Subcision Treatments

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The Secrets Behind Subcision Uncovered

If you’re trying to find an effective treatment for persistent acne scars, subcision might offer a solution. This technique specifically targets atrophic (indented) scars by severing the underlying structures that pull on the skin and inducing collagen remodeling. In this article, we’ll explore subcision’s approach to improving skin texture and its role in the landscape of acne scar treatments, with expert insights on what to expect from the procedure.

Icepick Scars

Ice pick scars are characterized as narrow indentations in the skin that usually result from severe cystic or papular acne burrowing deep in the skin. Among the three, ice pick scars are the most severe due to their tiny diameter and depth of penetration. They often appear on the forehead, cheekbones, and nose.

Boxcar Scars

Boxcar scars have sharp defined boundaries with more geometric indentations in the skin.Boxcar scars result from collagen depletion caused by acne breakouts, leaving a visible depression behind on the skin. Boxcars are typically shallower and wider than ice pick scars, and have vertical walls with an even, flat base.

Rolling Scars

Rolling scars develop when fibrous tissue tethers the epidermis to the underlying subcutaneous tissue, creating sloping and wave-like indentations in the skin. Rolling scars are shallow and soft depressions that become more noticeable when skin ages and loses its elasticity. Rolling scars can disappear over time but may require intervention depending on their severity.

Key Takeaways on Subcision

  • Subcision is an effective, minimally invasive dermatological procedure for treating various types of atrophic scars by breaking fibrous scar tethers beneath the skin and promoting collagen production, resulting in smoother skin texture.

  • Types of acne scars like rolling, boxcar, and ice-pick scars respond well to subcision when individually assessed. Combining subcision with other treatments, such as laser therapy or fillers/biostimulators, can significantly boost outcome efficacy and patient satisfaction.

  • The number of subcision sessions varies based on the individual’s scar severity, healing response, and the expertise of the dermatologist. Potential risks and complications are generally minimal and manageable with proper care and technique. Book a consultation at the Scar Healing Institute to learn more.

Types of Acne Scars Suitable for Subcision

Having understood what subcision entails, we can now explore the specific types of acne scars it is equipped to treat. Subcision is effective for treating various types of scars, but certain scar types can benefit more from this treatment than others.

Icepick Scars

Subcision can also treat ice-pick scars, which are deep, narrow, and pitted scars. The type of instrument used for the procedure can influence its effectiveness on ice-pick scars. For instance, using needles in multiple rounds of subcision has been shown to be effective for these types of scars.

It’s important to note that these scar types often occur together. Therefore, a thorough assessment to differentiate scar types is vital in the treatment planning for acne scars. Understanding the type of scars you have can guide the treatment strategy and ultimately lead to more satisfactory results.

Boxcar Scars

Next, we have boxcar scars. These are another form of atrophic scar, characterized by round-to-oval depressions with sharply demarcated vertical edges. They can be shallow or deep, but regardless of their depth, subcision has proven to be effective in improving these scars.

Rolling Scars

Rolling scars, for instance, respond exceptionally well to subcision treatment. These scars, characterized by their wide, undulating appearance, are caused by fibrous connections to deeper tissues, including scar tissue. They make up 15 to 25 percent of atrophic scars and require a focus on their subdermal component due to the tethering effects they exhibit. A liberator subcision, a specific type of subcision procedure, is particularly effective in treating these scars.

To conclude, subcision provides a concrete solution, whether you’re dealing with rolling, boxcar, or ice-pick scars. By targeting the root cause of these scars—the fibrous tethers—subcision can effectively treat these scars and lead to smoother skin.

Understanding Subcision: A Breakthrough Acne Scar Treatment

Known as subcutaneous incisionless surgery, subcision represents a distinctive method to address acne scars, particularly atrophic acne scars. It was first introduced by Orentreich and Orentreich in 1995 as a method to treat depressed scars and wrinkles. Since then, it has gained recognition in the field of cosmetic dermatology for its effectiveness in treating acne scarring.

But it’s not just acne scars that subcision can tackle. If you’re dealing with scars from chickenpox, liposuction, or even general surgery, subcision treatment can be a potential solution. This versatile technique has been in the literature for 30 years and is well-studied, making it a reliable option for acne scar revision.

Subcision operates on a simple concept—it breaks the scar tethers, enabling the skin to “bounce” back to its original position. It also promotes the production of new collagen, a vital component that rejuvenates the skin and contributes to a more even skin texture.

