Is Subcision the Best for Treating 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.
Subcision vs. Laser Treatment for Acne Scars
Laser resurfacing, microneedling, and other treatments that involve flattening and thinning the skin to match the level of the acne scarring can be likened to grinding down the entire road to the level of the pothole. Despite this, dermatologists still widely use laser treatment to enhance the appearance of acne scars and atrophic scars. While Dr. Hazany acknowledges the value of lasers in scar revision, he advocates for the subcision procedure for larger areas of scarring and even smaller affected areas. Subcision for acne scars avoids unnecessary thinning of the skin and promotes a healthier, more resilient appearance. Moreover, unlike many lasers that require multiple sessions for visible results, subcision typically achieves desired outcomes in a single procedure.
What Does Subcision Involve?
Subcision is an outpatient surgical procedure typically completed within a few hours. Patients receive local anesthesia, tumescent anesthesia, and sometimes anti-anxiety medication to ensure their comfort during the process. During the procedure, a hypodermic needle is carefully inserted into the skin and maneuvered sideways to release scar tissue from the underlying subcutaneous layer. This technique elevates areas affected by atrophic acne scars 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.
Recovery Timeline
Following aftercare instructions is important to ensure a speedy recovery. Following the procedure, it is typical to experience slight soreness in the treated site(s) during the first 24-48 hours. While skin discoloration on the treated area(s) is common, it does not always occur, and mild swelling usually subsides within 48 hours, though it may persist for up to a week in some cases. To prevent infection, avoid touching the treated site(s) and keep them completely dry for the initial 24 hours. After this period, you may relieve swelling and soreness by applying a cold, wet cloth to the treatment site(s) in intervals of 10-15 minutes. After showering, apply a thin layer of Vaseline or petroleum jelly to keep the skin moisturized. Normal activities can typically be resumed within 48 hours, but it is important not to pick at any scabs that develop, as they play a crucial role in scar healing. Refrain from applying makeup or other cosmetic products to the treated area for at least 24 hour and throughout the entire healing process, try to minimize sun exposure or apply SPF 50+ sunscreen if you must go out.
How Much Does Subcision 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. 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 Walnut for acne scar treatments. We encourage you to reach out to our scar specialists for more information and to create your personalized treatment plan!
