Is Subcision the Best for Acne Scar Removal?
Dr. Hazany describes acne scars as potholes on the street. When repairing a pothole, do you grind down the rest of the surrounding road to the pothole’s level? No! Flattening the rest of the street requires superfluous work in areas that are not broken, and the street becomes unnecessarily thin, leading to other complications. The correct way to fix a pothole is to fill it to the level of the surrounding street.
Similar logic applies to treating acne scars. Subcision, unlike other treatments like microneedling or laser resurfacing, lifts depressed scars or rolling acne scars to the level of the rest of your skin surface. A cannula—hypodermic needle—is inserted into the skin to manually break fibrotic bands underneath that tether scar tissue to the subdermal layer. Different sized needles are used to break scar tissue residing in the superficial, middle, and deep layers.
Comparing Subcision vs. Laser Treatment for Acne Scars
Laser treatments, microneedling, and other medical procedures that involve repetitive movements to thin the skin to the level of the acne scarring are like bringing the entire street down to the pothole’s level. Many dermatologists perform laser resurfacing as the standard treatment for improvement of the appearance of acne scarring and atrophic scars. While Dr. Hazany acknowledges that scar reconstruction lasers can be useful as a touch-up or for minor unevenness, for larger areas of scarring (and even smaller areas), Dr. Hazany champions the subcision procedure. This medical acne scar treatment avoids unnecessary thinning and wearing down of the skin, instead producing a healthier, fuller appearance. Additionally, while many lasers require multiple treatments in order to see results, subcision is typically only performed once.
How Does Subcision Work?
Subcision is a minor surgical procedure performed within a few hours. The patient is given 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 back-and-forth to destroy the tethers anchoring the scar tissue to the underlying basement layer. This allows areas of atrophic acne scars to rise back up to the level of the other healthy skin. This form of “controlled trauma” also stimulates collagen production, providing structural support underneath the scarred areas.
The subcision procedure can be performed in three different layers: superficial, middle, and deep.
- 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 and deep-layer subcision treatments 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.
Recovery After Subcision
- Blood-tinged oozing is expected in the first hour after treatment.
- Keep the treated site(s) completely dry for the first 24 hours after the procedure.
- For the first 24-48 hours after the procedure, you may feel slightly sore and experience mild swelling in the treated site(s). Residual soreness and swelling may last up to one week.
- For swelling and soreness, apply a cold, wet cloth to the treatment site(s) in intervals of 10-15 minutes.
- Skin discoloration on the treated site(s) is common, but does not always occur.
- You may resume normal activities within 48 hours.
- Do NOT pick scabs that develop in the treated areas since they are important to heal scarring.
- Do NOT wear makeup or other cosmetic products in the treated area for 24 hours.
- Avoid sun exposure, but if necessary, apply minimum SPF 50 sunscreen on treatment areas.
- Apply a thin layer of Vaseline/petroleum jelly after showering.
How Much Does Subcision Cost?
The cost of subcision varies depending on how which layers of skin you need subcised—deep, middle, and/or superficial—and the number of areas you plan on subcising. Since the subcision procedure produces lasting results, you will not have to keep shelling out money for never ending maintenance treatments. Furthermore, subcision does not thin out your skin in the treated areas, meaning that you do not have to worry about additional products such as collagen-boosting formulas or dermal fillers post-procedure. Today, subcision is one of the most advanced procedures available to patients in Los Angeles for acne scar treatments. Reach out to our specialists at the Scar Healing Institute today to create your personalized treatment plan!
