Punch excision is a method for treating acne scarring in which a is utilized to remove scar tissue. This scar revision treatment is a minimally invasive surgical procedure, ideal for deep ice pick scars.
Using the technique of punch excision the acne scar is surgically removed through the use of a surgical tool that matches the size of the scar (ideally 1.5-3.5 mm). The remaining wound is closed with a stitch. Punch excision is an ideal technique for revising deep ice pick scars and narrow, deep boxcar scars (<3 mm).
How to perform punch excision
After preparation of the site, the skin is stretched perpendicular to the lines of least skin tension so that the wound forms an oval. While holding the stretched skin taunt, the punch instrument is introduced vertically using a smooth twisting motion. Once the instrument reaches its maximum depth or goes through the dermis and into the subcutaneous tissue, the punch can be removed.
The wound may be closed and hemostasis achieved by gel foam or by suture. Gel foam is indicated as a hemostatic device for use with surgical procedures. The wound may also be closed with nonabsorbable suture to aid in hemostasis and to produce a better aesthetic result.
Does punch excision hurt?
Prior to performing a punch excision, the treated area is injected with lidocaine. This numbs the treatment area to minimize discomfort associated with the procedure. You can generally expect that the most uncomfortable step in the process of punch excision is the simple lidocaine injection used as a local anesthetic before the procedure. Typically, patients do not experience side effects, though there may be mild soreness at the site of treatment post-procedure for a few days.
SKIN TENSION LINES (LANGER’S LINES)
Skin tension lines, also known as Langer’s lines or lines of cleavage, are linear clefts in the skin that indicate the direction of orientation of the underlying collagen fibers. If the skin is disrupted parallel to the long axis of the fibers, the wound tends to reapproximate. However, if the wound crosses the long axis of the fibers perpendicularly, they are disrupted in a manner that causes the wound to gape open; therefore, greater tension is required to close the wound. Lacerations that run parallel to these lines naturally reapproximate the skin edges. Lacerations that run at right angles to the tension lines tend to gape apart
Does punch excision leave a scar?
Punch excision for acne scar revision generally does leave behind slight scarring of its own, though the scars are smaller, softer, and less noticeable than the original atrophic scars. The scar left behind after punch excision will most often resemble a small line as opposed to a depression.
In areas under a great deal of static tension, such as the cheek, there is a real risk following any kind of excision (including punch excisions) for the subsequent development of stretch scars and even tram track stitch marks, which can be quite unsightly, especially in an area as prominent as the cheek.
punch excision vs subcision
Both scar Subcision and punch elevation are acne scar treatments involving a minor surgical incision performed with local anesthesia that aids in releasing tethered scars.
Subcision is a very effective technique for correcting atrophic scars, whereas punch techniques are very effective for deep boxcar and ice pick scars.
Leave a Reply