is ok? And it is located near the middle of my nose. So is it risky that my scar will be ripped apart? Thanksssssss again.

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This is way over my head! There are so many different scar treatments people write about on this site that I cannot even keep track of all of them. The only one I really know about is dermabrasion. I guess Ill just talk to my derm since I dont understand what any of you are talking about =/

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i've had about a dozen done. the surgeon is terribly important. moreover, the person who stitches the wounds is even more important.

most of them went well. they healed with a very small scar, occassionally indented slightly.

however, the last set i had, an assistant did the sutures. one of them 'healed' with a sort of boat shape- sunken in the middle where the very tight stitches had been then slightly puckered to either side.

it's also the procedure that left me with a very wide, deep scar. i had one wound that always tingled/hurt a bit after she sewed it up and it eventually got infected (two days later i'd say) so i called, was told to put a bandaid on it and come in for my regular 1 week follow-up. at that point it was too late and the scarring is horrible and i regret it every minute. but if you get a good surgeon and someone competent with suturing, i think it's a fairly good option and i'm actually considering having more done with my new derm surgeon. however, it's absolutely a rather large risk every time.

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2 mm is kind of in the middle range as far as size goes, I would say. Mine was larger than that and a lot of other ppl's were as well, but a lot of people also got excision on smaller scars. From what I read, people who started out with a very small scar were very happy with how the procedure turned out--no puckering, sunken look but the scar is just gone (unless they went to a quack doctor, of course). I think this is because smaller scars are just damaged on the surface, whereas the pit that I had was really sunken and had a lot of tissue/fat loss underneath. And concerning your scar being in the middle of your nose, it's kind of tricky because that's where you're probably more oily so if the doctor gives you steristrips afterwards they might have problems staying on. This is all speculation, of course, and you should go over every concern with your doctor. Don't make the mistake that I did by not getting enough info before I got it done. S/he should be happy to answer your questions and should be honest about the risks. If s/he brushes off your questions and makes this procedure seem like a piece of cake, don't let that person go anywhere near your face. Some will tell you stuff like "Oh, cutting and stitching is the first thing they teach us in med school", but obviously it's not that simple if so many got bad results. My point is that unless the doctor can guarantee success (which s/he can't), you need to be thoroughly informed of the complications before you make your decision. Unfortunately there are so many greedy doctors out there who could care less about their patients, so you will have to be proactive in getting all the info.

I was just thinking, if the scar isn't that big/deep and doesn't bother you much, maybe you could try retinoids or copper peptides first and see if it helps any. But whatever you decide, I wish you the best of luck.

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