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On 18/3 I had scalpel excision done on 3 acne scars. Since there are very few threads about this particular procedure, especially with photos, I decided to create one and will update it as often as I can.
Some backstory
I got sudden acne on my cheeks approximately 5 years ago, that left me with 3 indented scars. I've tried numerous treatments “ microneedling, TCA cross, spot dermabrasion, one session of laser spot treatment and punch excision once with a 1 mm round scalpel, no stitches (didn't improve the scars but didn't make them worse either), without any progress. After a consultation with a dermatologist, I was referred to a plastic surgeon.
The procedure
The excision was done with a regular scalpel by a plastic surgeon (won't name him here). The area was first numbed with local anesthesia. Then he excised 3 scars, two on my right cheek and one on my left. I got a total of 10 stitches I think, and each scar with one or two understitches (I don't recall the exact number). The procedure took half an hour or so to complete. A week later I got the stitches removed and was told to put tape on them for at least a week, and to continue to tape them for a few months whenever I leave the house.
Results
Here are two before pictures of my scars on the right cheek, before the excision:
I currently don't have a photo of the scar on my left side but it looked similar to the larger one, except it was slightly more indented. The smaller was 2 mm in diameter, and the larger one around 2.5 mm.
WARNING: GRAPHIC PHOTOS BELOW!!!
Here are two pictures 4 days after the excision. The tape was falling off so I had to remove them and replace them with new ones.
Unfortunately, as you can see, one of the scars opened up, leaving it exposed. (Date: 22/3)
These pictures were taken right after stitch-removal.
I taped over two of the scars. I had to wait for the third one to dry up and once a scab was formed, I put tape on it again. (Date: 25/3)
Two days after stitch-removal.
The scars have healed pretty well. (Date: 27/3)
Here are two photos I took today. This is what my scars currently look like.
The one on the right side turned out pretty good. It's a super thin straight line that's 1 cm long, barely noticeable. The one on the left side turned out so-so. Initially it looked good but it seems like a part of it have gotten wider for some reason. It's still too early for me to make a judgement though. There's still a lot of swelling underneath it. Hopefully it will look better with time. (Date: 4/4)
Final thoughts
I contacted my surgeon a couple of days ago and was advised to let the exposed scar dry up and update him with pictures the next couple of months. If the scar looks worse, which I have a feeling it will, then I will get it re-exised. I might get the left one, or at least part of it, re-exised as well if it doesn't improve in appearance.
Overall I have mixed feelings about this procedure. It's very risky and the outcome is unpredictable. I think there are many factors weighing in “ how skilled the surgeon is, aftercare and genetics (your ability to heal). Even then the results can still turn out bad. I think it mainly boils down to luck.
Would I recommend it? Both yes and no. If you have just a few scars then maybe but only if you've ran out of other options. For those with more severe scarring then I would probably advise against it due to the risks.
I will update with more photos once the scab have fallen off. Until then, feel free to ask any questions you want and I will try to answer them all.
21 minutes ago, chrishank said:i cant see your before pics may i know what type of scars are they? you did have a pretty good improvement results good luck!
Thank you! That's strange. Can you see the pictures now? I updated the first post. Anyway, I'm not sure about what kind of scars I hadbut I believe they're boxcar scars.
4 hours ago, Vidrar said:I would never do excision again, tried it on a few scars and they turned out worse. Subcision with RF microneedling is the gold-standard.
Will subcision work for textural scars? The OPs scars looked mild to me so Im wondering if sibcision is the answer.
@Sccttts21Please make your own post. Acne scars are never like someone elses's, you need a customized plan to treat them. If you have textural scars, subcision alone will not treat the texture. I will respond to your post(if you make one) or PM tomorrow as I have 100+ to respond to today 😉
@Ravi.kumar.engineer Be very careful comparing your scar condition to others. There are many factors that come into play. (Scalpel free hand cutting out tissue)Surgical exicsion is the riskiest procedure one can have. Why do you think plastic surgeon's hide the scars in the hair for a facelift. Results can be terrible. It's very dependent on the surgeon and they should be a plastic surgeon who knows how to do multiple kinds of "stitches," geometric closures. It is high risk, Whenever we cut there are possibilities of infection, loss of pigment (especially in ethnic patients), healing poorly, deformed closure, unsuccessful closure that needs to be revised. IF someone has areas all over their face, that can be a nightmare The larger the area the more the risk. It also depends how you heal, sensitivity, and your health concerns. IF you have one spot sure it could do well, many areas could be a nightmare. Always test patch a small scar before doing several. They always take more tissue (Excision) than the scar so be prepared for a larger area of healing or a larger linear scar. Note below there will be possible pigmentation issues, a linear scar still, and the wound is not healing up fully. That linear scar if not undermined properly can diviot, dog ears, stitch hypro and hyperpigmentation, pulling with skin tension (deform), or never blend in. Some people are prone to hypertrophic scarring when they do this as they set the body up to over produce scar tissue. I normally say do this last if everything else fails (other treatments) and you are willing to take on the risk of side effects (See above about test scar). Any surgery makes new scars.
