Would I benefit from subcision? (photos)

Question

I have done fraxel, CO2 laser, micro needling, RF needling, chemical peels. Looking for something that will actually improve appearance.

Nelson Lee Novick, MD · Answer

So sorry that you have wasted so much time and money and suffered such frustration with the treatments you have already gone. I have been writing these kinds of answers for years already cautioning my followers to exercise a very healthy dose of "buyer beware" when considering expensive "bells and whistles" light and energy-based devices, such as lasers and RF machines, since the hard science to support their use lags woefully behind the heavy marketing to promote them. And I have also been alerting readers that while treatments, such as microneedling (professionally manually performed--not RF microneedling), which I have been using with gratifying results for years, much like a series of superficial chemical peels, is best reserved as a final  "polishing" step to improve superficial skin texture and color irregularities after more appropriate treatments have been performed, rather than being used a primary therapy for deeper scars. I hope that other readers of this answer finally get the message. Subcision, both Field Subcision (for elevating & smoothing acne scar-related cheek atrophy and sinking) & individual subcisions (for individual boxcar/rolling scars), which I have been performing practically daily since 1995, on the other hand, have a proven track record for both efficacy and safety for elevating and smoothing all kinds of indented scars in all skin types. Likewise, TCA CROSS, which I have been routinely performing for well over two decades for ice pick scars and dilated pores, is another technique that has stood the test of time for efficacy and safety in all skin types. Since so many venues are into hawking their expensive, supposedly "next big thing" light or energy-devices, you will have to do a good deal of due diligence to locate a board certified cosmetic dermatologist with experience in these relatively inexpensive tried and true treatment approaches. Best of luck and happy holidays.

Raffy Karamanoukian, MD, FACS · Answer

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best, 
Dr. Raffy Karamanoukian
Realself100 Surgeon

Jeff Rapaport, MD · Answer

In my opinion, Subcision with PRP will help your dermal and subdermal saucer shaped scars. I recommend a combination of Nokor needle and a field Subcision with a Cannula. We provide a suction device post operatively. Multiple sessions will be needed.
Find a scar expert.
Jeff Rapaport MD FAAD 
Realself Hall of Fame

James G. Wu, MD, FAAD · Answer

It looks to me like you have rolling and boxcar scars caused by atrophy of the dermis. You would most definitely benefit from nokor needle subcision. I would have recommended subcision first in your case, before lasers/RF/chemical peels.

Would I benefit from subcision? (photos)

Answers (4)

Answer: Yes

Answer: Yes

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Would I benefit from subcision? (photos)

Answers (4)

Answer: Yes

Answer: Yes

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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.