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Types and Techniques of Acne Scar Revision Surgery

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Types and Techniques of Acne Scar Revision Surgery

4 min read


Acne is one of the skin conditions in which surgical modalities have a significant role with certain limitations. Read the article to know more.

Written by

Dr. Suvash Sahu

Medically reviewed by

Dr. K. Shobana

Published At February 28, 2017
Reviewed AtMarch 27, 2024


Acne scars and wrinkles have always been a challenge for treatment. Surgery for acne is usually indicated either for acne scars or post-inflammatory hyperpigmentation. Pitted facial scars, although commonly caused by acne, also result from a variety of conditions such as chicken pox, herpes zoster, and more. They are deep with well-defined margins, which cast a shadow, thus making them cosmetically more conspicuous. These deep pitted scars are either crateriform or ice pick-shaped with a depressed fibrotic base and with firm, indurate, rolling, or sloping edges.

What Is Meant by a Scar?

A scar is a body’s way of healing and replacing damaged skin. A scar may be caused due to various reasons like infection, surgery, inflammation, or injury. Scar consists of fibrous tissue, which can be formed anywhere in the body and may appear flat, lumpy, sunken, or colored. The scar can be painful or itchy; the appearance of the scar depends on:

  • Skin type.

  • Location.

  • The direction and type of the injury.

  • Nutrition status.

  • Age of the injured person.

What Are the Types of Acne Scars?

Acne scars are of three types:

  1. Ice Pick Scars: Ice pick scars are very small and are common on the cheek region. Ice pick scars are narrow, less than two millimeters deep, and sharply marginated with vertical extents to the deeper layers of skin.

  2. Rolling Scars: This scar makes the skin surface look very wavy and uneven. These scars have varying depths and sloping edges. Rolling scars occur when scars are adherent to the dermis with relatively normal-looking skin. They are wider than four to five millimeters. The abnormal adherence of scars to the dermis leads to superficial shadowing and rolling or undulating appearance of the overlying skin. In this type of scar, subcision is essential for successful treatment.

  3. Boxcar Scars: These scars are depressions with sharp edges. These are caused by chickenpox, bigger acnes, or varicella (a virus that causes red, itchy blisters). These scars occur over the lower cheek or jaw, usually on the surface with thicker skin. They may be shallow or deep and are commonly up to 0.5 mm (millimeters) or more than 0.5 mm in diameter, and most often 1.5 mm to 4 mm in diameter. These types of scars respond well to punch excision or punch elevation treatment.

What Is Scar Revision?

Scar revision is a procedure that is performed to alter the appearance of the scar formed. This procedure helps to improve the cosmetic appearance of the scar and also helps to restore function if it is interrupted by the formation of the scar. It also helps to improve an itchy scar; no procedure can completely eliminate the appearance of a scar.

What Are the Benefits of the Scar Revision Procedure?

Treatment can help to enhance the scars.

  • Color.

  • Size.

  • Stiffness.

  • Texture.

  • Thickness.

How Does a Person Prepare for Scar Revision Surgery?

Before starting with any scar procedure, the scar should be examined by the doctor, and various characteristics are considered, such as:

  • Color of the scar.

  • Contour.

  • Thickness.

  • Vascularity.

The position and the region where the scar is formed are also considered, and any tissue stiffness is taken into consideration. Then, the doctor will discuss the opinion, risks, and benefits with the patient. Some pre-operative instructions should be followed, which can help with the procedure, such as avoiding smoking and drinking alcohol.

What Are the Various Techniques Used to Treat Acne Scars?

  • Subcision - A technique of uplifting the scars by cutting the underlying fibrous band with the help of hypodermic needles.

  • Punch Excision and Closure - A kind of circular blade is attached to a pencil-like handle. In this method, the scar tissue will get cut and sutured back.

  • Punch Incision and Elevation- In this method, the scar tissue will just get incised with a punch and uplifted to the level of surrounding skin by elevation techniques. This procedure is useful for deep boxcar scars.

  • Punch Excision and Graft Replacement - In this type, pitted scars of up to four millimeters in diameter are first excised with the help of a punch and immediately replaced with a skin graft taken from other parts of the body.

What Are the Factors That Decide Which Technique Has to Be Followed?

  • Number of Scars: If plenty of closely placed scars are present, subcision should be preferred. If scars are less in number, then other techniques can be done subsequent to subcision for a better result.

  • Orientation Along RSTL: Scar lying along or parallel to RSTL (relaxed skin tension line) should be punch excised and closed primarily for best results.

  • Scar Surface: When a few scars are present, not along the RSTL, then two alternatives are available. Punch incision and elevation are performed for scars with normal surface texture, and punch excision with graft replacement for those with atrophic surface and irregular skin texture.

  • Size of Scar: The excision with grafting should be avoided for scars more than four millimeters to prevent poor esthetic results. In these types of scars, elliptical excision and suturing can be done.

  • Shape of Scar: Linear scars are best excised and closed primarily. Circular scars probably require punch float.

What Are the Complications Caused Due to Scar Revision Procedure?