Severe acne scars or depressed acne scars can be particularly challenging to treat. They often manifest as deep pits or have a wave-like appearance, making them prominent on the skin surface. To treat depressed acne scars, subcision proves advantageous in this situation. It facilitates the elevation of these depressed acne scars to provide a smoother skin surface by breaking the fibrous bands that tether these scars to the underlying tissue.

One should also bear in mind that subcision isn’t a universal fix-all procedure. The treatment is tailored to the individual acne scars, their depth, and the patient’s overall skin concerns. This personalized approach is one of the reasons why subcision has gained traction as a potent acne scar treatment.

Moreover, the subcision procedure is a minor surgical procedure that is minimally invasive. The procedure involves small punctures and does not require extensive cuts or stitches. This characteristic makes subcision a convenient option, especially for those who might be apprehensive about undergoing a major surgical procedure for acne scar revision.

To sum up, the subcision for acne treatment signifies a notable breakthrough in the realm of acne scar treatments. With its ability to treat a wide range of scars effectively, it is a promising option for those seeking to improve their skin texture and bid farewell to those pesky acne scars.

The Subcision Procedure at the Scar Healing Institute: Step by Step

Let’s traverse the course of the subcision procedure at the Scar Healing Institute, where our concentration lies in delivering optimal results with detailed attention. From preparation to the procedure itself, we’ll guide you through each step.

Before the subcision procedure, patients should take an antibiotic and stop using all retinols or harsh chemicals three days beforehand. Removal of makeup and shaving (if necessary) a day before the procedure also helps ensure clarity in the treatment areas.

On the day of your appointment, we’ll take professional photos to monitor your progress in our Phase System. We also mark each scar individually to locate every one. This allows us to target each scar precisely during the procedure.

To ensure patient comfort, local anesthesia is administered to numb the treatment area. This could involve infiltrative and/or a large volume of tumescent anesthesia to make the tissue turgid, enhancing the procedure’s safety.

Once the treatment area is numbed, the subcision procedure begins. We start with needles, cannulas, and other small instruments to target your finer scars. Then, with a small puncture made by a scalpel, a specialized subcision probe such as a Liberator is inserted and used in a fan-like motion to release fibrotic bands under the scar. A snapping sound may be heard as the scar is released, signaling the breaking of the fibrous bands tethering the scar to the underlying tissue.

After the fibrotic strands are released, excess blood is squeezed out to prevent hematoma formation, and the small entry area is usually left without suturing. Throughout the procedure, patients lie in an angled position, with special care taken to avoid over-treating any one area.

At the Scar Healing Institute, our aim is to secure patient comfort while yielding effective results. From the initial preparation to the post-procedure care, we’re with you every step of the way.

Benefits of Combining Subcision with Other Treatments

While subcision is a potent procedure by itself, combining it with other treatments can significantly boost its effectiveness. This synergy can lead to higher rates of improvement in the appearance of atrophic post-acne scars, higher patient satisfaction, and improved scar appearance.

Chemical Reconstruction of Skin Scars (CROSS)

One of the treatments that can be combined with subcision is chemical reconstruction of skin scarring (CROSS). When subcision is combined with CROSS, patients have reported higher satisfaction rates compared to those who underwent subcision alone. These treatments can be performed on the same day as the subcision procedure or within a certain timeframe.

Biostimulators and Fillers

Hyaluronic acid fillers or poly-L-lactic acid biostimulators are other treatments that can be used in conjunction with subcision. These injectable treatments can enhance skin plumpness and reduce superficial scarring. Patient testimonials highlight that integrating subcision with these treatments leads to improved skin texture and shallower scars.

Combining subcision with biostimulator treatment, in particular, has been found to be beneficial for patients with darker skin types. This can potentially reduce the number of treatment sessions needed, saving time and cost for the patient.

Laser Scar Treatments

Subcision can also be effectively combined with energy-based treatments such as laser resurfacing for treating atrophic acne scars. By combining these treatment modalities, dermatologists can provide a comprehensive acne scar treatment that addresses individual scar characteristics.

To conclude, even though subcision is a powerful acne scar treatment by itself, combining it with other treatments can significantly augment the results. This comprehensive approach not only leads to improved scar appearance but also higher patient satisfaction.

Recovery and Aftercare Following Subcision

The recovery and aftercare are as crucial as the subcision procedure itself. Post-treatment care is crucial in ensuring the best results and minimizing potential complications.

