Should Punch Excision Of Acne Scars Be Done Before Or After Facial Laser Resurfacing?

Q: Dr. Eppley, I’m hoping that the full facial laser ablation will help greatly with my acne scarring. My only concern is that I have a few scars on my cheeks that are noticeably larger than the rest (they look more like “boxcars” whereas the others just look like large pores) Would you recommend doing the full facial laser ablation first then tackling any punch excisions if needed? Or would it be better to do punch excisions on the few larger ones immediately prior to full ablation in order to maximize success? Of all of the aesthetic goals I’m trying to achieve, having a beautiful “poreless” face is of the most importance.

A: The most important concept about laser resurfacing of facial acne scars is that perfectly smooth and poreless skin is not possible. Improvements in skin texture and irregularities can be obtained, it is just about how much improvement can be obtained and whether one treatment alone is adequate. This can not be specifically gauged beforehand in any patient and more in that regard will be known after the results of the laser treatment is seen. Acne scars that are amenable to excision (ice pick scars, not boxcar scars) should be done beforehand. That way those scar revisions get the benefit of the laser resurfacing as well.

Dr. Barry Eppley