Microneedling/subcision for tethered linear indentations? (Photos)

Question

Post fractional Co2 I developed linear indentations on both sides of my scalp where the procedure stopped. These are deep indentations of volume loss that have tethered down and are fixed firmly in place. I also have shallow vertical linear indentations on my forehead. I was screened for autoimmune to be safe and was cleared. Would subcision of these indentations work? Could they be filled with something like Radiesse or Sculptra after subcision?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

The short answers to your question are "Yes."  Subcision, which I have been performing since 1995, is an excellent and simple method for breaking up scar tethering and elevating and smoothing indented scars from all causes and in all skin types. Manually performed professionally performed microneedling (no need for the added expense and risks of RF microneedling) can then be used to treat the superficial, surface textural irregularities. As so many venues out there are hawking this or that expensive laser or other gizmo, you would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist experienced in both subcision and manual microneedling.. Best of luck.

Microneedling/subcision for tethered linear indentations? (Photos)

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Microneedling/subcision for tethered linear indentations? (Photos)

Answers (2)

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Everything you need to know about Subcision

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