Is subcision safe and what are the risks involved / likelyhood of re-tethering? (photos)

In my opinion, Subcision is safe, however most Acne scar treatments are safe in experienced hands. Nerve injury can occur, but usually resolves. Further scarring does not usually occur in expert hands with proper patient selection. Retethering can be prevented with the use of PRP and a suction device postoperatively. Multiple sessions are necessary. The additional value of CO2 laser depends upon the results of the Subcision. Remember, lasers don't lift scars! Find a scar expert.
Jeff Rapaport MD FAAD
Realself Hall of Fame

I have been performing subcision for elevating and smoothing boxcar and rolling scars (as well as other indented scars from trauma, surgery, chickenpox, etc.) since 1995. The idea behind it is that not only are the scar tethers broken up, but a blood pocket (i.e. a bruise) is purposefully created below the scar that not only serves to diminish the chance of reforming the scar tethers, but supplies the necessary growth and wound healing factors that stimulate the new collagen and new elastic fiber synthesis that gives rise to the long-term to permanent results desired. The Dr. Google concept of using fillers as "spacers" is actually entirely unnecessary, since the person's own blood as as a temporary "spacer" while supplying the necessary ingredients for a long-lasting result as described above. If a filler is used (and it should be a temporary one--not a permanent filler (due to all the potential adverse consequences of using a permanent filler)--its value is really for added stimulation of the fiber making cells (fibroblasts) that produce the collagen and elastic fibers. There is a very small risk of infection and for the development of an overabundant production of collagen. In the well over tens of thousands of times I have performed subcision I have not had one case of an infection and only a couple of cases of overabundant production of collagen that was easily flattened with an injection of an antiinflammatory agent. Subcision is performed under the skin surface so that it can be safely used in all skin types. The same CANNOT be said of lasers and other energy-based devices, like RF, as these can have been associated, especially in skin of color, with pigmentary problems, either overpigmentation or loss of pigmentation, both of which can be very difficult to treat. So, exercise a healthy dose of buyer beware caution when evaluating the CO2 laser treatment offered. Hope this helps.