Are my Scars Suitable for Subcision? (photo)

Question

I'm convinced that subcision would be the best way to treat these scars. When I stretch my skin, the scars don't flatten. Can subcision still be preformed on both these scars since they're right next to each other? Also, I know that subcision is better paired with a filler or the 'subcision suction method'. Rather than subcision alone.

Harold J. Kaplan, MD · Answer

Hi Andrew.  Yes, you are a candidate for subcision.  In this procedure, we use the needle of the Restylane syringe to release hard, fibrous scar tissue below the depression and then we injection the Restylane in the void created by releasing the scar tissue.  

	While this will give you immediate benefits, the best results are when we perform the procedure every 6 - 9 months over a period of years.  This increases your chance of having collagen remodeling fill the scar from below.  

	Take a look at the before and after photos at the link below and call us for a free consultation if you are in the Los Angeles area.

Raffy Karamanoukian, MD, FACS · Answer

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

Richard Ort, MD · Answer

You would likely benefit from a subcision procedure to lift and smooth your scars. However, it’s not possible to say for sure just from looking at a single picture. It is very important to examine acne scars under different types of lighting and to palpate and stretch the skin to see how it will respond.   In general, subcision is one of my favorite treatments for rolling scars and some boxcar scars. I have been performing subcision for approximately twenty years. Traditional subcision is performed with a sharp needle which can result in significant bruising and some lumpiness during the healing period. My technique has evolved over time. I usually avoid using sharp needles nowadays and prefer to do a blunt subcision using a cannula rather than a sharp needle. Results are still good but there is much less bruising, swelling, pain, and lumpiness in the recovery period. I usually inject some filler such as Restylane Lyft immediately after completing the subcision to give the most improvement. Overall, I feel that subcision is a very valuable technique that is under-utilized for treatment of acne scars.Regards,Dr. Ort

Daniel Chang, MSc, MBBS, MRCS · Answer

Dear abc,
  
Thank you for your question. 
  
Acne scars are common, but with advancement in technology, thankfully it is not something you have to live with.
  
Acne scars are the result of the breakdown of collagen and elastin in your dermis. They frequently occur at sites which were acne prone in the past, namely your temples, cheeks etc.
  
You have atrophic rolling and boxscars so subcision is one of the modalities that would help. Combination treatment would give you the best results.
Acne scars are 3 dimensional, hence submitting a photo will not do justice to your scar. It requires real time examination (touch and animation), combined with lighting from various angles. That is why you may notice your scars differently in the bathroom mirror and in the dressing table mirror.
  
Dr Daniel Chang’s 3 STEP ACNE SCAR Treatment Formula: 
  
1- Control acne
  
2- Treatment – Fractional laser + skinboosters ( to promote collagen growth)
  
3- Maintainence with lasers ( to optimise collagen stimulation)
  
STEP 1: CONTROL YOUR ACNE. (Refer to this page on acne for more information)
  
Achieving good control of your acne is the important principle towards helping your acne prone skin. This prevents new scars from forming, which is a big step forward. Dont be too worried about your existing acne scars. Focus on prevention first.
  
STEP 2: Treatment based on scar type. Below are the 4 main types.of atrophic scars.
  
Ice pick scars =>    can be treated with TCA CROSS, Fractional and Microneedling
  
Rolling and box scars scars => are best treated with a combination of  RF Microneedling, PRP, fractional lasers and subcision
  
Hypertrophic scars can be treated with
  
 Microbotox
  Intralesional steroid
  
Atrophic scars -> A combination approach is what I would recommend to improve the appearance of such scars.
  
Laser Resurfacing +/- RF microneedling 
  Subcision
  Dermal fillers – Skinboosters – Please refer to my Page on Skinboosters 
  Intralesional saline – ( Latest evidence from Journal of Dermatology Sept 2016)
  
Fractional C02 used to be the industry gold standard for treatment of acne scars. Current studies point towards combination therapy, as I have outlined above. In addition, As collagen takes 3 months to grow, multicentre studies show one would require at least 4 sessions to see results. 1 session is unfortunately not enough.
I hope you find this helpful.

Keith Denkler, MD · Answer

Subcision is an excellent start for your acne scarring.It can be done alone, or a filler can be added.In your case I would try simple subcision first and do subcision/filler second if needed.Best wishes, Dr. Denkler

Are my Scars Suitable for Subcision? (photo)

Answers (8)

Answer: ACNE SCAR TREATMENT | DR DANIEL CHANG RECOMMENDS COMBINATION APPROACH

Answer: ACNE SCAR TREATMENT | DR DANIEL CHANG RECOMMENDS COMBINATION APPROACH

Answer: Subcision is a good start

Answer: Subcision is a good start

Recommended reading

Everything you need to know about Subcision

Our mission is to create a world where every investment in modern beauty is Worth It.

Are my Scars Suitable for Subcision? (photo)

Answers (8)

Answer: ACNE SCAR TREATMENT | DR DANIEL CHANG RECOMMENDS COMBINATION APPROACH

Answer: ACNE SCAR TREATMENT | DR DANIEL CHANG RECOMMENDS COMBINATION APPROACH

Answer: Subcision is a good start

Answer: Subcision is a good start

Browse related questions

Recommended reading

Everything you need to know about Subcision

Our mission is to create a world where every investment in modern beauty is Worth It.