Hi all,
Anyone have punch excision experiences, particularly combined (same day ideally) withFractional CO2?
I've had two known acne scar specialists float the idea, but I'm quite intimidated by how long it will take to heal completely after removing sutures. There's hardly any info about it - I've only found this user on Youtube who's been posting videos lately about her experience. (I just removed the link at the user's request).
It looks like she's headed towards results, but there's residual redness that has lastedfor months after (I believe her latest video is post 3 months). I'm a lighter skin type, but I'm just not sure I'm willing to commit the way she has. Can anyone tell me if this is typical?
Punch excision was recommended by a known acne scar specialist combined with fractional CO2 the same day. Any idea if this will reduce the scab healing after removing sutures + reduce the timeline that this patient experienced?
Hi @Rickyduds,
I am Julie,the Youtuber who had the punch excision 🙂
May I ask you to remove the link to my video please? I have recently takenmy videos down from my channelbut somehow the link still allows people to see the video. It would be very much appreciated if you could do that.
Thanks a lot 🙂
x
Sure of course! Best of luck with everything + I really appreciated you posting your videos. It helped me a lot. I want to clarify that I think it'll be worth it for you in the long run. I used you as an example because I've got some events coming up where I wouldn't want a risk of any marks like that for several months 
On 2/1/2021 at 9:15 PM, Rickyduds said:Hi all,
Anyone have punch excision experiences, particularly combined (same day ideally) withFractional CO2?
I've had two known acne scar specialists float the idea, but I'm quite intimidated by how long it will take to heal completely after removing sutures. There's hardly any info about it - I've only found this user on Youtube who's been posting videos lately about her experience. (I just removed the link at the user's request).
It looks like she's headed towards results, but there's residual redness that has lastedfor months after (I believe her latest video is post 3 months). I'm a lighter skin type, but I'm just not sure I'm willing to commit the way she has. Can anyone tell me if this is typical?
Punch excision was recommended by a known acne scar specialist combined with fractional CO2 the same day. Any idea if this will reduce the scab healing after removing sutures + reduce the timeline that this patient experienced?
I've had an excision done but not on the same day as CO2. I've seen some doctors on YouTube do this, and keep in mind that I'm just an individual with no medical background.
I'd rather do CO2 months after an excision. Why? Because you can resurface the site of the excision. If the doctor just wants to treat the other parts of your face so that you heal at the same time everywhere, then I understand. But I don't understand how lasering the excision site on the same day would help.
How big are your scars? Punch excisions are best with small scars. I looked on RealSelf and some people have mentioned that punch excisions led to slight dips or depressions. This could be doctor-dependent, where the scar is, how big the scar is, or how the patient heals. Some doctors will do elliptical excisions so that the skin on both sides will "connect" or be brought together better in a geometrical way.
On 2/9/2021 at 12:20 AM, Amanda Hall said:I've had an excision done but not on the same day as CO2. I've seen some doctors on YouTube do this, and keep in mind that I'm just an individual with no medical background.
I'd rather do CO2 months after an excision. Why? Because you can resurface the site of the excision. If the doctor just wants to treat the other parts of your face so that you heal at the same time everywhere, then I understand. But I don't understand how lasering the excision site on the same day would help.
How big are your scars? Punch excisions are best with small scars. I looked on RealSelf and some people have mentioned that punch excisions led to slight dips or depressions. This could be doctor-dependent, where the scar is, how big the scar is, or how the patient heals. Some doctors will do elliptical excisions so that the skin on both sides will "connect" or be brought together better in a geometrical way.
Has punch worked for you?
On 7/23/2021 at 5:41 PM, Dontgiveupitsonlyscars said:Has punch worked for you?
I only had one punch excision done and the result wasn't good. This could be due to my dermatologist not having the best skills. Or it could be that a punch excision in that area of my cheek was not ideal. Perhaps the punch excision was too big. I'll never know.
I saw a plastic surgeon about 3-4 months later and he cut around it. That scar healed extremely well and is undetectable. Nobody can tell.
