Q: Dr. Eppley, I suffered from severe cystic acne when I was younger that left pitting in concentrated areas on my cheeks. I’ve tried $15,000 of laser surgeries, dermabrasions, retinal products, and punch excision (the punch excision left the pits even bigger) and nothing has worked. The dermatologists won’t try punch grafts, because they do not believe my skin will heal properly with the small punch grafts. This may sound silly, but I know that burn victims have large area skin grafts completed, and I know that I would want a skin graft to my cheeks to match the facial skin as closely as possible. I have quite a large forehead, and I’ve read that during forehead reductions they remove the excess skin. I’ve exhausted all other possibilities, and I was wondering if you think it would even be possible for me to have a forehead reduction and use the extra skin as a graft for my cheeks (all in one procedure). I’m sorry if this question sounds absurd, but it doesn’t sound like there is any technology currently available to replace the dermal layer of the skin to help with ice pick scarring. I’ve attached some pictures of the scars on my cheeks as well as my forehead to show how much extra skin it might have. Please let me know what you think.
A: What you are suggesting for your acne scars is far from absurd, it is actually extremely insightful. It is known as ‘recycling’ in plastic surgery….using the discarded tissue from one area to augment/graft another area. This would certainly be the best tissue to use for punch grafting to the cheeks. Most of the time the punch graft harvest site comes from behind the ear where the skin is actually thinner and lighter. Forehead skin is a bit thicker than cheek skin but at least it is closer in color.
As you have learned through all of your treatments is that it is hard to get a pick scar elevated to the surrounding skin. Every treatment you have done made an effort to lower the surrounding tissue to it, which helps, but can never get it down to the right level. So punch grafting is the most biologic approach at this point.
Dr. Barry Eppley