Can a subcision procedure not work on certain dense bound down scars?

I have had a subcision procedure twice now on one large rolling/boxcar scar on my cheek. Each time the elevated tissue has ended up adjacent to, but not under the depressed area, making the scar appear worse. Is it possible that my scar tissue is just so dense that the needle can not elevate the correct area? Or is it more likely that my Dr. just missed the scar?

Doctor Answers 2

Hidef acne scar protocol

I would couple the subcision procedure with ematrix RF, fractional laser, and fillers to even out the depression. 


Dr. Karamanoukian

Los Angeles

Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Subcision Helps To Improve Indented (Depressed, Atrophic) Scars

I have been performing subcisions for 22 years now and have found them overall to be a very effective method for treating all kinds of depressed scars, whether traumatic, surgical, infectious or inflammatory acne in origin. They have also proven very useful for improving the deep dimpling that accompanies cellulite, a fact that has gotten a great deal of media attention recently. Subcision relies upon the skin's natural ability to produce new, native collagen (neocollagenesis) and new, native elastic fibers (neoelastogenesis). Although quite uncommon in my experience, occasionally, the skin "overshoots" and may make a bit too much collagen giving rise to a tiny bump or mound, this is usually in the center of the scar and not at the periphery, the way you describe. In fact, your description of the elevated tissue ending up "adjacent" to the treatment area is much more characteristic of what happens when a filler is injected into a boxcar scar. This happens because the filler cannot pop up the heavily bound down scar tissue and instead spills around to the periphery of the scar, a result, which, as you clearly indicate, makes the scar look even worse. I would suggest discussing this with your current treating physician or seeking a second opinion from a board certified aesthetic physician with experience and expertise in all forms of scar treatments. I wish you the best of luck.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 30 reviews

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