Tiny hard lumps after subcision? Normal?

subcision shouldn't leave scarring but if you feel lumps or tissue and cannot see it, there is no reason you should be concerned.  fillers shouldn't be affected.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. 

These will usually go away and are related to inflammation. Gentle massage might help. They won't affect fillers because when doing them for acne scars, I always subcise at the time. Other methods to improve acne scarring are Infini, lasers, PRP, TCA Cross. 

You don't need to worry about donut effect from fillers if you see a specialist well versed in this procedure. If we can see filler go around the scar we will stop the injection, break down the fibrosis and scar, then fill. So, in summary don't worry about the filling at a later stage, let the specialist worry about that. Back to the present, if you can FEEL but not see lumps, all good- gentle massage can help. Use vaseline - massage 10 min a day for the next week. Gentle to moderate pressure will be fine. Unlikely you will scar if your acne - inflammation is well controlled. Subcsion was first reported in 1995. Since then this technique has taken many pathways. Most dermatologist and plastics still perform the old method- using sideways motion to break scars down. In the original papers this took 6-10 sessions using a needle. This still can be effective, but its OUTDATED. Since then other methods have evolved including-



The use of other size needles
The use of NOKOR or cutting needles
The use of cannula techniques


Of all these techniques, cannula stands out. The most recent paper this year shows that it has the best rate of scar breakdown with much less side effects than with NOKOR. Namely less bruising and ‘lumps’ from bleeding. 



The results of subcision is extremely variable and will depend on the technique and experience of your Plastics or Dermatologist. Ensure they can perform all techniques competently. This is especially important with dermal fillers (or fat transfer). If one subcises a depressed scar and find it has NOT got significant tethering, a filler is needed. In this situation filler or fat is needed to elevate the scar. Subcision is my preferred method for scar revision, as I can feel how many scars I am breaking with my 3 level cannula technique. This is now considered the Gold Standard in subcsion as reviewed by peer papers. All other modalities including lasers, energy devices and peels are considered ‘instruments’ in the way I practice acne scar revision. Remember treat the scar type with a method, and you will achieve the desired outcomes. Subcsion releases and remodels acne scarring from underneath. Needless to say this just a method, the results you will achieve is 90% dependent on the skill sets of your Plastic surgeon or Dermatologist.  



All the best, Dr Davin Lim 

Acne Scar Specialist. Brisbane. Australia.