Acne Scarring Subcision Treatment

What is subcision?

Wh Subcision is short for Subcutaneous Incisionless Surgery meaning there is no incision or cutting of the skin. Instead a hypodermic needle or blunt cannula enters the skin via a needle entry point and is then moved backwards and forwards (and sideways if necessary) in the deep dermal plane. 

What is the purpose of subcision?

Subcision is a very effective way to treat certain types of scars. Scars that respond well are rolling acne scars (undulated appearance of skin) and anchored scars (deepens or puckers with animation i.e. smiling). Ice-pick and boxcar scars will improve to a degree but using other modalities i.e. TCA CROSS in conjunction will deliver a superior result. 

How and why does subcision work?

The afore mentioned scars have fibrotic strands which tether the skin/ scar to the underlying subcutaneous tissues- be it fat or the SMAS layer. The needle or blunt cannula cuts through or disrupts these fibrotic strands and the depression/ scar is lifted due to the releasing action of the procedure. The trauma causes some bleeding under the skin which is beneficial in the healing process in a couple of ways, the underlying haematoma prevents the fibrotic strands from reattaching and secondly blood contains many growth factors which stimulate neo-collagenesis as part of the healing cascade. 

PRP or dermal filler can be used concurrently as an alternative spacer. 

Is subcision painful?

Subcision with blunt cannula is less painful than with a sharp needle and most patients can tolerate the procedure without anaesthetic. When we use PRP at the same time, anaesthetic is not recommended as it affects the efficacy of the platelet therapy. 

If we do subcision with a needle or without PRP we will use local anaesthetic to optimise patient comfort.

How long is the recovery process?

Following the procedure there is minimal discomfort and mild swelling only. There is almost invariably a degree of bruising which can take 7-10 days to completely clear. 

How many treatments will I need?

Even though there is an immediate improvement after a single treatment it can take 3-6 treatments for optimal results. Treatments are spaced 3-6 weeks apart. 

Can we combine subcision with other acne scarring treatments?

Yes, combination treatments are often recommended and depending on the extent and type of scarring a patient has we might recommend Radiofrequency micro- needling / chemical peels/ dermal filler/ skinbooster/ biostimulator/ TCA CROSS and fractionated or full field ablative laser. 

Are there any contraindications to treatment?

Patients that are prone to keloid or hypertrophic scarring.

Active infection or inflammation in the area.

Recent (< 3 months) cessation of oral Isotretionoïn therapy.

Pregnancy or breastfeeding mothers.

Caution in patients on blood thinners 

What are the possible complications?

Bruising.

Haematoma formation.

Post inflammatory hyperpigmentation (transient)

Infection

Poor response

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