I've seen many great results from the fusiform/elliptical exicision, for example here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168245/#B14. I cannot see a white a line and after one month there is just some redness. It looks great. The plastic surgeon I went to see, however, told me that there is a 50% chance that the new scar will look worse than the old.
Do they say that so as to not raise too high expectations or do excisions really fail that often? I've tried to find some data, but I couldn't find it. Of course, I know that complications can arise, but 50% just seems too high to me.
What do you think?
I don't know. I went to see a facial plastic surgeon and she told me I shouldn't let anyone cut my skin - according to her, the resulting scar would be much more evident than my pockmarks. Also she made a point that a surgical scar would look better on otherwise healthy scarless skin than skin that has bad texture and other scars around it. I'd like to have more consultations and hear more about people's experiences though, since I'm still inclined to think that surgical methods would be the most effective way to treat boxcars.
I've had a number of excisions, and some came out pretty good. I had one though that failed epically, and it was much worse than the scar it replaced. Whether or not an excision fails is determined by your physiology, whether the excision is in a high tension zone, technique, and aftercare. Remember that the reason certain people get severe acne scars is due to a defect in their healing abilities, which doesn't bode well for a procedure that calls for cutting and suturing. Unless your scar is truly disfiguring, I wouldn't go the excision route because the chance of it coming out worse after all the downtime is very real. It's a roll of the dice.
If you decide to go this route, I would recommend a plastic surgeon over a dermatologist for anything larger than a punch excision. For larger excisions, the skin must be undermined to relieve tension, and must be closed with doubled layered sutures (internal dissolvable sutures, and external sutures). I had my failed excision done by a dermatologist, and I wished I would have spent the money and gone to a bona fide plastic surgeon. Spend the money, it's your face!
This guy though had a successful outcome, so for the right person it can produce dramatic results. Question is, how do you know if your skin will do well before you go through with it? Tread lightly, and do one or two test scars first.