However, that plastic surgeon also did another excision that did not heal as well and it left a visible linear scar. I'm guessing his technique was the same.I firmly believe that scars heal differently depending on the area (some have more skin/fat), size of excision, and amount of facial movement around the scar. Also, if you have very light complexion, I will guess that you will heal better.
Here is a study its an old study but it was combined with CO2 laser and punch excision done in the same day.
12 hours ago, getsmart121 said:Here is a study its an old study but it was combined with CO2 laser and punch excision done in the same day.
The 21 year old woman in that study looked like she healed well but then again she was smiling. I detest when doctors post pictures with the patient smiling because it can distort the scars/lines, which they know this. They are taught in medical school how to take proper before and after pictures. When I smile, all my scars are gone. Thats why I say that. The older women in the study looked the same or slightly better but one of them were smiling so again, its really hard to tell.
15 hours ago, Amanda Hall said:I only had one punch excision done and the result wasn't good. This could be due to my dermatologist not having the best skills. Or it could be that a punch excision in that area of my cheek was not ideal. Perhaps the punch excision was too big. I'll never know.
I saw a plastic surgeon about 3-4 months later and he cut around it. That scar healed extremely well and is undetectable. Nobody can tell.
However, that plastic surgeon also did another excision that did not heal as well and it left a visible linear scar. I'm guessing his technique was the same.I firmly believe that scars heal differently depending on the area (some have more skin/fat), size of excision, and amount of facial movement around the scar. Also, if you have very light complexion, I will guess that you will heal better.
Thats great that the plastic surgeon cut around it and improved the scar. Do you have any pictures, Amanda? I would love to see how you had it before the excision, after the first excision and then after the second.
I dont know if light complexions heal better, for me thats speculation. I know that our bodies all heal differently but I am sure there are people who have dark complexions who have healed perfectly fine and probably others who did not heal as well. Its all based on how we heal, what we eat, the methods the doctors use to suture and also the resurfacing used. I have even read that stress and emotional factors can affect healing of wounds. Or if the patient is a smoker. I just think there are too many variables.It seems excisions are very dependent on too many factors to draw only one conclusion. Thus,I wouldnt just plainly adopt the ideathat healing is based on the color of ones complexion. I think its much more than that. Unless there was compelling evidence such properly conducted medical studies on excisions and skin complexions or science-based evidence that lighter skin and darker skin heal different when a wound is stitched, then perhaps. While most of the time I would like to make sweeping conclusions about things, I dont think there is enough evidence out there to conclude that dark skin types in comparison to lighter skin types heal poorly to excisions. I would perhaps place more merit in age related healing such as how older people might heal better with excisions do to a chemical protein in their body or something like that where it affects healing, a study that Livingwithfaith supplied from Penn medicine. But even then, some young people do heal well after excision so its not entirely dependent on age. The range at which punch excision affects healing is to great to conclude anything specific yet.
16 hours ago, Dontgiveupitsonlyscars said:The 21 year old woman in that study looked like she healed well but then again she was smiling. I detest when doctors post pictures with the patient smiling because it can distort the scars/lines, which they know this. They are taught in medical school how to take proper before and after pictures. When I smile, all my scars are gone. Thats why I say that. The older women in the study looked the same or slightly better but one of them were smiling so again, its really hard to tell.
Thats great that the plastic surgeon cut around it and improved the scar. Do you have any pictures, Amanda? I would love to see how you had it before the excision, after the first excision and then after the second.
