Subcision is used to remodel and restructure acne scars. It breaks the fibrous bands that create tension between the outer epidermis and deeper structures. It aids in forming new collagen. Subcision is useful for rolling, indented scars with gently sloping edges that are caused by the skin being weighed down by scar tissue. Subcision is a specialized procedure that can only be done by a qualified plastic surgeon or dermatologist.
The procedure and cost of Subcision
Subcision is done only after administering a local anesthetic. A sharp needle (Nokor needle or Number 18 gauge or 20 gauge needle) or scalpel is used to cut below the scar tissue and lift it away from unscarred skin. The skin is elevated, made even and smooth. Subscising helps to break down old scar tissue (adhesions) and reorganize the creation of elastic tissue and new collagen. The procedure also allows blood to fill and clot in the unbound tissue area. Blood clots form connective tissue below the scar.
Sutures are not required since the overlying skin is not incised. Once the wound heals, fillers are injected under the scar. This brings all depressed skin to a surface level. Synthetic materials, human fat or collagen is used as the filler material. To reintroduce clotting and attain better results, suction can be done a few days or weeks after the procedure.
Post-operative care includes placing ice packs on the treated areas and taking anti-inflammatory drugs and antibiotics for up to a week after the procedure.
Subcision costs $50- $750 depending on the area to be treated or if the doctor charges based on the number of scars or based on each session that will usually include all scars to be treated. Usually 1-3 sittings may be required.
Benefits of Subcision
Surgery for rolling, indented acne scars using subcision produces very good results. It is a safe and simple procedure that can be combined with other acne procedures to improve appearance of severe scarring.
90% of patients who underwent subcision have reported improvement. All side effects are transient. Other benefits of subcision are minimal risk, works well as a complement to other acne scar treatments, there is no downtime and the size and appearance of broad-based acne scars and sauces-shaped scars are reduced.
Doctor’ reviews suggest subcision works well for bound-down rolling scars when combined with dermabrasion or Fraxel Restore. Subcision usually does not cause scarring.
Limitations of Subcision
Subcision for raised acne scars requires other acne treatments like laser resurfacing, fractional resurfacing or dermabrasion for otherwise these scars can reappear. Several rounds of subcision maybe required 3-4 weeks apart before an improvement can be seen. Haematoma and a bluish discoloration can be observed for a few days. If there are many scars, then only a few maybe be treated at a time to avoid edema.
Possible Side effects of Subcision
Side effects of subcision include recurrence of scars, bruising, raised or hypertrophic scarring and discoloration of the treated areas. The bruising and swelling will remain for a couple of weeks and then improve.
Subcision does not eliminate rolling scars but only improves them. Fibrosis that causes rolling scars to form can reappear. Dark skinned patients can develop hyperpigmentation. Subcision may not work for a lot of pitted scars.
Subcision must be done only by trained doctors. It requires a lot of training to master this technique. Patients are advised to avoid anti-inflammatory medications, blood thinning medications (that can cause bruising after the treatment) and naturopathic treatments a week before and after the procedure.
Most users recommend using subcision for severe or moderate rolling acne scars since the results were excellent and scars practically disappeared. The cost and downtime varies depending on the number and size of scars. Patients say the effect is better when combined with other acne treatments like Fraxel laser.
Users report a few minor issues such as mild pain during the procedure and swelling and bruising afterwards. Patients who used it on ice pick scars found no improvement. However, this treatment is for rolling and not ice pick or boxcar scars. The swelling and bruising was covered quite easily with makeup and disappeared after a few days.