What kind of scars are these and would they benefit from having subcision done? (photo)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

In  my opinion, you have tethered, bound down scars that are common after excoriations. Subcision is the gold standard for tethered scars. I would recommend subcision combined with microneedle RF and a fractionated CO2 laser. Fillers can be used at a later time. Find a scar expert. Good luck.
Jeff Rapaport MD
Realself All-star

A combination approach will give the most improvement. These scars can be improved with laser spot treatment, fillers, microneedling/prp and subcision to help texture and blending. I recommend getting a formal evaluation with a scarring expert. Best, Dr. Emer

Hello LH.  Perhaps what your practitioner meant when she said there was nothing to subcise is that you don’t have traditional acne scarring.  With that said you do have several areas with deeper indentations that would likely respond well to subcision with dermal filler.  Think about subcision this way.  The wider and deeper the pocket if scarring, the more appropriate it is for subcision.  For example the indents on your nose would not likely respond well to subcision because they are small and in tissue that is not the same as the cheeks.  But the larger areas on the cheeks are better candidates.  You are also a good candidate for fractional laser resurfacing but likely did not receive deep resurfacing.  

Dermatillomania causes damage to the dermis and causes atrophy of that area (thinning). A variety of treatments can be performed to remodel atrophic scars from energy-based lasers and radiofrequency devices to mechanical disruption of the scar with microneedling. Deep wide scars can be released and filled in with subcision and a filler such as Bellafill which is specifically designed for discrete divets and depressions. I would use the subcision with Bellafill for the individual deeper scars. Not everyone is a candidate for all the treatment options however as certain skin types can get worse from certain treatments. For the best treatment options, it is important to visit an expert for an in-person examination. Hope this helps!
Johnson C. Lee, MD
Board-Certified Plastic Surgeon

I do agree with my colleagues regarding the nature of scarring, as well as the possible treatment options. Histology of this type of scarring can range from atrophy to fibrosis, with pigment loss. If clinically atrophic, filler and energy devices may help. If fibrotic and tethered, subcision and possible filler. Challenging condition to treat, especially if scars are near the nasolabial fold. Dr Davin S. Lim, Brisbane. Australia.