How Does Subcision Work?

During subcision, a small, fine needle (usually a tri-beveled hypodermic needle) is inserted just under the scar through a tiny puncture in the skin. The needle is carefully maneuvered to break the fibrous bands, tethering the scar to deeper layers of the skin. By disrupting these bands, the skin is freed from being pulled downward, allowing it to lift and flatten over time.

The body’s natural healing response then kicks in, promoting new collagen formation. This collagen helps fill the indented scar, resulting in a smoother appearance. To enhance results, subcision is sometimes combined with other treatments, such as dermal fillers, laser therapy, or microneedling.

Types of Acne Scars Best Treated with Subcision

Subcision is particularly effective for certain types of acne scars, including:

• Rolling Scars: These scars have a wave-like, undulating appearance and are typically shallow. They form due to fibrous bands pulling down on the skin from beneath the surface.
• Boxcar Scars: These are wider and have sharply defined edges, resembling craters or pits. Subcision can help release the tethering beneath these scars.

It is less effective for ice-pick scars, which are narrow, deep, and resemble enlarged pores. Ice pick scars typically require different treatments, such as punch excision or laser resurfacing.

What Are the Benefits of Subcision for Acne Scars?

Subcision offers several benefits for those struggling with acne scars:

• Minimally Invasive: Subcision is performed with a small needle and does not require extensive surgery or major incisions.
• Effective for Depressed Scars: It directly targets the cause of rolling and boxcar scars by releasing the fibrous bands beneath the skin.
• Natural Collagen Production: By stimulating the body’s natural collagen production, subcision promotes gradual scar improvement.
• Can Be Combined with Other Treatments: To maximize results, subcision is often paired with other acne scar treatments like laser resurfacing, dermal fillers, or microneedling.
• Minimal Downtime: Recovery time is generally short, with most patients returning to normal activities within a few days.
• Long-Lasting Results: Once the fibrous bands are broken, they do not reattach, meaning the results are permanent, though the skin’s appearance will continue to improve as new collagen forms.

Who is a Good Candidate for Subcision?

Good candidates for subcision include individuals who:

• Have depressed or tethered acne scars like rolling or boxcar scars.
• Have good skin elasticity that allows for proper healing.
• Are in good overall health and have no active acne or infections in the treatment area.
• Looking for a minimally invasive procedure to improve the appearance of acne scars.
• Have realistic expectations about the outcome of the procedure.

Subcision may not be suitable for those with raised (hypertrophic) scars or keloid scars, as these types of scars require different treatments. A consultation with a dermatologist is necessary to determine if a subcision is the right choice for your skin type and specific scars.

The Subcision Procedure

• Consultation
  • Before subcision, you will meet with a dermatologist to evaluate your acne scars and discuss your treatment goals. The dermatologist will examine your scars to ensure they are suitable for subcision and may recommend complementary treatments for optimal results.
• Preparation
  • On the day of the procedure, the area to be treated will be cleansed, and a local anesthetic will be applied to numb the skin. This ensures that you remain comfortable throughout the treatment.
• The Procedure
  • Once the area is numb, the dermatologist inserts a small needle just below the skin’s surface through a tiny puncture. The needle is moved fan-like to break the fibrous scar tissue tethering the skin. The procedure typically takes about 20-45 minutes, depending on the size and number of scars.

Aftercare and Recovery

After subcision, the treated area may experience mild swelling, bruising, or tenderness. These effects are normal and usually subside within a week. Your dermatologist may advise you to:

• Apply cold compresses to reduce swelling.
• Avoid strenuous activities and exercise for 1-2 days.
• Keep the treated area clean and avoid excessive sun exposure.
• Use topical ointments or prescribed medications to aid healing.

The downtime is minimal; most patients can resume regular activities within 2-3 days.

Expected Results from Subcision

Results from subcision are not always immediate but gradually improve as the skin heals and produces new collagen. Patients can expect noticeable improvements in the texture and appearance of their skin within a few weeks to months. Multiple treatments (typically 2-4 sessions) may be necessary to achieve optimal results, depending on the severity of the scars.

Before and After Subcision

The results from the subcision are generally long-lasting, particularly when combined with complementary treatments like fillers or laser therapy.

• Before: Indented, tethered scars are visible, causing uneven skin texture.
• After: The skin appears smoother, and the scars are lifted due to the release of fibrous bands and collagen production.

Combining Subcision with Other Treatments

Subcision can be enhanced by combining it with other acne scar treatments. Common complementary treatments include:

• Dermal Fillers: Fillers can be injected into the treated area after subcision to provide immediate volume and lift, filling in the scar while collagen builds over time.
• Microneedling: Microneedling stimulates further collagen production, enhancing the effects of subcision.
• Laser Resurfacing: Fractional lasers or other techniques can help smooth the skin’s surface, complementing the deep scar improvement achieved by subcision.

Contact Us Today

St. Louis Dermatology & Cosmetic Surgery is committed to providing exceptional care and personalized treatment plans to help you achieve your skincare goals. Whether you’re interested in a consultation for a cosmetic procedure, have questions about your skin health, or need more information about any of our services, we are here to assist you.