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.
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.
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.
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.
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.
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.
Please click on the following clip for watching a real procedure