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16 hours ago, Ravi.kumar.engineer said:Hey I think it is improvement.
You had double stitches or single stitches ??
And can you please provide latest update ?? Did it improved your self esteem of how you think about your self ??
Hi, thank you! The stitches I got was one under stitch, and three for closure on each scar.
As for my self esteem I don't really know. The scars did bother me but not to the extent where it made me insecure. I just wanted to get rid of them. I do feel like it's an improvement, at least on one of the scars. The other ones I will get re-excised.
I have uploaded a picture of my right side. There's still a little swelling left but other than that the scars have healed.
Picture taken 1/5
@beautifulambitionyes I agree with you and I consider you most eligible person to give us advise .
But sometimes it is very frustrating to have multiple treatments for few % of incremental result , people also talk about punch graphing and all , is it something promising ?
I myself is computer engineer , this sort of things really encourage me to leave my current job and study medicine and do some research in this fields. I mean there is lot to achieve yet for us as human beings.
I have heard that USA is starting some stem cell research may be i can join there.
@FriendlyRosei wish for your healthy healing . Keep us posted hope everything end smoothly and you become inspiration for us . Just one question for you your initial scars were smaller , why you didn't went for punch than scalpel.
@Ravi.kumar.engineerWe should not clog up this person's thread, ... perhaps you can respond in your own post. My reply will be there.I have stated above clearly why I feel this is a poor choice to start with before trying manual scar revision and some laser - last ditch thing, but it's up to the individual to decide their treatment plan.
I just wanted to make an update. I just got a re-excision done on two scars. On one scar I got two understitches and three overstitches, and on another I got two under and five over. It took approximately half an hour. The stitches will be removed in a week.
I've been thinking a little about the scars that turned out worse and I believe it was mostly my fault. First of all, I didn't leave my scars alone. I removed the tape a bit too early because I was curious about what it looked like. I also didn't tape it long enough. Another mistake I did was to wash my face when my scars weren't fully healed. The scabs were removed when I washed my face.
A very STUPID mistake I did was removing a piece of suture that was sticking out (it was used for the understitching). I suspect that this is what made the scar on my left side wider. I should have left it alone and let it fall of by itself.
This time I won't touch or even look at my face. I will just leave it alone. And if one of the tapes get too loose, I was told to put another piece of tape over.
I wish you the best of luck!
Thank you for updating and I hope you will continue updating us since there are not many getting excision done and reporting about it!
@FriendlyRoseGood job, I would put a silicone scar patch on this especially at night now for a few months. Why so it can even out a bit and the color will get better. It will need some potential co2 laser for the texture when you heal more, and possibly some pulse dye laser for the PIE or redness. Because of your skin tone this is possible, anyone darker this would be very evident.
It's been 9 days since I removed the sutures and I'd like to make a quick update. So far everything have gone well. No complications and no enlargement of any of my scars. There's still A LOT of swelling and redness going on. I've been taping the scars with silicone sheets and will continue to do so for the next couple of months. After that I'll probably do laser.
I will upload pictures so you can see the progress. The picture above is right after stitch removal. The picture below is from today.
@FriendlyRoseNext steps. 1) silicone scar patches nightly on the area. 2) vitamin c serum but not under the patch & niacinamide cream, retinoids (dilute with moisturizer if needed) can be used once or twice a week but again not under the patch, 3) susncreen!!!!! 4) CO2 laser may be needed on the scar 4) Pulse dye laser for the redness. It's a young scar and healing.
-BA
1 hour ago, beautifulambition said:@FriendlyRoseNext steps. 1) silicone scar patches nightly on the area. 2) vitamin c serum but not under the patch & niacinamide cream, retinoids (dilute with moisturizer if needed) can be used once or twice a week but again not under the patch, 3) susncreen!!!!! 4) CO2 laser may be needed on the scar 4) Pulse dye laser for the redness. It's a young scar and healing.
-BA
Thank you! Would Retin-A cream be too harsh to use and maybe interfere with the healing? Should I just stick to vitamin C serum and niacinamide?
@FriendlyRoseUse Retin- a 1.5 months after healing has occurred then to be safe. Start with the C and Niacinamide. The silicone scar patches are a must nightly!!!!
Hi, @FriendlyRose, i was going through your post and i feel like I'm going through a same situation about scars not healing well
I had a chickenpox scar on my forehead and one on my cheek, i already tried subsicion, fillers, peels, micro dermabrasion but nothing worked
Finally i decided to go with the punch excision, the doctor said the forehead scar is not that deep, dermabrasion will be better option and for cheek, punch excision will better, today I'm on 20th day after the procedure and my forehead looks like doughnut with white dent in the middle surrounded by brown ring and my scar on the cheek is still indented like one of yours scar opened up, but mine didn't open up, the sutures were intact.
But looking at your journey i also feel that i will have to re-excise it again.
How long did you wait to go for the second time?