Concurrent use of laser skin resurfacing and punch excision in the treatment of facial acne scarring

BACKGROUND. Laser skin resurfacing has added to the numerous treatment options available for acne scarring. Adjunct modalities such as punch excision should be considered to enhance treatment outcomes. Traditionally, punch excision and grafting have been performed, followed 1-2 months later by dermabra sion. OBJECTIVE. TO determine the effectiveness of laser skin resurfacing and the concurrent use of punch excision performed at the same treatment session in the treatment of acne scarring. METHODS. Twenty-one patients with skin types I-III with mild to severe facial acne scarring were treated with a combination of laser skin resurfacing and punch excision of acne scars in the same treatment session. Baseline, postoperative, and follow-up photographs were taken and evaluated by an independent dermatologist and a laser nurse blinded to patient treatment. In addition, subjective patient assessments of improvement were obtained. RESULTS. There was a range of clinical improvement by the independent assessor of 25-50% in skin type I, 50-75% in skin type II and 50-75% in skin type III. There was a patient subjective improvement of 25-50% for skin type I, 50-75% for skin type II and 75-100% for skin type III. Postoperative hy perpigmentation teas noted in five patients and postoperative hypopigmentation was not seen in any patients. There was no wound dehiscence, evidence of infection, or hypertrophic scarring of treated areas noted on follow-up. CONCLUSION. Laser skin resurfacing with the concurrent use of punch excision improves facial acne scarring. This newly described method negates the need to delay additional resurfacing for a future visit. (C) 1998 by the American Society for Dermatologic Surgery, Inc.