Following the subcision procedure, here are some post-procedure care instructions:

  1. Apply dressings to the entry site wounds and keep them on for 24 hours. The dressings can be changed if necessary.
  2. Apply ice to the treated area to help reduce swelling.
  3. Protect the treated area with a waterproof dressing to prevent it from getting wet initially.
  4. Consider applying a facial compression wrap to accelerate healing.
  5. You may be required to use a suction device or lightening cream after your treatment.

For the first week post-procedure, patients are advised to:

  • Avoid strenuous exercise.
  • Avoid consuming hot/spicy food and drinks.
  • Avoid washing the face vigorously.
  • Avoid blood-thinning medications such as ibuprofen and aspirin.

Common side effects like pain, swelling, and bruising can be expected following the procedure. Swelling often resolves within 24-48 hours, and mild shape changes of the cheek can also be observed.

Post-treatment care includes:

  • Prescription of antibiotics and anti-inflammatory drugs for 7-14 days
  • Moisturizing with aloe vera or sensitive skin creams once the skin has healed
  • Cleanliness with mild soap

Typically, the skin heals within a week to a month.

To conclude, the post-procedure care forms a crucial step in the journey of acne scar treatment with subcision. By following these guidelines and maintaining communication with your dermatologist, you can ensure a smooth recovery and optimal results.

Factors Affecting the Number of Subcision Sessions Needed

One frequently asked question regarding subcision treatment is: “How many sessions will I require?” The answer to this question can vary, as several factors can influence the number of subcision sessions required.

One significant factor is the type of subcision instrument used. For example, Liberator subcisions are typically intended to be done only once, potentially reducing the number of treatments needed. Needle subcisions may require multiple sessions or touch-up treatments.

The severity of acne scars also directly affects the number of subcision sessions required. For instance, more severe acne scars, which can be identified by grading systems like the Goodman and Baron scale, may require more sessions for optimal results.

Another consideration is the individual’s healing response. As some patients may form collagen differently, the technique used during subcision can significantly influence the number of treatments needed. For instance, patients who form collagen more slowly may require additional sessions.

Skin types prone to keloid scars or hypertrophic scarring may also influence the total number of subcision sessions. Patient satisfaction and perceived improvement can lead to adjustments in both the treatment strategy and the total number of sessions.

Finally, the dermatologist’s expertise and their personal preferences in performing subcision can also contribute to the decision on the number of necessary sessions. This factor highlights the importance of choosing a dermatologist who is not only experienced but also well-versed in the intricacies of subcision treatment.

To conclude, although the number of subcision sessions required can differ, being aware of these influencing factors can assist in setting expectations and preparing for the treatment journey.

Risks and Potential Complications of Subcision

As with any other procedure, subcision also carries potential risks and complications. However, these are generally rare and can be managed with proper care.

Bleeding is a common occurrence during subcision as the procedure can disrupt blood vessels. Measures are taken to minimize bleeding during the procedure, such as applying pressure to the area and using a blunt-tipped cannula.

Infection is a potential risk after subcision. To minimize the chance of infection, antibiotics are prescribed post-procedure. This is a standard preventative measure followed in many surgical procedures.

Swelling post-procedure is a normal response, which correlates with the amount of bleeding during the treatment. Temporary or permanent changes in skin color can also result from subcision. These are usually minor and resolve over time.

Scarring may occur from the small incisions made during subcision treatment. However, these are typically small and fade over time. In rare cases, anesthesia-related complications can occur, but these are extremely rare.

In some cases, a hematoma, a collection of blood under the skin, can complicate subcision and might need surgical drainage if severe. Similarly, nerve damage, a potential consequence of subcision, can lead to sensory disturbance or numbness, and in severe cases, facial paralysis. However, these complications are rare and can be minimized with proper technique and care.

Lastly, chronic inflammatory reactions can lead to foreign body granulomas, causing subcutaneous nodules and induration post-subcision. These are rare but can occur with certain injectable materials and repeated injections. If less invasive treatments fail, surgical intervention may be necessary for granulomas.

How the Scar Healing Institute Minimizes Subcision Risk

At the Scar Healing Institute, we prioritize patient safety and satisfaction above all. We have implemented a number of techniques to minimize the risks associated with subcision.

One of the ways we do this is through the use of tumescent anesthesia. This type of anesthesia offers several benefits:

  • It numbs the treatment area, ensuring a pain-free experience.
  • It provides a fluid barrier between your skin and the underlying fat, muscle, and nerve structures, reducing the risk of damage to these structures.
  • It minimizes bleeding during the procedure, resulting in less bruising and swelling.
  • It allows for more precise and controlled fat removal.

