Birthmark Treatment

Punch excision is a highly effective surgical technique used to treat deep ice pick acne scars, which are among the most challenging types of acne scars to improve. This procedure involves removing the individual scar using a specialised circular instrument known as a punch biopsy tool. Although this instrument is commonly used to obtain skin biopsies, it can also be used with great precision to permanently remove selected acne scars.

Under local anaesthetic, the punch biopsy tool carefully excises the deep ice pick scar, usually creating a very small wound measuring approximately 2–3 mm in diameter. The area is then meticulously closed using fine sutures to promote optimal healing and minimise the appearance of the resulting scar. The procedure is straightforward, is usually completed within a single appointment, and the stitches are typically removed after one week.

The aim of punch excision is to replace a narrow, deep acne scar with a much finer superficial surgical scar that is significantly easier to improve with additional treatments. Following healing, many patients achieve the best cosmetic outcome by combining punch excision with Fractional Laser or Laser Resurfacing, which help smooth the skin surface and stimulate new collagen production.

Professor Firas Al-Niaimi is a highly trained dermatologic surgeon with extensive experience performing complex facial surgical procedures. Having treated hundreds of patients using punch excision, he carefully assesses every scar to determine whether this technique is the most appropriate treatment or whether it should form part of a broader acne scar management plan.

Acne scarring can present in several different forms, which dermatologists classify into three main subtypes: rolling scars, boxcar scars and ice pick scars. Many patients have a combination of these scar types, meaning there is rarely a single treatment suitable for every scar. Instead, treatment is tailored according to the type, depth and severity of each scar.

Ice pick scars are characterised by their narrow surface opening and deep extension into the skin, giving the appearance of small puncture marks. They most commonly occur on the cheeks and temples but may affect any area of the face. The number and severity of scars can vary considerably, from a handful of isolated scars to extensive scarring involving multiple facial regions.

Because of their depth, ice pick scars generally respond less well to many traditional resurfacing treatments alone. Punch excision physically removes the deepest scars before further skin resurfacing is carried out. Depending on the extent of the scarring, this may be performed over one or several treatment sessions. Additional procedures such as Subcision, Microneedling or Fillers for Acne Scars may also be recommended for patients with mixed acne scar types to achieve the best possible cosmetic outcome.