I dont know if light complexions heal better, for me thats speculation. I know that our bodies all heal differently but I am sure there are people who have dark complexions who have healed perfectly fine and probably others who did not heal as well. Its all based on how we heal, what we eat, the methods the doctors use to suture and also the resurfacing used. I have even read that stress and emotional factors can affect healing of wounds. Or if the patient is a smoker. I just think there are too many variables.It seems excisions are very dependent on too many factors to draw only one conclusion. Thus,I wouldnt just plainly adopt the ideathat healing is based on the color of ones complexion. I think its much more than that. Unless there was compelling evidence such properly conducted medical studies on excisions and skin complexions or science-based evidence that lighter skin and darker skin heal different when a wound is stitched, then perhaps. While most of the time I would like to make sweeping conclusions about things, I dont think there is enough evidence out there to conclude that dark skin types in comparison to lighter skin types heal poorly to excisions. I would perhaps place more merit in age related healing such as how older people might heal better with excisions do to a chemical protein in their body or something like that where it affects healing, a study that Livingwithfaith supplied from Penn medicine. But even then, some young people do heal well after excision so its not entirely dependent on age. The range at which punch excision affects healing is to great to conclude anything specific yet.
No pictures. After the initial excision, the area was still a round bruised area about the size of a pencil eraser. It was also a little depressed. From having done a number of procedures, I had a feeling it wasn't going to heal as I wanted. The plastic surgeon was blunt about it and echoed my thoughts without hesitation. I'll bet some other doctors would have said to wait months until the color goes away or for the scar to keep remodeling.
When I say people with light complexions heal better, I don't mean that their scars are structurally better. I mean that their scars look better. This could be because they have less pigmentation issues which make a huge difference. Also, scars don't look as bad on fair-skinned people because of the lack of contrast. This doesn't mean they heal better so my choice of words could have been better.
On 2/2/2021 at 12:15 AM, Rickyduds said:Hi all,
Anyone have punch excision experiences, particularly combined (same day ideally) with Fractional CO2?
I've had two known acne scar specialists float the idea, but I'm quite intimidated by how long it will take to heal completely after removing sutures. There's hardly any info about it - I've only found this user on Youtube who's been posting videos lately about her experience. (I just removed the link at the user's request).
It looks like she's headed towards results, but there's residual redness that has lasted for months after (I believe her latest video is post 3 months). I'm a lighter skin type, but I'm just not sure I'm willing to commit the way she has. Can anyone tell me if this is typical?
Punch excision was recommended by a known acne scar specialist combined with fractional CO2 the same day. Any idea if this will reduce the scab healing after removing sutures + reduce the timeline that this patient experienced?
Hello hello.
I had punch excision of 12-13 atrophic scars on each cheek and I would do it again in a heartbeat. My texture has improved a lot and I definitely don™t have to deal with the horror of overhead lighting as much as before. Most scars look a lot better than they did before. Mind you, my dermatologist injected baby botox (about 1 unit) to each punch excision suture to minimize the chances of a hypertrophic scar forming. Unfortunately, it gave me a smile complication - where I have been unable to fully smile (my punch excision was on April 27 2021 and it has mostly worn off). but overall, I don™t think I regret the micro botox to each suture. Maybe a hypertrophic scar would have formed if I didn™t do that.
I may even want to do more punch excisions in the future on some remaining atrophic scars. But I am not sure, last time my derm said he didn™t see anything worth excising. I may have gotten a bit obsessive about my acne scar treatments and seeking improvement lol.
I will admit, having 12-13 sutures in each cheek for a week was obviously awkward lol had to avoid the public and keep mask on at all times xD .. also polysporin daily.
interestingly, a lot of the scars filled in over time, like several weeks. I have mostly linear scars left, flat and pink/reddish but they have been fading over time and blending with the surrounding skin. Something I hated was the top lighting effect and how they made my scars look horrific. I don™t deal with that worry as much anymore / rarely.
added some photos for reference - immediatelyafter the procedure.
after the sutures were taken out: May 4th
Prior to fully ablative erbium on May 11 2021
june 16 2021 - all healed up from erbium
On June 25, I had TCA Cross 90% and two syringes of restylane skinboosters. Unfortunately there was malpractice that has left me with a TCA line that is now new permanent scarring.
pictures below are June 28 2021
Here I am on July 20. TCA Line is still there. 
I am quite devastated by the tca line. It has been the same derm who has done all my treatments, someone I had a lot of respect for and who is supposed to be one of the best in Ontario. Just goes to show you that you can never be too careful.
