skin subcision before

THE MAGIC OF ACNE SCAR TREATMENT WITH SUBCISION IN 2024

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What is scar subcision?

Scar subcision is a special type of acne treatment that is best suited for those who have very deep “rolling” acne scars. Basically, after the injection of some local anesthetic, a needle is inserted under the scarred area and moved back and forth, breaking up the scar tissue. This releases the overlying skin and generally decreases the depth of the scar depressions.

atrophic scar treatment before and after
acne scar treatment

Subcision vs Microneedling

It is a simple procedure, the main disadvantage being that the procedure must be repeated multiple times under each of the depressed areas that is being targeted. Scar subcision does work on “ice pick” type scars, however for these “rolling” scar depressions it is an ideal treatment.

Most people notice significant improvement; however those who experience the best results are probably those who combine this procedure with another treatment modality such as micro needling. 

acne scar types
acne scar types

Technique

Both subcision and microneedling improve the appearance of scars by creating wounds in an effort to break up scar tissue and trigger collagen regrowth. Microneedling involves the use of a microneedling pen with several small needles that glide across the skin at different depths and speeds. Subcision is achieved with one larger gauge needle that is injected into scars at different angles and depths to break up scar tissue.

The mechanism of subcising deeper scar tissue also seems to be more effective than that of microneedling. It often takes fewer subcision treatments than microneedling treatments to achieve comparable improvement of depressed scars. Microneedling needles are limited to penetrating at best 2.5 mm beneath the skin surface, while subcision allows the freedom to penetrate deeper into the dermis to reach deeper dermal scars. This treatment also creates larger channels within the scar tissue, which create more space for collagen regrowth, while microneedling does not.

This technique  is an excellent treatment for rolling or boxcar-type acne scars, which often have fibrous attachments holding the base of the scar down to the underlying deeper tissue. After the surrounding skin is anaesthetised, a small needle is carefully inserted under the skin to sever and release these attachments beneath the scar.

During the healing process, collagen remodelling occurs and new collagen is laid down beneath the scar, further improving the smoothness of the skin. Occasionally a filler substance (hyaluronic acid) can also be injected under the scars after the procedure, to make the scar look less visible and to produce further enhancement.

forehead scar treatment before and after
subcision before and after

Side effects

Subcision is the gold standard for treating depressed scars. When doing this procedure, the area needs to be marked and then anesthetized.The numbing is often the most difficult part as it is uncomfortable. Postoperatively bruising is the most common side effect.

Also, the insertion site of the needle or blade used to perform the subcision may create a scar in itself which will resolve after few weeks.lumpiness and  redness may occur over the  area that may be due to hematoma or hard fibrous scar tissue which forms after any skin trauma but as more elastin cells form  skin will soften and the lump will flaten out.

subcision with filler before and after
subcision with filler

cost

In most cases acne scares need two procedure in one session for example a combination of subcision and micro needling may perform for deep scars and the cost will be individualized for each case.

subcision

subcision reviews

This procedure must be done only by trained doctors. It requires a lot of training to master this technique. Patients are advised to avoid anti-inflammatory medications, blood thinning medications (that can cause bruising after the treatment) and naturopathic treatments a week before and after the procedure.

Subcision with the Cannula appears to be a safe method with high efficacy in the treatment and high satisfaction in patients as we observed an interesting cure rate (more than 50% after 2 sessions). It demonstrates to be a safe procedure because it performed by single perforation in each side instead of multiple perforations that helps to reduce the patients’ pain and risk of scars. In other hand Cannula-based Subcision needs considerable fewer sessions of surgery and also less recovery time.

Subcision Recovery Time

There is some minor downtime associated with this treatment, and patients are advised to avoid strenuous activities for 48 hours following the procedure. Side effects may include bruising and swelling on the treatment area.

