ABSTRACT
This chapter discusses the surgical interventions, including subcision, dermal grafting, and excision and punch techniques, are often the best options for improving the deepest and most fibrotic forms of acne scarring in addition to correcting superficial scars. Both subcision and dermal grafting are aimed at achieving long-term augmentation of depressed acne scars with indistinct borders. Punch grafting is only feasible if the patient has a suitable donor site with skin that matches the scar site in color and texture. Punch grafting is most successful in less mobile areas of the face such as the forehead and upper cheeks. Punch grafting entails replacing an excised scar with a full-thickness, autologous punch graft, and punch elevation involves preserving an excised scar base and allowing it to rise to the level of the surrounding skin. Excision and punch techniques have a distinct advantage over nonsurgical scar revision techniques in their capacity to substantially improve the appearance of ice pick and deep boxcar scarring.
