subcision acne scars treatment

Subcision Acne Scars

Release deep tethered scars to restore and elevate your skin.

Subcision is a method to release deep fibrous scar tissue while forming new connective tissue.

subcision procedure for acne scar
Subcision for cheek acne scar

Table of Contents

What Is Subcision Acne Scars treatment?

Subcision acne scars treatment is a surgical technique to break down deep acne scars that are tethered down within the skin layer. Subcision is also known as subcutaneous incision-less surgery. The principle is to break the fibrotic strands of scar tissue through a small puncture through the skin surface.

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.

OUR APPROACH TO ACNE SCARS

subcision acne scars

Subcision acne scars treatment stands as a transformative solution for individuals seeking to address the enduring impact of acne scars on skin texture and confidence. As a minimally invasive procedure, subcision involves the careful insertion of a cannula or small needle beneath the surface of the skin to break up fibrous scar tissue that tethers the scar to deeper layers. By releasing these fibrous bands, subcision effectively lifts and smooths depressed acne scars, promoting the natural regeneration of healthy collagen and elastin fibers. This process encourages the gradual filling of scar indentations, resulting in a visibly improved skin texture and a more even complexion over time.

acne scar removal for rolling scar type
Rolling scars are suitable for subcision

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

Rolling acne scars have sloping edges, and can be superficial or deep. Rolling scars are not to be confused with ice pick and boxcar scars which have different morphology and treatment options.

How does the Subcision Procedure Work?

More than just the mechanical release of the strands of scar tissue, it can also be thought of as a bio-mechanical process. 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. During the short-term, blood prevents reattachment of the scars. Most individuals will notice a small swelling underneath the subcised area. This is due to the small blood clot (haematoma) formation which will gradually subside in a few weeks.

Overtime the healing phase leads to a reorganisation of blood and growth factors are released. By creating an environment for connective tissue reorganization and collagen regeneration, your acne scars will significantly improve.

subcision using nook needle illustration
Subcision method seeks to release the deeply tethered acne scars that lie deeper within the skin

What are the Subcision Methods?

subcision with blunt cannula

Blunt tip cannula

  • Able to cover a wider area of acne scarring
  • Flexible
  • Less traumatic
  • Lower risk of haematoma, swelling or serious bruising
  • Minimal risk of hyperpigmentation
nokor needle for subcision

Needle method

  • For localised tethered scarring
  • Multiple needle insertions required
  • More traumatic
  • High risk of haematoma, swelling or serious bruising
rejuran s acne scars procedure
Subcision procedure involves carefully preparing area(s) to be treated

Subcision Acne Scars treatment is a safe and effective way of treating atrophic acne scars. It is part of the acne scar treatment range that includes TCA CROSS, fillers, surgery, laser and energy-based resurfacing to provide the best acne scar treatment results.

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. Where appropriate, 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. 

Another method of subcision uses the blunt cannula approach. With this method, side effects such as blood clots, bruising and pigmentation are reduced compared to needle subcision.

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.

How Does Blunt Cannula Compare to Needle Subcision?

advantages of blunt cannula over needle
Needle vs.Blunt cannula subcision

When compared to needle subcision, studies show that blunt cannula subcision resulted in greater satisfaction and lesser side effects. As the blunt cannula subcision uses a flexible instrument with a blunt tip, there will be less trauma to the underlying skin. Moreover, with the blunt cannula subcision method, there will be lesser needle entry points to the skin, and therefore lesser trauma and discomfort.

While both needle and blunt cannula leads to similar improvement and recovery rate, the cannula method has shown to have lower rates of bruising, hyperpigmentation, blood clot (haematoma) and nodule formation.

rejuran S
Rejuran S with Subcision

Subcision and Rejuran Scar Treatment

Depending of your scar type and depth, Rejuran Scar treatment may be delivered to the base of the scar to enhance and improve the appearance of your acne scars.