The results are permanent and are usually noticeable after 2-3 treatments, but this may vary from patient to patient.  Treatment may also be combined with micro needling, Fractional CO2 laser or PRP (platelet rich plasma) therapy for optimum results.

subcision with filler

Injecting acne scars and nasolabial or marionette lines with fillers or person’s own fat can be a very satisfying procedure with relatively minimal downtime. However, because scars and skin septae may tether down the skin, some of these indented scars cannot be smoothed out with filler alone.

Benefits of filler

Because the center portion of the indented acne scar is tethered down with collagen fibers, the filler tends to extrude around the tethered area to create a “doughnut effect.” In other words, the indentation barely improves, and the edges of the acne scar become filled and rise up higher, worsening the overall appearance.

In these cases, some subcision is helpful in untethering the collagen fibers to allow the filler to lift up the central portion of the indented scar. Without subcision, the filler does not have enough “hydraulic” pressure to push out the indentation.  This technique allows patients to experience the benefits of therapy with relatively little recovery time.

subcision
Summary
Acne Scar Subcision
Article Name
Acne Scar Subcision
Description
Scar subcision is a special type of acne treatment that is best suited for those who have very deep "rolling" acne scars.
Author
Publisher Name
Niayesh Beauty Clinic
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Comments

20 responses to “THE MAGIC OF ACNE SCAR TREATMENT WITH SUBCISION IN 2024”

  1. Hello In the case of slightly indented scarring or atrophic scarring, in expert hands which treatment is better to smooth out/ blend in a scar which is slightly atrophic? Ultrapulse co2 or subcision? There is so much conflicting scientific information and it seems some experts prefer co2 laser while others prefer subcision. I am specifically concerned with treatment of a slightly indented scar.

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    1. Thank you for your question
      Both Subcision and CO2 lasers are powerful treatments that can effectively address atrophic scars and improve skin texture. The choice between the two depends on various factors, including the specific characteristics of your scar, your skin type, and your individual preferences.
      Having said that,Subcision promote collagen production in subcutaneous layers making it a suitable choice for addressing more severe scars and skin irregularities.
      On the other hand, CO2 lasers promote collagen remodeling and skin tightening, leading to a smoother and more even skin texture.
      In my experience, combination approach with both lasers as well as Subcision have synergistic effects and better outcome.
      Best of luck

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  2. Hi, I had a subcision for my acne scars it didn’t take long at all. No pain in where the subcision sites are but there is an intensive amount of pain in my teeth and when chewing. The pain in my teeth increased when laying down and sleeping as well. No actual pain within the puncture only bruising and soreness. What could that be?

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    1. Thank you for your question
      Having tooth pain after subcision sounds highly unusual. Unless your doctor did something unusual perhaps a dental block for local anesthesia and hitting the nerve root.
      Nerve injury is very rare and self-limited with conservative measures.
      Having said that,the procedure itself should not cause pain it was your teeth. This may be coincidence and I suggest you get a dental check up. Especially if it’s just one tooth that is causing pain.
      Best wishes

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  3. Hello , My scars are shallow rolling scars and tethered scar but with movement my skin fold in the scars and create me crease and line , its like the scars is pulled down with movement ?
    so im wondering if multiple sessions of microneedling by itself without subcision can have the same effect as subcision for that type of scars if the scars are shallow ?

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    1. Thank you for your question
      While microneedling is remarkably effective for treatment of superficial scars, fine lines, and crease, subcision tends to be more effective for the treatment of deeper scars such as atrophic and rolling scars.
      However,in my experience combining both modalities has a synergistic effect on the atrophic scars while remaining inexpensive and highly efficacious.
      Best of luck

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  4. Hi! I’m thinking about either getting subcision or punch excision for acne scars on both of my cheeks I have done micro needling with a little results and I am afraid to get CO2 laser because of the color of my skin and the risk that comes with that, also not sure I would see results I’m looking with a laser rather than subcision or a punch excision.

