Is subcision permanent for acne scars even without filler or laser?

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

Subcision on its own (physical; although sometimes we add chemical/saline as well) can be very beneficial and permanent for scarring even in the absence of fillers/laser. If budget is an issue, I'd say to try subcision on its own and see how you do, but yes, you can have long-term and even permanent results in some cases. I do think that some filler in the first 1-2 treatments not only gives a faster result, but also prevents some of the re-tethering/attachments.

I recommend subcision with filler for the best result. The subcision releases the original tethered scar. Once the skin is "popped" back up, filler such as Bellafill, can be placed underneath to keep the skin up and flush against surrounding normal skin. Subcision alone is sometimes enough as the body will be stimulated to fill in the lifted area with collagen however you may require several sessions to create enough collagen and the lift may not be as great as adding filler. Hope this helps!

Johnson C. Lee, MD
Board-Certified Plastic Surgeon