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Subcision vs Punch Elevation

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What is the difference in terms of result between subcision and punch elevation? Both effectively “raise” the scar, but is one better than the other? Do elevations leave a mark? Why are punch elevations hardly talked about anymore? 

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Subcision works by going below the scar, and cutting the bands tethering the skin down, allowing them to "float to the surface". I think you are referring to excision, which involves cutting the scar on the surface, and stitching the wound together, effectively replacing a deep scar with a linear one.

Subcision is popular because it is the treatment of choice for most acne scar patients in need of treatment. Excision is usually an option for icepick scarring I believe, but TCA cross is the preferred treatment method for such scars.

Edited by QuanHenry
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Punch elevation is typically used for boxcar scars.   It involves using a punch to cut out a circle around the boxcar,  and then they lift that piece of skin up to the level of the normal skin and stitch it in place.  That's in contrast to a punch excision where that piece of skin is removed and the wound is stitched closed.   

I haven't heard of very many docs who do this because it's fairly antiquated

 

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The problem with excision is that if you do not heal well, then the results might not be what you want. Reading these forums, it seems excision can be very hit and miss, because quite often these people have been on Accutane and if you do not heal well, you could be replacing your scar with another similar scar. 

Subcision can work for tethered scars, and people have had success with those kind of scars, especially if you use filler as a spacer or do chinese cupping. 

I personally wouldn't use excision on my scars, due the high risk that it would be a blunder. That is me personally though. 

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Depends... if one has BROAD box car scars, yes, surgical elevation is the method of choice. Punch elevation can be used for depressed scars, however the shape and size must fit the punch 1, 2, 3, 4,5, 6 mm punches available, but most scars are not circular. Over the years newer methods have been developed, hence older methods are less described, that is the progress of medicine. 

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Personally, I think punch elevation is a horrible idea. If it has worked successfully on some people, thats great.. but as some have mentioned i think you have a good chance of replacing a scar with another type of scar. Ive seen surgeons perform this on youtube, and I cant imagine the outcome being very good.

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As with all instruments, it depends on the surgeon. Give a pair of $3000 Japanese steel hair cutting scissors to an excellent director hairsylist and the outcome, in general will be different to an apprentice hairdresser. The instrument (pair of scissors) is exactly the same. Its the execution of the procedure (hair cut or scar revision)  that can give you a pleasing result or a disaster. Lasers, NOKOR needles, Microneedling, RF devices,  Fillers, punches, scalpels and scissors are merely instruments to get a job done. It's the X Factor that determines outcomes. @seattlegal90, I do agree with you - once agin speaking in general terms as there is a Seattle Plastics that does this procedure frequently - often with less than ideal results. Agreed, if there is another way to treat broad based box car scars, this would be preferred, as you are indeed correct - you are replacing one scar with a full thickness scar. The same goes for punch excisions as I have heard of famous LA Dermatologists creating full thickest sub dermal fibrotic scars, replacing a bad scar with an even worse scar. Everything needs to be taken into context, but your statements hold true for replacement of scars with other scars. 

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