subcision procedure for acne scar
Image from DermNetNZ.org

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, laser and energy-based resurfacing to provide the best acne scar treatment results.

Subcision Acne Scars

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.

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

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.

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. It can be thought of as an 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. The blood is useful to prevent short-term 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. This creates an environment for connective tissue and collagen regeneration and further dermal reorganisation. 

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 and rejuran

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.

dermal fillers after subcision

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 for selected atrophic acne scars can lead to long lasting results.

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.

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. 

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 2-4 subcision sessions spaced about 4-6 weeks apart give the best results. For the treatment of multiple scars, few scars are treated at a time to avoid severe swelling and allow maximal healing.

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.

Where can I get more information?

  • Dermnet NZ. Subcision. Click here.
  • Medscape. Treatment of Acne Scarring. Click here.
Dr Moses Ng dermatologist

Subcision for acne scars

Acne scar whether new or old can be improved. Subcision for acne scars produces significant improvement over time. By releasing the scars tethering the skin, the natural healing process that follows allows collagen remodelling and skin resurfacing to take place. I use a variety of needles sizes for the various scars, and find the Nokor needle most effective for deeper rolling scars on the cheeks.

Dr. Moses Ng

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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.
  3. Chandrashekar, Bs, and As Nandini. “Acne scar subcision.” Journal of cutaneous and aesthetic surgery vol. 3,2 (2010): 125-6. doi:10.4103/0974-2077.69029