Does Subcision Offer the Best Scar Solution?
Dr. Hazany describes acne scars as potholes in the street. When fixing a pothole, do you flatten and grind down the surrounding road to the level of the pothole? No! Flattening the rest of the street requires unnecessary work in areas that are not defective, and the street becomes unnecessarily thin, leading to other complications. The proper way to fix a pothole is to fill the pothole and lift it to the surrounding street level.
This same logic applies to treating acne scars. Subcision, unlike other treatments such as microneedling or laser treatments, lifts depressed scars or rolling acne scars to the level of the rest of your skin surface. A hypodermic needle is inserted into the skin to manually break fibrotic strands underneath that tether scar tissue to the subdermal layer. Needles of various sizes are used to mechanically break scar tissue residing in the superficial, middle, or deep layers.
Subcision vs. Laser Resurfacing
Other acne scar treatments such as laser resurfacing, microneedling, and dermabrasion that flatten and thin the skin to the level of the acne scarring are like bringing the rest of the street down to the level of the pothole. However, laser treatment remains the go-to for dermatologists to improve the look and feel of acne scarring. While Dr. Hazany agrees that scar reconstruction lasers can be useful as a touch-up or for minor unevenness, for large areas of scarring (and even smaller areas), Dr. Hazany champions the subcision procedure. This medical acne scar treatment avoids unnecessary thinning of the skin, instead producing a healthier, more robust appearance. Additionally, while many lasers require multiple sessions to obtain any results, subcision is typically a one-time procedure.
How Does Subcision Work?
Subcision is an outpatient procedure that can typically be accomplished within a few hours. Local and tumescent anesthesia are administered to the patient along with anti-anxiety medication to ensure the patient remains comfortable throughout the treatment. To start the procedure, a hypodermic needle is inserted into the skin and moved back-and-forth to break up the fibrotic strands tethering the scar tissue to the underlying subcutaneous tissue. This releases the depressed acne scars, allowing them to rise to the level of the normal skin again. 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 Recovery
After undergoing subcision, there are several post-care instructions to follow for optimal healing. After the first hour of treatment, it is normal to experience blood-tinged oozing from the incision site and mild discomfort for the first 24-48 hours. Additionally, some bruising may occur and mild swelling may persist for up to one week. It is important to keep the treated site(s) make-up free and dry for the initial 24 hours, but after that, to alleviate swelling and soreness, a cold and wet cloth may be applied in intervals of 10-15 minutes. After showering, apply a thin layer of unscented Vaseline or petroleum jelly to aid in moisturizing the treatment areas. Any scabs that form should be left alone and sun exposure should be minimized throughout the healing process. These steps will help ensure a smooth recovery and optimal results from the procedure.
Pricing for the Subcision Procedure
The cost of subcision varies based on depth (superficial, middle, and/or deep layer) as well as the number of sites. The long-lasting results of the subcision procedure mean you do not have to continuously pay to maintain the appearance. Furthermore, it does not affect skin thickness in treated areas, so collagen-boosting formulas and dermal fillers may not be necessary.
Today, subcision is one of the foremost procedures available to patients in Irvine for acne scar treatments. We encourage you to reach out to our scar specialists for more information and to create your personalized treatment plan!