Is Subcision the Best Method?
Dr. Hazany uses an analogy of acne scars as potholes in a street, emphasizing that the correct repair method does not involve leveling the entire road to match the depth of the pothole. Instead, the approach is to fill and raise the pothole to the level of the surrounding street.
This analogy applies to acne scar treatment through subcision, which lifts depressed or rolling scars to align with the surrounding skin surface. Using a hypodermic needle, fibrotic strands tethering scar tissue are manually broken, addressing scar tissue across superficial, middle, and deep skin layers with needles of various sizes.
Comparing Subcision vs. Laser Treatments for Scarring
Treatments that flatten and thin skin to bring it down to the level of the acne scarring can be likened to leveling the entire road to the depth of a pothole. Despite this flawed logic, lasers and microneedling are still widely used in attempts to treat depressed and atrophic scars. While Dr. Hazany recognizes the effectiveness of lasers in scar revision, he recommends subcision for larger and even smaller areas of scarring. Subcision avoids unnecessary skin thinning and promotes a healthier, more resilient appearance. Additionally, unlike many lasers requiring multiple sessions for noticeable results, subcision typically achieves desired outcomes in a single procedure.
What Happens During Subcision?
As an outpatient medical procedure, subcision can be accomplished within a few hours. Local anesthesia, tumescent anesthesia, and anti-anxiety medication are administered to ensure comfort throughout the treatment. To begin, the provider carefully inserts a hypodermic needle into the skin and maneuvers it back-and-forth to release the fibrotic bands attaching the scar tissue to the underlying subcutaneous layer. This technique elevates atrophic scarring to match the surrounding healthy skin, thus filling the aforementioned pothole. This “controlled trauma” also triggers collagen production, which helps to reinforce and support the previously 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.
Post-Procedure Guidelines
- Blood-tinged oozing is normal in the first hour post-treatment.
- Expect soreness, swelling, and mild discoloration in treated areas for up to one week.
- Avoid touching treated areas and any scabs that form to prevent infection and aid healing.
- Keep treated areas dry for the first 24 hours, but after this you may reduce swelling and soreness with a cold, wet cloth every 10-15 minutes.
- Apply a thin layer of Vaseline or petroleum jelly after showering.
- Avoid makeup in treated areas for 24 hours.
- Minimize sun exposure; use SPF 50 sunscreen if necessary.
Pricing for Subcision Treatment
The cost of subcision varies depending on how many layers of subcision you require (e.g., deep layer, middle layer, or superficial layer) and the number of areas you plan on subcising. However, the results of subcision are long-lasting, which eliminates the need to spend additional money on maintenance treatments. Also, subcision avoids thinning the skin, which means you will not have to invest in collagen-boosting formulas or dermal fillers either.
Today, subcision is one of the foremost procedures available to patients in Manhattan Beach for acne scar treatments. We encourage you to reach out to our scar specialists for more information and to create your personalized treatment plan!
