Subcision for Acne Scars

If you have significant boxcar or rolling scars, you have to fill the missing volume — and lasers, radio frequency, or ultrasound devices alone might not be able to achieve that. Subcision for acne scars remains one of the most classic procedures for scar revision. This treatment method is often a more helpful option compared to microneedling and lasers, especially for tethered, rolling, anchored, and bound-down acne scars.

Dr Gerard Ee
MBBS (UK), MRCS (Edinburgh), DP Dermatology (Cardiff)

What is Subcision?

Subcision is a minimally invasive surgical procedure designed to treat depressed or atrophic acne scars. These scars form when the skin’s underlying support structure is damaged, leading to indentations on the skin’s surface. Subcision helps release the tethered scar tissue, stimulating collagen production and improving the appearance of these indentations. It is a safe and widely recommended treatment for improving skin texture and reducing the appearance of acne scars.

How Subcision Works

The principle of subcision involves using a hypodermic needle to break the fibrotic strands that tether the scar to the underlying subcutaneous tissue. These fibrotic strands pull the skin downwards, creating the depressed appearance of the scar. By releasing these strands, the depression is lifted, and the skin’s natural healing process is stimulated.

This wound-healing process leads to new collagen deposition, which gradually fills in the depressed area and improves the scar’s appearance. Subcision is particularly helpful for rolling and boxcar acne scars, which are characterised by this type of tethering.

In some cases, where the treated area issmall, the blood clot formed may not be large enough to prevent the untethered skin from healing. As such, your doctor may inject fillers or collagen stimulatorsto further enhance the results. These injectables provide additional support and volume, reducing the risk of the scar re-attaching to the underlying tissue.

Types of Acne Scars Suitable for Subcision:

  • Rolling Scars: These scars have gentle, rolling edges and create a wave-like appearance on the skin.
  • Boxcar Scars: These scars have sharper edges and a more defined, “box-like” shape.
  • Pitted or Depressed Scars: These are generally indented scars, regardless of their specific shape.
  • Deep Wrinkles: Subcision can also be used to improve the appearance of deep wrinkles and lines.

Subcision Acne Scar Treatment Experience

During the subcision procedure, a local anaesthetic is applied to numb the treatment area. A fine hypodermic needle is then inserted beneath the skin, below the acne scar tissue. The doctor will manoeuvre the needle in a fan-like motion to release the tethered scar tissue.

You may hear a snapping sound as the fibrous bands are broken, but this is common and nothing to be concerned about. The procedure typically takes no longer than 20 minutes and involves minimal discomfort.

Following the procedure, you may experience some swelling and bruising, which will subside within a few days. The doctor will provide detailed aftercare instructions to ensure optimal healing and results.

Combining Subcision with Other Treatments

While subcision may help treat deeper acne scars, it may not address surface-level irregularities, pigmentation changes, or volume loss on its own. To optimise the results, the doctor may recommend combining subcision with other acne scar treatments.

By combining treatments, the doctor can suggest a comprehensive approach that targets different aspects of scar improvement. This recommended treatment plan will depend on your specific scar type, skin condition, and treatment goals.

Fractional CO2 Lasers: These lasers create microscopic columns of thermal injury in the skin, stimulating collagen remodelling and improving skin texture and tone. When combined with subcision, fractional CO2 lasers can enhance the overall improvement of depressed acne scars. The subcision releases the tethered scar, while the laser stimulates collagen production and resurfaces the skin, leading to a smoother, more even appearance. This combination is particularly helpful for treating rolling scars and boxcar scars.

TCA Cross: This approach involves the precise application of trichloroacetic acid (TCA) to the base of individual scars. The TCA creates a controlled chemical injury, stimulating collagen production and lifting the depressed acne scar. Combining subcision with TCA Cross treatment in Singapore can help treat ice-pick scars and boxcar scars. The subcision releases the tethered scar, while the TCA Cross stimulates focused collagen remodelling at the base of the scar, promoting a more even skin surface.

Dermal Fillers: Dermal fillers are injectable gels that add volume and support to the skin. When used in conjunction with subcision, fillers can help maintain the lifted position of the acne scar and prevent re-tethering. This combination is particularly helpful for deeper scars or those prone to re-attachment. The subcision releases the acne scar, while the filler provides structural support and volume, leading to a smoother, more contoured appearance.

Learn More About Dr Gerard Ee

MBBS (UK), MRCS (Edinburgh), DP Dermatology (Cardiff)

Dr Gerard Ee is a medical aesthetic doctor specialising in treating acne and acne scar removal in Singapore. He earned his medical degree (MBBS) from St George’s University of London. He pursued further training and became a member of the Royal College of Surgeons (MRCS) in Edinburgh.

  • Acne and Acne Scar Treatment
  • Medical Aesthetics
  • Skin Rejuvenation

Dr Gerard Ee believes in building strong relationships with individuals based on trust and open communication. He takes the time to understand their concerns and goals, creating personalised treatment plans tailored to their specific needs. He is committed to providing a comfortable and supportive environment where patients feel empowered to make informed decisions about their skin health.

Frequently Asked Questions About Subcision

Subcision is generally a safe procedure with minimal risks when performed by a licensed medical professional like Dr Gerard Ee. However, some of the common side effects include:

  • Bruising and swelling: These are the most common side effects and typically subside within a week.
  • Tenderness: You may experience some tenderness in the treated area for a few days.

While rare, potential complications can include:

  • Infection: The doctor will take precautions to minimise the risk of infection.
  • Hyperpigmentation or hypopigmentation: Temporary changes in skin pigmentation can occur but usually resolve over time.
  • Nerve injury: Nerve injury is rare and usually temporary.

The doctor will discuss the potential risks and side effects in detail during your consultation and take all necessary precautions to ensure your safety and comfort.

You may notice some improvement in the appearance of your acne scars within a few weeks of subcision treatment as the skin begins to heal and collagen production is stimulated. However, optimal results typically take 2-6 months to become fully apparent, as collagen remodelling is a gradual process.

For patients with deeper or more severe scars, multiple subcision sessions may be required to achieve the desired results. The doctor will assess your individual needs and recommend an appropriate treatment plan.

Subcision typically involves minimal downtime. You can return to your daily activities within a day or two. Mild bruising and swelling are common side effects and usually subside within 5-7 days.

The doctor will provide you with post-care instructions to optimise healing and results. These may include:

  • Avoiding makeup for at least 24 hours after the procedure.
  • Protecting your skin from sun exposure.
  • Applying prescribed topical medications.

While subcision can improve the appearance of acne scars, it may not completely remove them in all cases. The degree of improvement depends on the type and severity of your scars, as well as your individual skin characteristics.

In some cases, the doctor may recommend combining subcision with other treatments, such as lasers or fillers, to further enhance your results. During your consultation, he will discuss the expectations and suggest a personalised treatment plan to help you achieve your desired outcome.