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SharonBarnes

Has anyone had PUNCH excision that looks better than the original scar or pore ?

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Following this thread. I’m super interested in punch excision and it’s never really discussed by dermatologists or anyone on here for that matter 

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On 9/7/2020 at 4:39 PM, SharonBarnes said:

And if so who did the procedure. Pls add pix if possible thank you ! 

I had one done and it was not good. The dermatologist who did it seemed to rush the procedure. I thought it was ok at that time because based on his website and talking to him, he said he did many.  I also naively thought it was routine since I saw YouTube videos of it being done. The result was a scar that was caved in a little and the redness didn't go away. I knew before the stitches came off that it looked weird. I ended up seeing a plastic surgeon about three months later who cut out the scar in an elliptical way that made the scar almost undetectable.

The punch excision is round so when the area is stitched up, it kinda bunches the skin. Obviously smaller punch excisions are better for minimizing the appearance of a scar. I've read under 2mm is ideal but you need to do your research and talk to doctors. When a doctor makes an elliptical cut, it's easier to stitch the "flaps" together because of the shape - but the resulting scar is a little longer. However, the angle of the stitching may make the scar less noticeable. I believe plastic surgeons are more experienced in this regard. With that being said, I've seen some really good results from punch excisions on YouTube by both dermatologists and plastic surgeons. Also, one of my friends had an oval scar about the size of a tiny bean cut out by a dermatologist and I can barely see that scar on his face. 

There are several other things you need to know. Scar revisions have different results on different parts of the body. On the face, I believe they heal better where there's more fat and less tension. The type of suturing makes a difference too. There's a double layer closure and some simpler ones. Obviously, talk to doctors, see before and after photos, do your own research, etc. Always keep in mind that you are trading in a scar for another scar - ideally a more inconspicuous one.

If you go online, doctors like Dr. Lim and Dr. Emer will simply say revise the scar and laser it and you're good. This works with some, but not all, patients. People heal differently and not everyone will get a good result. Yes, lasers will smooth out scars but sometimes the scar may be too indented for lasers to be effective. 

I had another revision done (thanks to Volleyball!) that SUCKED when it healed. It took a number of treatments (the usual including lasers, Cross, peels, etc.) to make the revised scar look less deep. It's still visible now but the new shape is much better than the original one. Was it worth it? Yes for me because I was getting my other scars treated so this was just another one of the bunch. But it was so visible for almost a year that it made me so self conscious. During this year, it was hell, and this is probably not worth it to a lot of people. But seeing the result about two years later, I'm content.

https://www.realself.com/question/etobicoke-punch-excision-fail-excise

https://www.realself.com/question/all-plastic-surgeons-perform-punch-excision

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You just have to be careful. If they accidentally remove some of the fat beneath the dermis, you could end up with a large indentation. That's in addition to the issues of stitching up a circular wound and how it bunches skin. I would do scalpel excision if you're set on it.

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Hi @Amanda Hall, thanks for posting such a thorough reply.
 I’m from Toronto too and finding that there really aren’t that many dermatologists who know how to deal with  acne scars effectively. I’ve been to several  

It’s pretty surprising actually. Is it possible to provide the name of your plastic surgeon? I have a similar scar in my cheek that I thought to get excised. I’ve tried filler and it literally makes no difference to the appearance. 
Thanks again! 

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2 hours ago, nicky1818 said:

Hi @Amanda Hall, thanks for posting such a thorough reply.
 I’m from Toronto too and finding that there really aren’t that many dermatologists who know how to deal with  acne scars effectively. I’ve been to several  

It’s pretty surprising actually. Is it possible to provide the name of your plastic surgeon? I have a similar scar in my cheek that I thought to get excised. I’ve tried filler and it literally makes no difference to the appearance. 
Thanks again! 

Check out this guy in New Jersey. He seems to get really good results.

 

Edited by Amanda Hall
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On 9/10/2020 at 7:53 AM, shei514 said:

Following this thread. I’m super interested in punch excision and it’s never really discussed by dermatologists or anyone on here for that matter 

My dermatologist who was well versed in such procedures discouraged the use of punch excision. The problem being that the outcome is unpredictable often leaving a bigger scar than the one it try's to remove. 

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I had to have two punch biopsies for non cosmetic reasons. One was on normal skin and the other was inside of a pre-existing area of hypo pigmented scar tissue.  They were small at 3 mm. Stitches out on day 5 and silicone scar gel, non ablative laser on day 14. By month 2 they were both invisible.  The punch made the pre-existing scar smaller.  Only caveat is that I can now feel a  pea sized lump of scar tissue under the skin. it's invisible but it's there.

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54 minutes ago, F1racer said:

I had to have two punch biopsies for non cosmetic reasons. One was on normal skin and the other was inside of a pre-existing area of hypo pigmented scar tissue.  They were small at 3 mm. Stitches out on day 5 and silicone scar gel, non ablative laser on day 14. By month 2 they were both invisible.  The punch made the pre-existing scar smaller.  Only caveat is that I can now feel a  pea sized lump of scar tissue under the skin. it's invisible but it's there.

Where are you based and which doctor performed the punch excision? 

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Sorry I have no clue who did it, it was just a registrar at my local hospital.  Was a skin biopsy for testing so not cosmetic. 

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14 hours ago, OddMarket said:

My dermatologist who was well versed in such procedures discouraged the use of punch excision. The problem being that the outcome is unpredictable often leaving a bigger scar than the one it try's to remove. 

Yeah that’s unfortunate I have two boxcars that will not close up no matter what. They are less deep but still there maybe punch excision is good for me? But I don’t know. 

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20 hours ago, shei514 said:

Yeah that’s unfortunate I have two boxcars that will not close up no matter what. They are less deep but still there maybe punch excision is good for me? But I don’t know. 

Yes I was surprised when he mentioned it. Maybe TCA cross would be a better match.  

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