Is Subcision the Most Effective Treatment for Scars?
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 treat 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.
Comparison Between Subcision and Laser Resurfacing
Laser resurfacing, microneedling, and other medical treatments that involve vertical movements to 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. At the moment, many dermatologists default to laser treatment for improving 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 recommends the subcision procedure. Unlike alternative acne scar treatments, subcision is usually a one-time procedure that avoids unnecessary skin thinning and produces a healthier, more robust appearance.
How Does Subcision Work?
The subcision treatment can be accomplished within a few hours and involves a local anesthetic, tumescent anesthesia, and anti-anxiety medications. Next, a hypodermic needle is inserted into the skin and moved side-to-side to break up the fibrotic strands that tether the scar tissue to the underlying subcutaneous layer. This allows the depressed regions of acne scarring to lift back up to the level of the rest of the 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.
Aftercare Following Treatment
To optimize healing, it is important to closely follow aftercare instructions. In the first 24-48 days, you may experience blood-tinged oozing as well as mild discomfort. It is important to keep the treated site(s) make-up free and dry for the first 24 hours, but after that, to alleviate swelling and soreness, a cold and wet cloth may be applied in intervals of 10-15 minutes. Additionally, some bruising may occur and mild swelling may persist for up to one week. After showering, apply a thin layer of unscented Vaseline or petroleum jelly to keep the treatment areas moisturized. Any scabs that form should be left alone and sun exposure should be minimized throughout the healing process, or if necessary, SPF 50+ should be applied. These steps will help ensure a smooth recovery and optimal results from the procedure.
How Much Does Subcision for Acne Scarring Cost?
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. The long-lasting results of the subcision procedure mean you do not have to keep paying money for maintenance treatments. And, compared to laser resurfacing, it ensures you do not have to spend as much money on collagen-boosting formulas or dermal fillers to regain skin thickness in the treated areas.
Today, subcision is one of the foremost procedures available to patients in Newport 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!
