Subcision on keloid scar?

Laser Resurfacing along with Cortisone injections can help reduce scars and keloids by sending targeted injuries to the epidermis, in congestion with heat to the dermis. This will then prompt the growth of new collagen fibers, allowing the scars to appear smoother. Depending on the patients skin tone (Fitzpatrick Skin Type I- Type IV preferred) the best single treatment device is the Fraxel Repair (Fraxel Co2).
Fraxel Repair uses pixelated, long-wavelength carbon dioxide, rather than light energy to vaporize the s. Following the laser we inject cortisone directly into the raised scars. Due to the intensity of the Co2 patients can expect 5-10 days of downtime. Though rare, patients may be asked to repeat treatment in 6 months to optimize scar reduction. Always discuss possible side effects with your Board-Certified Dermatologist

A picture will be helpful, but in your case, a real time examination is needed to determine the extent of scarring,(depth, hardness). Subcsion is not the ideal method of raised scars, the use of cortisone, 5FU and fractional Co2 or PDL are the best methods. See a specialist. 2-5 sessions for optimal outcomes. Start silicone gel or dressings ASAP. Acne scar revision comprises of specialised procedures. For the best results, one should target the acne scar type with ideal treatments METHODS. Using one device is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 

As an example deep ice pick scars, and narrow box car scars are best treated with TCA CROSS. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat grafts, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations. 

The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combination that give you best results, and everyone is unique! It is never about the device, its about the specialist behind the equipment that will deliver the best outcomes. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.