Overall, tumescent anesthesia increases the safety and effectiveness of the procedure.

We also take steps to thicken your skin using chemical reconstruction and biostimulators. This reduces the risk of breaking or thinning your skin during the subcision procedure.

Before the procedure, your scars are carefully marked so any healthy skin is not unnecessarily damaged during the procedure. This ensures that only the scarred areas are treated, minimizing the risk of unwanted side effects and complications.

Finally, our providers have significant training and expertise in the subcision procedure. This expertise is crucial in minimizing risks and ensuring the best possible results for our patients.

In summary, the Scar Healing Institute is committed to ensuring the safety and satisfaction of our patients. We strive to minimize the risks associated with subcision and provide the highest level of care.

Special Considerations for Darker Skin

Darker skin types are more prone to post-inflammatory hyperpigmentation (PIH) after CROSS, which may persist for several months. To help minimize the risk of pigmentation changes, darker skin patients are advised to use a bleaching cream nightly for two weeks before the procedure and avoid tanning.

Managing Hyperpigmentation

The CROSS technique is proven safe and effective for ice pick acne scarring on darker skin types, but vigilance for post-inflammatory hyperpigmentation is vital. Hydroquinone creams are commonly prescribed to prevent and treat resulting hyperpigmentation in darker-skinned patients following CROSS treatment. They may be applied nightly.

Patients are advised to avoid tanning and utilize sun protection for 2 weeks before and up to 2 months after treatment to minimize pigmentation risks.

Customized Treatment Plans

Customized treatment plans are imperative as they consider each patient’s unique skin type and acne scarring, thus optimizing the outcomes of CROSS treatments. An experienced dermatologist may incorporate CROSS with ancillary treatments such as:

  • chemical peels
  • laser procedures
  • dermal fillers
  • specialized skincare products

To comprehensively treat acne scars, target acne scars and enlarged pores.

Proper evaluation during a comprehensive consultation to assess the variety of acne scars is pivotal in creating an individualized treatment plan to meet the specific needs of the patient.

Choosing the Right Dermatologist for Subcision

Opting for the right dermatologist for your subcision treatment marks a vital step in your journey to acne scar treatment. But what should you look for in a dermatologist?

Firstly, the dermatologist should be board-certified. This certification ensures that the dermatologist has undergone rigorous training and meets the high standards set by the medical board. It’s a testament to their competence and dedication to the field.

Secondly, the dermatologist should have substantial experience in performing the subcision procedure. The more experienced the dermatologist, the more adept they are likely to be at handling different types of scars and adjusting the procedure to meet individual patient needs.

When selecting a dermatologist for subcision, it’s crucial that they have experience with the specific procedure and can address the particular type, location, and severity of your acne scarring. This is because treating acne scars is not a one-size-fits-all solution. Each patient is unique, and the treatment plan should be tailored to their individual needs.

Consulting with a board-certified dermatologist is essential to receive a tailored acne scar treatment plan, which can include subcision with other treatments as an option to treat acne scars. By choosing a dermatologist who can offer a comprehensive treatment plan, you can ensure that you receive the most effective treatment for your specific type of acne scars.

To conclude, securing the right dermatologist for your subcision treatment is vital to attain the best outcomes. By considering these factors, you can ensure that you are in capable and experienced hands.

Real-Life Success Stories: Subcision Results

Subcision has revolutionized the lives of numerous individuals by helping them attain smoother skin and significantly improved acne scars. But don’t just take our word for it—let’s hear from patients who have undergone this breakthrough treatment.

Many patients on the Acne.org forums, Reddit, Yelp, and Google have reported over a 50% improvement in rolling acne scars a year after undergoing acne scar subcision at the Scar Healing Institute. They detail a journey with multiple sessions that led to significant skin texture enhancement.

These testimonials underscore the potential of subcision to achieve remarkable results. Patients have reported not just improved skin texture, but also increased confidence and satisfaction with their appearance.

The success stories serve as a testament to the transformative power of subcision. They offer hope to those struggling with acne scars and demonstrate the significant results that can be achieved through this breakthrough procedure.

It’s important to remember that everyone’s skin is different, and the results can vary based on various factors such as the severity of the scars, the individual’s healing response, and the expertise of the dermatologist. However, these success stories demonstrate the potential of subcision to make a significant difference in the appearance of acne scars.