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    1. Thank you for your question
      IMHO Punch excision of acne scars especially areas under static tension or subject to much movement such as cheeks or chin often result in the development of stretch scars and even in the appearance of stitch related “track track” scars.
      Having said that, I would suggest a combination treatment with Subsision, and Mico needling rather than punch excision.
      Best of luck

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  5. enthusiast2000 Avatar
    enthusiast2000

    Hi,I’m a 29 year old female who has always had visible pores. I would love to get either subcision or laser treatment to minimise the pores and also improve the skin texture and smoothness overall, ideally a very long lasting treatment rather then e.g., a monthly one, what’s the best choice for me? Thanks

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    1. Thank you for your question
      Subcision works well for deep atrophic/rolling rather than superficial scars and pores.
      Having said that,you will likely not find anything long-lasting. Using retinoids daily will improve their appearance eventually. You may additionally benefit from minimally invasive lasers and microneedling but these all should be repeated.
      Best of luck

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  6. Hi, I’m a 29 year old female who had subcision and fraxel laser done for my acne scars almost 2 months ago with no results whatsoever. My dermatologist recommends now subcision and Microneedling. What are the chances of having some improvement with this new laser if I had none with the previous one?thanks

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    1. Thank you for your question
      There are many different treatments for acne scarring, some more effective than others. The treatment(s) used typically depends on the type of acne scarring being treated. In my opinion lasers are overrated for acne scarring and Subcision gives best results for atrophic scars however,most types of acne scars can be corrected with Micro needling , injectable fillers, and Nanofat injection.
      Best wishes

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  7. Ive been suffering with acne scarring for 10 years now. Ive done numerous co2 laser, I have seen result but still lot of scarring. Im think thinking about subcision but scared of pain and edema.what’s your suggestion?thanks

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    1. Thank you for your question
      Since Co2 laser is best for treating superficial, surface texture and color irregularities and is not useful, as you found out the hard way, as a monotherapy for deeper acne scars.C02 laser runs the risk, especially in skin of color, for the post treatment development of pigmentary (both hyper or hypopigmentation) problems that can be long-standing.
      Subcision, on the other hand, is a treatment technique for elevating and smoothing boxcar and rolling scars, that has a proven safety and efficay record overall and in SOC.
      I use cannulla for Subcision to reduce risk of vascular damage and hematoma because of its blunt tip.
      Having said that, most patients hadn’t have bruise or seroma after the procedure with little edema that subsides 48 hours later.
      Most patients tolerate pain with local anesthesia as well as Nerve block and sometimes IV sedation.
      Best of luck

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  8. F.Sebban Avatar
    F.Sebban

    Hi, I am a 32 year old female. I have been acne prone skin for years and have recently done microneedling for scarring treatment. This session broke me out badly and I have been recovering. I would like to know if subcision is a better option?

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    1. Thank you for your question
      I personally like to use a combination of both treatments. Microneedling and Subcision can be done simultaneously.
      I will typically do three sessions over a 3-4 month course. This can help with scar tissue remodeling and lightening of the scar tissue as well as addressing Rolling/Atrophic scars.
      Best wishes

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  9. Hi doc, I went for subcision for atropic acne scars 3 weeks ago, after swelling settle down , i have noticed hard lumps on my cheeks.I’m very concerned about these lumps. please advise me what is this? thank you

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    1. Thank you for your question.

      It is not uncommon to develop subcutaneous nodules after Nokor Subcision. It’s because of hematoma formation and subsequent scar tissue formation.
      These generally appear a couple of weeks after treatment and typically resolve of their own.If persist then intralesional corticosteroid would resolve them completely.
      However, in my practice with blunt tipped cannula, I have never encoutered such complications and after over 10000 subcision I never seen such nodules.
      Best of luck

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  10. I just had fractional Co2 laser for my face scars and I’d like to continue with subcision. How often I should be getting these done and how many sessions I need for best results?
    Thank you Dr

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    1. Thank you for your question.In my practice best approach for acne scar treatment is combination technique ;skin resurfacing with Subcision in multiple sessions.
      Ideally 4 to 6 weeks interval between treatments is enough for skin repairing and recovery.
      Depending on the depth and extent of scars multiple treatments should be done.However, on average 2 to 3 sessions may be required for optimal results.
      Best wishes

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