Punch Techniques for Acne Treatment

Punch techniques for acne scars are commonly used for depressed or pitted severe lesions. The results are permanent removal of scars since they are literally ‘punched’ out of the skin using any of 3 techniques – punch excision, punch elevation and punch grafting. 

This type of acne surgery is very effective to remove, separate, raise or fill scar tissue from the skin beneath. In this way, deep, large scars are removed and replaced by small, flat scars that are less noticeable and could fade after the skin heals. These flatter scars can be subsequently treated using laser resurfacing. 

Procedure and Cost

Punch techniques must be performed by a certified and trained dermatologist usually at his or her clinic. The patient normally receives a local anesthetic that numbs the treatment area. Alternatively a mild sedation can be administered. The following are the 3 techniques in this type of acne surgery:

  • Punch excision is done using a round cookie cutter-like instrument. The entire scar is removed using this method.  The size of the instrument will depend on the scar’s size. Normally this is 1.5mm – 3.5mm in diameter. The area is prepped before surgery and a local anesthesia is administered. The resultant wound can be sutured closed.
  • Punch elevation is done after the scar is removed when the dermatologist will lift up the underlying tissue to be level with the rest of the skin.  This is used for deeper acne scars and causes less discoloration that punch grafting does and scars are less visible.   Boxcar scars with normal bases but sharp edges are ideally treated using punch elevation techniques. 
  • Punch grafting is done to close the opening left after excising the scar. Usually the patient’s own skin will be used in the graft.  This is an alternate to suturing the wound after punch excision. This is more suitable for larger scars for the treated area will look smoother after a grafting rather than suturing.  If a discoloration remains after grafting, skin resurfacing can be done after 4-6 weeks to correct this problem.

Punch techniques can cost as much as $250 to $300 per scar.

After punch techniques are carried out, there can be a few weeks of recovery time (6-8 weeks ). During this period the wounds will need to be treated by changing bandages and applying ointments. Bruising can remain if an incision is made. Your dermatologist will explain aftercare procedures and if you will need to return for further treatment.

Benefits of Punch techniques for acne

punch techniques for acne

Each of the punch techniques is useful for certain types of scars. Punch excision helps ice pick scars that normally resemble tiny puncture wounds. Punch elevation technique is ideal for boxcar scars that resemble large angular pores. Since the size of the scar means that simple removal will leave behind an ugly gaping hole, procedures like punch grafting, elevation or suturing is done to smoothen the skin’s surface. 

Punch techniques help in the creation of new epithelial cells that resemble the existing unblemished skin in both texture and tone.

Dermatologists recommend punch excision followed by suturing / Fraxel laser repair as the best treatments for ice pick scars. These scars can be difficult to treat with only chemical peels or laser resurfacing since the base is deep and sidewalls are steep. Experienced dermatologists are a must for there are several variations to these techniques and only they can achieve the best results.

Possible Issues and side effects

Some side effects of punch techniques, which could occur, are:

  • Bruising
  • Scab formation
  • Keloid formation
  • Punch excision may leave behind a smaller scar that requires further treatment like skin resurfacing
  • Punch elevation if not done properly can cause the skin’s surface to become uneven with the treated area being higher than surrounding areas
  • Grafting can result in unmatched skin, graft not ‘taking’ to the surrounding area or the treated area becoming more elevated.

Some issues pertain to the long recovery period (6-8 weeks).    Punch techniques alone cannot heal deep, pitted acne scars. They need to be used along with other techniques like microdermabrasion, dermabrasion, and laser resurfacing or chemical peels for patients to enjoy the best results. 


It is important that patients follow all their doctor’s instructions once punch techniques are completed. This includes cleaning wounds, applying ointments and changing the bandages. 

Only a qualified dermatologist can perform this acne surgery.

What are usres saying

Based on several user reviews we studies, punch techniques are beneficial for those with deep pitted ice pick scars as long as a qualified doctor performs the surgery. In such cases, it was thought that the cost was well worth the result.

Some minor issues concern the downtime for bruising. Some have reported not much difference to their appearance, inexperience of the doctors and expensive treatment.