On 7/28/2021 at 8:49 AM, Catharsis2018 said:Hello hello.
I had punch excision of 12-13 atrophic scars on each cheek and I would do it again in a heartbeat. My texture has improved a lot and I definitely don™t have to deal with the horror of overhead lighting as much as before. Most scars look a lot better than they did before. Mind you, my dermatologist injected baby botox (about 1 unit) to each punch excision suture to minimize the chances of a hypertrophic scar forming. Unfortunately, it gave me a smile complication - where I have been unable to fully smile (my punch excision was on April 27 2021 and it has mostly worn off). but overall, I don™t think I regret the micro botox to each suture. Maybe a hypertrophic scar would have formed if I didn™t do that.
I may even want to do more punch excisions in the future on some remaining atrophic scars. But I am not sure, last time my derm said he didn™t see anything worth excising. I may have gotten a bit obsessive about my acne scar treatments and seeking improvement lol.
I will admit, having 12-13 sutures in each cheek for a week was obviously awkward lol had to avoid the public and keep mask on at all times xD .. also polysporin daily.
interestingly, a lot of the scars filled in over time, like several weeks. I have mostly linear scars left, flat and pink/reddish but they have been fading over time and blending with the surrounding skin. Something I hated was the top lighting effect and how they made my scars look horrific. I don™t deal with that worry as much anymore / rarely.
added some photos for reference - immediatelyafter the procedure.
after the sutures were taken out: May 4th
Prior to fully ablative erbium on May 11 2021
june 16 2021 - all healed up from erbium
On June 25, I had TCA Cross 90% and two syringes of restylane skinboosters. Unfortunately there was malpractice that has left me with a TCA line that is now new permanent scarring.
pictures below are June 28 2021
Here I am on July 20. TCA Line is still there.
I am quite devastated by the tca line. It has been the same derm who has done all my treatments, someone I had a lot of respect for and who is supposed to be one of the best in Ontario. Just goes to show you that you can never be too careful.
Thank you for providing the photos. Do you have any pictures before the excision to compare? so this is your timeline, and correct me if I am wrong
1. May 4th Punch Excision
2. May 11 suture removal and erbium laser
3. June 20 TCA cross 90% (with same doctor that did punch excision or no?) and filler
4. July 20th you find you have new scar from failed TCA cross on one scar (it looks like it dripped)
Is there a chance you can tell the doctor to perform erbium laser to remodel the new TCA scar? what can be resolved? Let me know what happens.
I can't tell what your scars looked before punch excision. Are you caucasian or ethnic? I ask because I want to clarify if your healing process is dependent on your skin type. Also, how familiar are you with your doctor? Was he/she/they local or did you travel/fly somewhere?
You might still be swollen from the Erbium laser, so I noted that and I also noted that you have fillers in place on the scar areas I assume for collagen stimulation. You also mentioned botox, was the botox on every scar or just one area? You have a issue with smiling, is this issue painful or just a restriction from being able to smile? How many treatments have you done thus far? LOTS of questions, I know I know, I'm wildly curious about your journey and how it might affect someone like me if I followed all your steps.
On 7/26/2021 at 4:07 AM, Amanda Hall said:No pictures. After the initial excision, the area was still a round bruised area about the size of a pencil eraser. It was also a little depressed. From having done a number of procedures, I had a feeling it wasn't going to heal as I wanted. The plastic surgeon was blunt about it and echoed my thoughts without hesitation. I'll bet some other doctors would have said to wait months until the color goes away or for the scar to keep remodeling.
When I say people with light complexions heal better, I don't mean that their scars are structurally better. I mean that their scars look better. This could be because they have less pigmentation issues which make a huge difference. Also, scars don't look as bad on fair-skinned people because of the lack of contrast. This doesn't mean they heal better so my choice of words could have been better.
I appreciate your insight as always. I am mentally storing the information you gave me and as time goes on I will try to verify it against any data on punch excision I find. Thank you, Amanda.
@catharsis2018 what doctor did u go to ??? Please let
me know