Surgery for acne including subcision, punch technique and skin grafting
Acne scarring can sometimes develop as a complication of acne and if you pick your spots. Any type of acne spot can lead to scarring, but it's more common when the most serious types of spots (nodules and cysts) burst and damage nearby skin.
There are three main types of acne scars:
- Ice pick scars – Small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object.
- Rolling scars – Caused by bands of scar tissue that form under the skin, giving the surface of the skin a rolling and uneven appearance.
- Boxcar scars – Round or oval depressions, or craters, in the skin.
Treatments for acne scarring are regarded as a type of cosmetic surgery, which isn't usually available on the NHS. However, in the past, exceptions have been made when it's been shown that acne scarring has caused serious psychological distress.
If you're considering having cosmetic surgery, your GP will be able to discuss your options with you and advise you about the likelihood of having the procedure carried out on the NHS.
Many private clinics offer treatment for acne scarring. Prices can vary widely, up to several thousand pounds, depending on the type of treatment needed (the British Association of Aesthetic Plastic Surgeons website has more information about private treatment available in your area).
There are various techniques performed by the Surgeon or Dermatologist. The proposed procedure will be discussed with the patient first to evaluate psychological needs, patient’s expectations etc. The procedure will be explained, expected outcome based on the examination, information about the recovery time, any complications that may be expected, and advice give on after care.
Treatments for acne scarring include:
Punch technique is where the scarring is removed to a lower level. The cavity is then repaired with sutures or a skin graft - the aim being to join up the loopholes. This procedure needs a longer healing time but is very effective, especially for ice-pick scars and crater like depressions.
Punch techniques are used to treat ice pick scars and boxcar scars. There are three types of punch technique:
- Punch Excision – Used to treat mild ice pick scars. The scar is surgically removed and the remaining wound is sealed. After the wound heals, it leaves a smoother and more even area of skin.
- Punch Grafting – Used to treat very deep ice pick scars. As with a punch excision, the scar is removed, but the wound is "plugged" with a sample of skin taken from elsewhere on the body (usually from the back of the ear).
- Punch Elevation – Used to treat boxcar scars. The base of the scar is surgically removed, leaving the sides of the scar in place. The base is then reattached to the sides, but lifted up so it's level with the surface of the skin. This makes the scar much less noticeable.
Subcision is a surgical treatment that can be used to treat rolling scars. During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area. The blood clot helps form connective tissue, which pushes up the rolling scar so it's level with the rest of the surface of the skin.
Once subscision has been completed, additional treatment, such as laser treatment and dermabrasion, can be used to further improve the appearance of the scar.
Skin grafting may be necessary in extreme conditions when extensive tunnels called sinus tracts are found under the skin. These are caused by trapped sebum and bacteria in the pilosebaceous unit causing an inflammatory reaction. Grafting covers the unroofed sinuses.
It's important to have realistic expectations about what cosmetic treatment can achieve. While treatment can certainly improve the appearance of your scars, it can't get rid of them completely. After treatment for acne scarring, most people notice a 50-75% improvement in their appearance.
There are many products which have been specially formulated for the after-care of surgical techniques.
Sources used in writing this article are available on request
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Information written by the talkhealth team
Last revised: 1 May 2018
Next review: 1 May 2021