Deep ice pick and boxcar acne scars often do not respond adequately to creams or surface treatments alone. Punch excision is a precise minor surgical procedure that removes individual deep scars and helps create smoother, more even skin texture. At Kathmandu Clinic of Cosmetic Surgery in Nepal, punch excision is combined with advanced treatments such …
Advanced Surgical Scar Revision at Kathmandu Clinic of Cosmetic Surgery
Acne scars can remain long after active acne has healed. While lasers, microneedling, and chemical peels can improve many scars, some deep scars require a more targeted approach. Punch excision is one of the most effective procedures for treating deep ice pick scars and certain boxcar scars that do not respond well to surface treatments.
At Kathmandu Clinic of Cosmetic Surgery, punch excision is performed as part of a customized acne scar treatment plan designed to create smoother, more even skin texture.
What Is Punch Excision?
Punch excision is a minor surgical procedure used to remove deep acne scars individually. A small circular surgical instrument called a punch tool is used to carefully remove the scar tissue. The skin is then closed with very fine sutures, allowing the area to heal into a flatter and less noticeable scar.
The procedure essentially converts a deep, sharply indented scar into a small linear scar that is usually much less visible and easier to treat with lasers or resurfacing procedures afterward.
Which Acne Scars Respond Best?
Punch excision works best for:
- Deep ice pick scars
- Narrow boxcar scars
- Isolated deep atrophic scars
- Scars smaller than approximately 3–4 mm
It is usually not ideal for rolling scars or broad shallow depressions, which may respond better to subcision, fillers, or laser resurfacing.
How the Procedure Is Performed
At Kathmandu Clinic of Cosmetic Surgery, punch excision is performed under local anesthesia in a clinical setting.
The procedure generally involves:
- Careful scar mapping and evaluation
- Cleansing and numbing of the skin
- Removal of the scar using a punch instrument matched to the scar size
- Precise closure using microsutures
- Post-procedure wound care instructions
Most sessions take between 30–60 minutes depending on the number of scars treated.
What Makes Punch Excision Different?
Unlike lasers or microneedling that stimulate collagen gradually, punch excision physically removes the scar. This makes it especially useful for scars that are too deep for resurfacing alone.
For many patients, the best outcomes come from combination treatment plans such as:
- Punch excision + fractional CO2 laser
- Punch excision + erbium glass laser
- Punch excision + subcision
- Punch excision + TCA CROSS
- Punch excision + PRP or regenerative treatments
Combination approaches are commonly recommended because acne scars are usually made up of several scar types.
Recovery After Punch Excision
Recovery is usually straightforward.
You may experience:
- Mild redness
- Temporary swelling
- Small stitches for about 5–7 days
- Minor crusting during healing
Most patients can return to normal daily activities quickly, although strenuous exercise and excessive sun exposure should be avoided during early healing.
Over the following months, collagen remodeling continues and the scar gradually becomes flatter and softer.
Are Results Permanent?
Punch excision permanently removes the treated scar tissue. However, it replaces the original scar with a smaller surgical scar. In properly selected patients, this new scar is usually significantly less noticeable and easier to blend with surrounding skin.
Additional laser resurfacing or scar refinement procedures may further improve the final cosmetic outcome.
Is Punch Excision Right for You?
Not every acne scar should be excised. Proper scar assessment is essential before deciding on treatment. At Kathmandu Clinic of Cosmetic Surgery, your scars are evaluated individually to determine whether punch excision, laser resurfacing, subcision, or combination therapy will provide the best improvement.
Factors considered include:
- Scar type
- Skin thickness
- Scar depth
- Skin tone
- Healing tendency
- Previous treatments
Why Choose Kathmandu Clinic of Cosmetic Surgery for Acne Scar Treatment?
Our clinic offers advanced multimodal acne scar treatments tailored for Nepali skin types. We combine surgical scar revision techniques with modern laser technologies and regenerative procedures to achieve natural-looking improvements.
Treatment plans may include:
- Punch excision
- Fractional CO2 laser
- Erbium glass laser
- Subcision
- PRP and growth factor therapy
- TCA CROSS
- RF microneedling
Every acne scar pattern is unique, and personalized treatment planning is essential for optimal results.
Book a Consultation
If you are struggling with deep acne scars that have not improved with creams or routine treatments, punch excision may be an effective option.
Consult the team at Kathmandu Clinic of Cosmetic Surgery to receive a detailed acne scar assessment and customized treatment plan for smoother, healthier-looking skin.
Book a Consultation
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Kathmandu Clinic of Cosmetic Surgery (KCCS)
Kathmandu Clinic of Cosmetic Surgery, led by Dr. Suyog Mainali, is Nepal’s premier destination for advanced skin and laser treatments. Since 2012, we’ve helped thousands of patients achieve their cosmetic goals with cutting-edge technology and a highly skilled team.
