Subcision for Acne Scars

If you have a significant boxcar or rolling scar, you have to fill what’s missing — volume — and there is not a single laser, radio frequency, or ultrasound device that will bring that back. Subcision for acne scars remains as one of the most classic procedure for scar revision. This treatment method is often a more effective option compared to microneedling and lasers, especially for tethered, rolling, anchored and bound down acne scars.

Procedure of subcision

The principle of this procedure is to break the fibrotic strands, which tether the scar to the underlying subcutaneous tissue, using a hypodermic needle. The depression is lifted through the release of the fibrotic strands and new collagen deposition caused by wound healing leads to visible improvement of the acne scar appearances. The subcision technique works best for rolling acne scars and boxcar acne scars – essentially scars with certain forms of tethering. This tethering needs to be broken down horizontally, and not vertically. Lasers, derma rollers, micro needling all work on a vertical axis, while subcision works on a horizontal axis, cutting the fibrotic strands that pull down on your skin. In certain cases where the subcised area is very small, the blood clot formed may not be large enough to prevent the untethered skin from healing back into the depression. We may, in this case, inject fillers or collagen stimulators in a void under the scar to give the body the chance to stimulate the production of new collagen and reduce the re-adhesion risk post procedure.

Types of Scars Suitable for Subcision:

  • Rolling Scars
  • Boxcar Scars
  • Pitted or depressed scars
  • Deep Wrinkles

With your face numbed by local anesthetic, a hypodermic needle is inserted underneath the skin, below the scar tissue, and run from side to side in a fan-like motion, beneath the surface of the skin. This breaks the connective tissue holding the scar to the undamaged skin below, encouraging the skin to regenerate, and eventually promote new collagen growth, which lifts that depression in the skin causing the scar. A snapping sound is heard as the fibrous bands are broken. The procedure takes no longer than 20 minutes and has minimal discomfort associated with it.

The side effects of swelling, bruising, and pain are transient and will subside within 2-3 days after the procedure.

Definitely! The collagen stimulatory effects from subcision and Fractional CO2 Lasers are synergistic and will work well when done together. They can be done in a single session for maximum efficacy. Multiple studies have shown that subcision prior to the CO2 laser procedure showed excellent response when compared to CO2 laser alone.

Patients struggling with deep acne scars are great be candidates for treatments with subcision and  TCA Cross Technique. The TCA Cross Technique relies on trichloroacetic acid to stimulate collagen production. However, unlike a TCA peel which is meant to resurface a larger treatment area, the Cross Technique is used for targeted spot treatment. Precise amounts of the acid are applied to the base of the scar, causing micro damage and stimulating he body’s natural healing processes. This works hand in hand with subcision. Several treatments may be needed to achieve optimal outcomes, with each successive procedure stimulating more tissue growth, thus raising the scar.

This method would be most ideal when doing subcision. With subcision, the fibrous scar bands are cut to help soften and elevate a scar.  However, by itself, there may be instances where the indentation may reform due to scar contracture. Hence, filler injections work as an adjunct to prevent the tethers from reattaching and help in permanent acne scar correction.

Though there are few risks involved with subscision, it is nevertheless a specialised procedure and can only be performed by a medical practitioner. Risks of subcision include nerve injury, hematoma and deep scarring.

Our skin will take time to heal. The process of re-collagenation takes 2 to 6 months and during which, the acne scars will progressively fill out and lighten further.