Acne Scar Excision

Acne scar excision belongs to the dermatologic-surgery side of scar revision. It targets deep, narrow icepick scars—and some sharply defined deep boxcar scars—on areas such as the cheeks and temples, where scar tissue extends far into the dermis, deeper than lasers or microneedling can reliably reach from the surface. Common techniques include punch excision, punch elevation, and, for larger individual scars, elliptical excision followed by careful layered closure.

Excision does not make a scar vanish; it is a deliberate trade. A deep, steep-walled pit is exchanged for a small, flat linear scar that later resurfacing can soften further. The procedure treats a limited number of selected scars at a time—it does not smooth overall skin texture, and it does not treat active acne. Shallow rolling scars are usually better matched to subcision or laser treatments, which are covered in their own entries.

Punch excision removes the entire scar column—including the scarred lining that runs deep into the skin—with a small round instrument, then closes the edges with fine sutures so the skin heals along a controlled, narrow line. Punch elevation instead cuts around the base of a boxcar scar and floats the preserved skin plug up level with the surrounding surface. Before either technique, the surgeon marks each scar, takes baseline photos, and injects local anesthetic, which stings briefly before the area goes numb.