Can subcision be done on a skin that already has filler in it?

The simple answer to your question is that individual subcisions may be performed three months or even six weeks following the use of a ordinary filler, such as Juvederm, used for the cheekbone regions. However, if the Juvederm was used to simply to reflate the cheeks to stretch the overlying acne scars, I would question its value. For one thing, acne scarring is a permanent problem, so the use of a simple, temporary filler that yields short-lived results of only a few months at best, hardly seems like a reasonable or cost-effective result. However, if a more robust volumizing filler, such as Voluma XC, used for its biostimulatory effects, were combined with a "field subcision," i.e. a cannula xsubcision that covers the entire region of the cheeks to elevate and smooth the overlying scars, this would be a reasonable approach, especially when individual residual scars are subsequently treated by individual subcisions. Make sure that you are consulting with a board certified aesthetic physician with experience and expertise in acne scar treatments. Best of luck.

Yes subcision can be used with or without fillers if you are a candidate.Acne scar treatment needs a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif or fractora microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we alreayd pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments.  Best, Dr. Emer. 

Subcision can be done before, during or after hyaluronic acid filler injection, based on the confidence, experience and expertise of the clinician.  In our practice, combination therapy is routine, but please do your research and find the practitioner who is right for you.  Best wishes, Shobhan.

Answer is - NO. Filler is stable, even with high energy devices such as RF, or even RF subcision using devices such as the InnoPlus. IN CA, Dr Emer and Dr Peter Rullan are experts in this field .Acne scar revision comprises of many specialised procedures that are dependent on the skill sets of your Plastic Surgeon or Surgical Dermatologist. For the best results, one should target the acne scar type with an appropriate treatments METHOD. Using one or two devices is not optimal. Everyone has a unique pattern of acne scars- hence the best solution is a tailored one. Remember, scar revision is a medical procedure- much like the revision of inflammatory, traumatic and burn scars. It is not dependent on the clinic, branch, machine, or laser but by the skill and reputation of the surgeon. The surgeon MUST be skilled to deliver all forms of dermal fillers, and or autologous collagen- tissue matrix. The use of fillers, both on label and off label via needle and cannula techniques will usually give better results, and less downtime compared to lasers and energy devices. Scientific papers have recently confirmed the change in paradigm for acne scar revision. 



Take for example deep ice pick scars, and narrow box car scars. These are best treated with TCA CROSS and focused angled CO2 fractional laser in low density. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat graft, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations. 



In the vast majority of patients, different patterns of acne scars will be present. Monomorphic acne scarring (scars of the safe subtype) are extremely rare. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combinations that yields the best results. It is never about the device, it is about the specialist behind the equipment that will deliver the best outcomes. 

Global leaders in acne scar revision will always use manual methods to revise scars, and employ lasers and energy devices as instruments to assist. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.