Can acne scars be temporarily removed by dermal fillers and is subcision a good treatment for type 4 skin?

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars.
- Subcision for depressed, tethered scars.
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars.
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring.
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

I have been performing subcision for all kinds of indented scars, especially for boxcar and rolling acne scars, since 1995 and have literally performed tens of thousands of these during that time. Subcision, as the "sub" suggests, is performed underneath the skin in order to splice and release the tethering scar fibers that pull down the surface of the scar AND also by creating a temporary blood pocket beneath scar. The blood pocket contains growth factors and wound healing factors that promote the production of new collagen and new elastic fibers that is the basis for the long-lasting to permanent results that characterize properly performed subcision. If a temporary filler is used, it is not because it serves as a "spacer," as has been suggested by Dr. YouTube; it is instead being used to aid in stimulating fiber-making cells (fibroblasts) to respond more vigorously to the aforementioned blood pocket stimulation. That's how subcision works. Finally, since all the cutting of subcision is done below the skin surface, it is a safe procedure for all skin types--when properly performed by an experienced, board certified cosmetic dermatologist scar specialist. Hope this helps and best of luck.

Yes, subcision should be OK for that type of skin. It involves scraping underneath the skin to help elevate any tethered scarring. Fillers are temporary. Fat transfer can help, too.