To conclude, real-life success stories underscore the potential of subcision in achieving smoother skin and significant improvement in acne scars. These stories offer hope and inspiration to those struggling with acne scars and serve as a testament to the transformative power of subcision.

Our Proprietary Acne Scar Treatments

Meet The Acne Scar Phase-Out System

Our proprietary phase system is specifically designed to attack acne scars from all angles: chemical reconstruction from the top-down and physical reconstruction from the bottom-up and from the side. We pride ourselves in our meticulous, personalized, and longitudinal approach to treating your scars.

SHI Scar Phase Out System
SHI Scar Phase Out System Mobile On The Go

Skin Acne Treatments & Procedures

While our proprietary phase system is highly customizable and flexible for patients, we recognize that patients may benefit from other procedures as well. Explore these treatment options below and see if they may be right for you!

Scar Healing

Scar Healing begins at the start of when you decide your skin needs to start the repair process

Scar Management

Start the post-procedural process of managing your skincare regimen with us and watch the healing continue

Advanced Skincare

Find out about one of our many advanced skincare procedures to help alleviate any type of skin issues

Punch Excision

A quick and painless procedure to completely remove your ice pick scars with minimal downtime.

Laser Treatment

A personalized chemical formulation to melt your acne scars and rejuvenate healthy skin.

Steroid Injections

Steroid and/or peptide injections to calm your active acne before starting scar treatment.

How Can I Prevent Future Scarring from Happening?

Scarring is more common with poorly resolved cystic or nodular acne. In addition, it has an even greater likelihood of occurring when irritated or squeezed. Therefore, the first step to prevent scarring is to simply leave your acne lesions alone. It is difficult at first, but is worth the patience at the end.

At the same time, it is also important to ensure that your acne lesions do not become over-inflamed. The prolonged inflammation of your active acne will also increase scarring. Steroid injections, notably kenalog injections, are highly effective in quelling inflammation of your acne and thereby limit scarring.

How Do I Know What Type of Acne Scar I Have?

Our specialists at Scar Healing Institute can help identify your acne scar or scarring. We will work with you to create a plan that will help you achieve both mental and physical healing. Find out more!

If you are concerned that you may have acne scars, it is important to consult with a dermatologist or other skin care professional. Our dermatologists will be able to assess your skin and determine if you have any scarring.


In summary, subcision represents a significant advancement in the treatment of acne scars. This minimally invasive procedure breaks scar tethers and promotes collagen production, effectively treating a wide range of scars. Combining subcision with other treatments can further enhance results, leading to higher patient satisfaction and improved scar appearance. With proper aftercare and an experienced dermatologist, subcision can be a game-changer in your journey toward smoother, scar-free skin.

How long does subcision last?2024-06-09T00:34:21-07:00

You may have postoperative inflammation for up to 3 months after the procedure, so results will start to show at the 3 month mark. Collagen production will continue until the 12 month mark so it may take one year to see full results.

How risky is subcision?2024-06-09T00:33:37-07:00

Subcision, like any medical procedure, carries potential risks such as bruising and temporary swelling, which usually subside within a week or two.

How painful is subcision?2024-06-09T00:33:20-07:00

The topical anesthetic used during subcision will numb the area, making the procedure painless. However, some patients may experience slight bruising or swelling in the days following the treatment.

Is Subcision better than microneedling?2024-06-09T00:33:01-07:00

A combination of subcision and microneedling can give better results for different types of scars, as microneedling targets superficial boxcar scars while subcision targets rolling scars. Therefore, the choice between the two depends on the specific type of scarring.

Does Subcision really work?2024-06-09T00:32:45-07:00

Yes, subcision can effectively improve rolling and boxcar acne scars by lifting scars that have been tied down.

Follow-Up Treatments

For those who seek to boost their confidence by revising their scars, our team of top-rated terms in California, USA are ready to help you reach this goal.

Concierge Skin

Our goal, however, goes beyond just treating your skin. We are committed to learning your story and helping you move on to the next chapter in your life.

Our Treatments Create Results

We are specifically known to be not only the top doctors for subcision scar treatment in California but also the leading experts in the best scar treatment clinic in California.


Finding a team that understands your skin, and your body is key.

Finding a team that understands your skin, and your body is key.

With our guidance, medical expertise, and compassion, our goal is to help you reclaim the skin and confidence you deserve.

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