Q: I have an extremely deep acne scar on my cheek from cystic acne that has tunneled under the skin. Subsequent healing has resulted in some type of contracture and folding of the skin so that an indentation extends under the skin itself. The indentation extends for about 15 millimeters and seems to follow the track of a hair follicle. The opening is broad, about 9 millimeters and regular. I would happily trade this scar for an excision scar. Can you tell me if this can be done and is it a good idea?
A: Acne scarring can be quite severe and deep. This is particularly true on the cheek area which shows such scarring prominently due to the tighter skin stretched across the bone. I have seen this exact cheek acne scar situation that you have described several times before. What it really represents is the loss of subcutaneous fat underneath the skin due to the infection with the skin edges healing inward. You have described it quite accurately as a scar contracture.
As a result, the problem with this type of cheek scar is that it is not only indented but is missing tissue underneath. So while cutting it out is an important step (scar excision), replacement of deeper fat at the same time is also important. If not replaced, there is a chance of the wound edges pulling downward as it heals to a space with less fill underneath. For this reason, I would do a scar revision with the simultaneous placement of a fat graft underneath the skin edge closure. This would be particularly important in the tight skin that overlies the cheek.
Dr. Barry Eppley