Are my Scars Suitable for Subcision? (photo)

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.

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

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

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.

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

Hi,Subcision is a very good option for the depressed scars, and there should not be a problem with the scars being right next to each other. Suction after subcision helps to improve the results.Fillers are not always required following subcision, but they definitely help to give better results quickly. Good luck!

Subcision works best for 'rolled' depressions or 'rolled' scars (as opposed to 'ice pick'  or 'box car' scars). The technique involves inserting a special needle just under the skin to break up the scar tissue and bands that pull down the skin create these depressed scars. Looking at you pictures, I think you could benefit from a subcision procedure. You are also correct in that a phsyician will often place filler under the scars after subcision to lift them up, after the bands are severed. As well, usuing a suction device overtop of the skin after subcision also helps lift up the depressions. Subcision is associated with bruising and therefore has some downtime. As with any scar treatment, you will see significant improvement but 100% resolution of scarring is hard to acheive. Often to obtain maximum results, combination therapy with other resurfacing treatments is needed.

 

If you’re trying to make your acne scars better you need to have laser treatment, depending on how deep they are or what kind of scars you are dealing with. You have a few different options. There is Profractional laser, micro laser peel or even a face lift to stretch the skin and help improve the deeper scars. Good luck..