The complications of scar revision surgery are:

  • Hematoma.

  • Infection.

  • Wound dehiscence.

  • Graft rejection.

  • Allergic reaction to dressing.

  • Scarring.

What Are the Risk Factors and Precautions for Scar Revision Surgery?

One of the biggest and most common risk factors is that the person may not be satisfied with the result produced after the post-scar revision procedure. Each scar procedure varies; the procedure followed on one scar cannot be followed on other scars.

Other possible risk factors of the scar revision procedure are:

  • The reaction to anesthesia used during the procedure.

  • Bleeding, discoloration, or swelling at the surgical site.

  • Thrombosis of the deep vein.

  • Surgical site numbness.

  • Infections.

  • Pain.

  • Incisions that do not heal properly.

  • Need for additional revision surgery.

What Needs to Be Expected After the Scar Revision Procedure?

Recovery post-scar revision depends on the type of the procedure. Topical treatment usually takes a long time to produce results. Many people need resurfacing and many injections to achieve the goal. Recovery may take weeks to months.


The scar is caused due to various forms of injury. Scars can vary in shape, size, location, texture, and thickness. Some of these scars are barely noticeable. A scar revision procedure is performed to change the appearance of the scar, but no procedure can completely change the appearance. The scar revision procedure depends on the texture and region of the scar. Some surgical procedures will be the correct option, so consultation with a doctor before the start of any procedure is recommended.

Frequently Asked Questions


What Is the Best Surgery for Acne Scars?

A minor surgical procedure known as punch excision is done to eliminate the acne scar.  In this procedure, the doctor cuts out the individual scars and repairs the wound with stitches or skin grafts. A second surgery involves the breakage of scar tissue.


What Is the Most Common Scar Revision Technique?

Scar revision is a surgery used to alter the appearance of a scar so that it can blend in with the surrounding tissues. One of the most common scar revision techniques is z-plasty. In this procedure, more serious scars are revised and repositioned to reduce the scar tension and make it less visible.


How Is Scar Revision Performed?

Scar revision focuses on returning the anatomic structures to their actual esthetic positions. It is an atraumatic technique that involves multiple strategies and techniques. Skin grafts and flaps are also used in skin revision techniques.


What Is a Tummy Tuck Scar Revision Surgery?

Tummy tuck scars appear after the excess fat from the belly is removed by surgery. These scars are large and may require another surgical treatment done by scar revision. In this technique, a surgeon cuts the scar out of the skin and then closes the wound with stitches.


Which Laser Is Most Effective for Acne Scars?

The most effective laser that is used for the removal of acne scars is the fractional CO2 laser. This aggressive but highly efficient laser produces results after one sitting. It treats the skin in fractions leaving healthy skin and allowing fast healing.


Does Scar Revision Cause Pain?

Scar revision is not a painful procedure; it is performed under local or general anesthesia. However, the initial phase of surgical healing may include localized swelling, discoloration, or discomfort, and it may take around one to two weeks to heal completely.


Does Scar Surgery Have Any Risks?

Scar revision surgery is a safe and effective procedure, but like any other medical procedure, it does involve some risks. Patients should know about all the risks involved, although which are rare to occur, such as -
Bleeding (hematoma), infection, delayed healing, and temporary or permanent damage to deeper structures, including nerves, blood vessels, muscles, and lungs. Allergies to suture materials and glues, blood products, topical preparations or injected agents, skin discoloration, and swelling.


What Is the Duration of Scar Revision Surgery?

The time usually depends upon the case and can vary from person to person. Usually, most scar revision surgeries are done in a period of one to two hours. In cases where the scar is large and requires extensive revision and tissue repositioning, the time may vary for the surgery.


How Many Laser Sessions Are Required to Treat Acne Scars?

The number of sessions depends on two things; firstly, it depends upon the severity of the scar, and secondly, it depends on the type of laser. Powerful laser treatment can treat the scar in one or two visits. Usually, normal laser and light treatments require approximately three to six sessions for the results to be evident.


Can Deep Acne Scars Be Removed by Lasers?

Lasers are very effective in treating acne scars, but the result can vary among individuals. The lasers are the most effective against mild to moderate scars; however, with deep or large scars, patients should consider other options. Deep scars can be easily treated with surgical procedures like scar revision, as laser treatment results are inadequate.


Does Laser Scar Treatment Cause Any Side Effects?

The side effect of laser treatment are low, and in some cases, some minor side effects can occur, which include -
- Redness.
- Swelling.
- Itching.
- Infection.
- Change in skin color.


What Are the Home Remedies for Treating Acne Scars?

Many people opt for home remedies instead of laser or surgical procedures to remove acne scars. However, there is no significant evidence of their effectiveness. Some of the traditionally used remedies for acne scars include -
- Black seed oil can help improve skin pigmentation.
- Rosehip oil helps in reducing discoloration in postsurgical scars.
- Honey can help in wound healing and minimize future scarring.
- Aloe vera combined with manuka honey helps in the scar-free healing of wounds.
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Dr. Suvash Sahu
Dr. Suvash Sahu



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