Excision and Punch Replacement Graft for Acne Scars

  • In excision, the doctor cuts into the skin to remove the acne scar and then closes the wound with stitches
  • In punch replacement grafting, the doctor uses a round sharp tool matched to the size of the scar to remove it. A skin graft, usually taken from behind the ear, is used to fill the wound.

Before (top) and after (bottom) 1mm autologous punch grafts.
Photo courtesy of Pear E. Grimes, MD - Los Angeles, California


While no specific risks are associated with excision and punch replacement grafting, patients should be aware that the procedure leaves behind scars that are much smaller and lighter than the original.


Patients with deep "icepick" acne scarring are good candidates for excision and punch replacement grafting. These treatments can sometimes be combined with laser resurfacing.

Estimated cost

Excision and punch replacement grafting acne treatment can range from several hundred to several thousand dollars depending on the extent of treatment. Since most medical insurance companies consider excision and punch replacement grafting for acne scarring a cosmetic procedure, it is generally not covered.

Preparing for the procedure

  • Thoroughly discuss medical history and expectations with the doctor. 
  • Arrive to the appointment with a makeup-free face. 

What to expect after the procedure

  • Patients may not see immediate improvement.
  • Wounds must be cleansed, and bandages changed daily. 
  • Some bruising may occur for the first one to two weeks.