Follicular unit extraction micropunch for elevation and excision of deep icepick and boxcar acne scars.
Description
Therapeutic Challenge: Of the main types of atrophic acne scars, boxcar and icepick scars are known to be more resistant to laser resurfacing treatments. Although CO2 laser pinpoint or targetoid laser resurfacing1 are effective options for these types of acne scars, poor results can be seen in those cases with scars deeper than 1 mm and punch elevation or excision techniques are often required2. Nevertheless, there is a limitation in the range of commercially available punches with diameters under 2 mm, restricting an optimal fit for each individual scar width. Solution: For icepick and boxcar acne scars deeper than 1 mm and a diameter of 2 mm or less, we perform the elevation technique with 1.25, 1 and 0.75 mm diameter follicular unit extraction titanium micropunches (Figure 1). Under local anesthesia, a micropunch incision reaching the hypodermis is made, matching the diameter of each scar to that of the blade. For scars not perfectly circular, their shape of can be adjusted by stretching or pinching the surrounding skin to fit the punch circle. Immediate hemostasis is achieved by applying gentle pressure to the wound with a gauze soaked in 100 mg/mL tranexamic acid solution. The skin cylinder is then excised (if narrower than 1 mm) or elevated (if wider than 1 mm) using hair transplant precision forceps and attached to the surrounding skin using polyester filament-reinforced sterile strips (3M™ Steri-Strip™). At the 15-day follow-up, the strips are removed and fractional CO2 laser resurfacing is performed. With this novel approach, we have observed better results for deep boxcar and ice-pick acne scars compared to previous techniques.