Why Subcision for Acne Scar Treatment?
Dr. Hazany likens acne scars to potholes in a street. When fixing a pothole, you don’t level the entire road to match the pothole’s depth. Such an approach would involve unnecessary work and leave the street dangerously thin, leading to other complications. Instead, the correct method is to fill the pothole to the level of the surrounding road.
The same principle applies to treating acne scars. Unlike microneedling or laser treatments, subcision elevates depressed or rolling acne scars to the level of your skin’s surface. This is by breaking up the fibrotic tethers holding the scars down with a hypodermic needle. Various needle sizes are used to target scar tissue that resides in all different layers of the skin.
Comparing Subcision vs. Laser Resurfacing
Medical treatments that involve flattening and thinning the skin, such as laser resurfacing and microneedling, are akin to grinding the rest of the street down to the lowered level of the pothole. Despite this disadvantage, laser treatment remains the standard method for many dermatologists to use to improve the texture and appearance of acne scarring. Dr. Hazany does acknowledge the benefits of scar reconstruction lasers, but typically as a touch-up or for raised scars. Thus, for depressed, pitted acne scarring, Dr. Hazany champions the subcision procedure, which voids unnecessary thinning of the skin and produces a healthier, more robust appearance. Additionally, while lasers typically require multiple sessions in order to see results, subcision usually only needs to be performed once.
The Details of Subcision
Subcision is a minor surgical procedure performed within a few hours. The patient is administered a local anesthetic, tumescent anesthesia, as well as anti-anxiety medication to ensure comfort throughout. Then, a hypodermic needle is inserted into the skin and moved side-to-side to untether the scar tissue from the underlying basement layer. This allows areas of atrophic acne scars to lift to the level of normal skin. This form of “controlled trauma” also stimulates collagen production, which provides support underneath the scarred areas.
The subcision procedure can be performed in several layers: superficial-layer, mid-layer, and deep-layer.
- Superficial-layer subcision: A needle is used to infiltrate the skin right below the epidermis.
- Middle-layer subcision: A blunt cannula is used to penetrate deeper into the dermis.
- Deep-layer subcision: A special metal tool is inserted into the deepest layer of the dermis to separate the toughest scars from underlying tissue.
Since middle-layer and deep-layer subcision treatment are more invasive than superficial-layer subcision, an “introducer”-needle is inserted into the skin to create a small opening for the cannula to be inserted.
Guidelines for Healing
After the procedure, it is normal to experience mild soreness in the treated areas for the first 24-48 hours, though this typically resolves within a week. Skin discoloration and blood-tined oozing is also common but does not always occur. It is important to keep the treated sites completely dry and without any cosmetic products for the first 24 hours and avoid touching or picking at them to prevent infection. To reduce swelling and soreness, you may apply a cold, wet cloth to the treated areas in intervals of 10-15 minutes. Often, you may resume normal activities after 48 hours, but you must minimize sun exposure or at least apply a minimum of SPF 50+ sunscreen to treated areas. Finally, after showering, apply a thin layer of Vaseline or petroleum jelly to moisturize the healing sites.
What is the Price of Subcision?
The cost of subcision depends on the number of layers required (superficial, middle, or deep) and the number of areas to be treated. Its long-lasting results mean you won’t need to keep paying for maintenance treatments and compared to laser resurfacing, it eliminates the need for collagen-boosting formulas or dermal fillers to restore skin thickness.
Subcision is a leading procedure for acne scar treatment in Calabasas. We encourage you to contact our scar specialists for more information and to create your personalized treatment plan!
