Historically, surgical correction for smallpox scars was extremely limited and primitive. Before eradication, the pitted scars were largely considered a permanent, untreatable consequence of survival. While the concept of skin grafting existed in the 19th and early 20th centuries, these procedures were rarely used for cosmetic smallpox scarring due to the high risk of infection, poor graft survival, and the significant discomfort for what was viewed as a non-life-threatening condition. The techniques were crude, often involving punching out scarred tissue and replacing it with small plugs of healthy skin, which could itself result in a blotchy appearance. It was only in the latter half of the 20th century, around the time of smallpox's eradication, that more refined techniques like dermabrasion (sanding the skin) began to emerge. Today, survivors with lasting scars have access to much more advanced treatments like fractional laser therapy, which were developed long after the disease was eliminated and were never part of the historical medical response to smallpox itself.