Subcision with filler for deep boxcar scar on side of lip? (Photo)

Question

Would this scar be amenable to subcision and filler? This was not caused by acne, but caused by a super dry patch (derm said it was granuloma annulare), that would just not heal. I have tried microneedling and a Venus Viva NANO RF treatment. No results whatsoever. I had a consult and she suggested subcision with Restylane. Is it safe to perform subcision in this area? Any other tips? I need this improved!

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HIDEF 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 acne 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 acne scars and indented acne 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 been 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 laser 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.

Subcision works well alone and in combination with other laser and RF platforms, including fillers and air subcision. TCA Cross can be combined with subcision. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne 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

Nelson Lee Novick, MD · Answer

I have been performing subcision routinely for all kinds of depressed scars and skin depressions since 1994. It is a simple, safe, relatively inexpensive and effective technique for elevating and smoothing all kinds of depressions, indentations and scars in all skin types. The addition of a filler can not only help by providing an immediate result, but more importantly has been shown to help new collagen and new elastic fiber synthesis to create a more durable and lasting improvement. Just make sure that you are consulting with a board certified cosmetic dermatologist experienced in subcision and not simply some venue hawking this or that relatively expensive, faddish, light or energy-based devices; you have unfortunately already seen that fancy named devices don't necessarily translate into successful outcomes despite the heavy marketing hype that surrounds these "bells and whistles."  Hope this helps. Best of luck.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi Tina! Great questions. Subcision works well for deep and tethered scars to provide release. This can easily be done in clinic with a needle. I often try this and utilize microfat and nanofat to improve the volume and texture of the scar. The fat is a "natural" filler and provides stem cells and growth factors ideal for healing. The results can be quite nice. If no improvement with microneedling, another option would be excision of the scar to trade it for a more appealing one. Although not ideal, it does work well at times. Hope that is useful to you!

Subcision with filler for deep boxcar scar on side of lip? (Photo)

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Subcision with filler for deep boxcar scar on side of lip? (Photo)

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Everything you need to know about Subcision

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