subcision procedure for acne scar
Image from DermNetNZ.org

Subcision Acne Scars - What is it?

Subcision acne scars treatment is a surgical technique to break down certain skin scars that are tethered down within the skin layer. Subcision is also known as subcutaneous incisionless surgery, but this is a misnomer as the scar tissues are located in the dermal layer of the skin.

Subcision acne scars treatment is performed as an office based procedure. Deep scars are released by introducing a special needle to manually break down scar tissue that are anchoring the skin downwards. In addition, the healing phase that follows subcision stimulates collagen growth, repair and improvement of the scar appearance over time.

acne scar removal for rolling scar type

What type of scars are suitable for subcision?

We take into account your scar type, scar depth, skin type and downtime involved. Subcision for acne scars is an excellent option for the following types of scars:

  • Rolling acne scars
  • Chickenpox scars
  • Stretchable scars from injury or surgery
  • Deep wrinkles

Who is not suitable for Subcision?

Subcision is not performed in individuals with active skin infection, and in individuals who are prone to abnormal skin scarring such as hypertrophic and keloidal scars. If you are on blood thinners, or have a bleeding disorder this increases the risk of bleeding during and after procedure, therefore a consultation is needed to weigh the risk versus benefits of the procedure. In addition, if you have been on oral retinoids for the last 12 months, this procedure may not be suitable as risk of poor wound healing is significantly increased.

needles for subcision acne scars
Subcision using nokor 18G needle
18G Nokor Needle

How is Subcision acne scars procedure performed?

This office based procedure is performed under local anaesthesia and is well tolerated. Your skin is first cleansed of any impurities, and the scars are mapped out with a surgical pen. Local anaesthesia is injected to numb the skin.

We use a variety of needles catered to the scar type. Typically, we use either a hypodermic 18-23G needle, or a 18G Nokor needle. The Nokor needle is a  tribevelled needle designed specifically for subcision. Upon insertion, the needle is directed to break the bands of scar tissue beneath the skin. You may feeling the 'plucking' sensation as the needles breaks away the scar tissue tethering the skin downwards. 

Once the procedure is complete, pressure is applied to reduce bleeding and swelling. A topical antibiotic ointment is applied to prevent infection and encourage healing.

subcision using nook needle illustration

How does Subcision Acne Scar Procedure Work?

The subcision acne scar procedure is more than just the mechanical release of the strands of scar tissue. Multiple biological processes are thought to occur to bring about acne scar improvement.

The mechanical action of the needle and release of the scar tissue creates a pocket beneath the skin. Blood vessels which are disrupted during the process, allows blood to accumulate into the treated area. The blood is useful to prevent short-term reattachment of the scars.

Overtime the healing phase leads to a reorganisation of blood and growth factors are released. This creates an environment for connective tissue and collagen regeneration and further reorganisation. 

How long does it take to recover from subcision?

Immediately after the procedure, there will be some redness and swelling that lasts 2-3 days. Pain is minimal post-procedure. Bruising is common after the procedure and will fade in 7-10 days depending on your healing and skin type. 

How many sessions do I need?

This varies among individuals, location, scar depth and skin type. Generally 2-4 subcision sessions spaced about 4 weeks apart give the best results.

acne scar removal singapore

How much improvement can I see?

The majority of individuals improve in their acne severity by 1-2 grades after 6 months post-procedure. There will be continued scar remodelling 3-6 months after the subcision for acne scars procedure.

Can subcision for acne scars be combined with other procedures?

Mixed acne scarring is the most common form of acne scars. We usually perform subcision with TCA CROSS for ice pick and deep atrophic acne scars at the same time.

Once the deeper scars have satisfactorily improved, we resurface the entire face with INFINI, which is based on advanced fractional resurfacing technology.

The Acne Scar Removal Program integrates specific treatments to the different scar types to give the most optimal results. 

Where can I get more information?

  • Dermnet NZ. Subcision. Click here.
  • Medscape. Treatment of Acne Scarring. Click here.

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Related Information:

References:

  1. Orentreich DS1, Orentreich N. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg. 1995 Jun;21(6):543-9.
  2. Al-Khenaizan S. Nokor needle marking: a simple method to maintain orientation during subcision. J Drugs Dermatol. 2007;6:343–4.