Rejuran S treatment contains the active ingredient, Polynucleotide (PN) that promotes tissue restoration, collagen synthesis and acne scar resurfacing.

Having a higher viscosity compared to Rejuran Healer, the Rejuran S treatment is an excellent complement to your acne scar treatments.

From experience, Dr Ng may recommend Rejuran Scar treatment for deeper scars during your subcision procedure to optimize results. A suitable amount of Rejuran is injected at the base of the scar to act as a scaffold for collagenesis, remodelling and acne scar resurfacing.

Subcision and Dermal Fillers For Acne Scars

Dermal fillers for acne scars can help improve rolling scars, atrophic scars and tethered scars. We use Hyaluronic acid based fillers developed from cross-linking technology. This makes the filler more stable, and lasts longer.

Hyaluronic acid is a commonly found molecule that supports skin architecture and keeps skin hydrated through its water retaining properties.

Combining subcision with fillers (e.g. restylane, profhilo) for selected atrophic acne scars can lead to long lasting results.

dermal fillers after subcision
HA Fillers with subcision

Can subcision 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, fractional resurfacing acne scars treatment such as INFINI , Genius or Pico laser is carried out for maximal efficacy.

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

Subcision acne scars treatment is a well-established method of treating deeply tethered acne scars. A multimodal approach to your unique scar type, scar grade and skin type is customised for each and every single individual at APAX Medical & Aesthetics Clinic. Dr Moses Ng, with more than 15 years of clinical experience, will determine the best subcision acne scars treatment for you.

Frequently Asked Questions About Subcision

Subcision is most effective for treating rolling or boxcar acne scars, which are characterized by broad depressions and shallow edges. It may not be as effective for treating ice pick scars, which are deeper and narrower.

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. 

The procedure is performed under local anesthesia to minimize discomfort. Patients may feel some pressure or a sensation of movement during the procedure, but it should not be painful.

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 7-21 days depending on your healing and skin type. Haematoma (blood clot) under the subcised area may take at least a few weeks to subside.

This varies among individuals, scar location, scar depth and skin type. Generally, subcision sessions spaced about 4-6 weeks apart give the best results. Some patients may see improvement after a single treatment, while others may require multiple sessions spaced several weeks apart for optimal results.

Avoid strenuous activities, alcohol and facials shortly after your treatment. Ice-packs can be applied to reduced the swelling. An antibiotic ointment is prescribed to reduce the risk of infections.

The procedural fee is from $450 onwards.

Yes, subcision is often combined with other acne scar treatments such as laser therapy, microneedling, or dermal fillers to further improve results. Your healthcare provider can recommend a personalized treatment plan based on your unique needs and goals.

Dr Moses Ng dermatologist

Subcision for acne scars

Renowned for its efficacy in treating rolling and deep tethered acne scars, subcision offers a versatile solution for individuals with varying degrees of scar severity. With its minimal downtime and low risk of adverse effects, subcision presents a safe and well-tolerated option for individuals seeking significant and long-lasting improvement in their acne scar appearance. Through personalized consultation and expert guidance, we collaborate with patients to develop tailored treatment plans that align with their unique skin concerns and aesthetic goals.

schedule a consultation for subcision in singapore

We treat a range of acne and acne scars at both our clinics in Woodlands and Kovan. Contact us today to schedule a consultation, so Dr. Ng can develop a personalized treatment approach for resolving your skin concerns and helping you to achieve long-term improvements in the health and appearance of your skin.

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Or give us a call at +65 6769 6007 | WhatsApp us +65 9855 3022

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.
  3. Chandrashekar, Bs, and As Nandini. “Acne scar subcision.” Journal of cutaneous and aesthetic surgery vol. 3,2 (2010): 125-6. 
  4. Ahramiyanpour N, Rastaghi F, Parvar SY, Sisakht AK, Hosseini SA, Amani M. Subcision in acne scarring: a review of clinical trials. Journal of Cosmetic Dermatology. 2023 Mar;22(3):744-51.