Considering other surgical treatment options

Atrophic scars, such as ice-pick scars, boxcar scars, and small
depressed fibrotic scars, may be removed or improved by a punch
excision of each individual scar.
Excising scars: When zits are literally the pits
In this procedure, each scar is cut down to the layer of subcuta-
neous fat; the resulting hole in the skin may be repaired with
sutures or with a small skin graft. Alternatively, the punch may
simply be elevated. There are three techniques:
 Punch excision: Your doctor removes the pitted scar with a
cookie-cutter-like tool that punches out small portions of skin.
The surrounding healthy skin is joined together by suturing.
 Punch replacement: As with the punch excision, the scar is
removed and then replaced with a skin graft of unscarred
skin, usually harvested from behind the ear. This method is
usually the most successful for treating deep scars.
 Punch elevation: Here the scar is punched out, but not dis-
carded. It is allowed to float up to the level of surrounding
skin.
Your dermatologic or plastic surgeon may allow the scar from
punch techniques to fade on its own. Or she may perform the pro-
cedure before a more generalized resurfacing technique such as
laser resurfacing is performed. Less commonly, dermabrasion,
microdermabrasion, and chemical peels are sometimes used in
conjunction with punch techniques.
The prices of these procedures vary and depend upon the number
of grafts or punches that are done. Punch grafting can run $50 to
$150 per graft or $1,000 to $2,500 per session.
Subscising scars
Subcision helps to restructure and remodel scar tissue by breaking
fibrous bands that are creating tension between the epidermis and
deeper structures. It also helps induce new collagen formation. This
method is useful for indented, rolling scars that result from scar
tissue holding the skin down. This is a very specialized procedure
that is performed by a qualified dermatologic or plastic surgeon.
To perform this technique, a sharp instrument such as a tiny
scalpel or needle is used to undercut and lift the scar tissue awayfrom unscarred skin, elevating the skin to make it even. The sub-
scising procedure breaks down adhesions (old bands of scar
tissue), which helps to reorganize the formation of new collagen
and elastic tissue for a smoother skin surface. The overlying skin
isn’t cut, so sutures aren’t needed.
This breaking down of scar tissue helps to level the playing field.
After the wounds heal, an injection with a filler material under the
scar can help to replace any remaining defects and bring them to
surface level. The filler can be made of one’s own fat or a collagen
or other synthetic substance that I describe in the section
“Contouring the defects: Fill ’er up!”
The procedure can cost between $200 and $1,000 depending on the
number of lesions treated.