Subcision with or without filler?

Question

It seems as though subcision is a consistent effective acne scar treatment. Subcision without filler seems to yield permanent results; however, a lot of doctors say subcision with filler is only temporary. Does the combination of subcision with filler prevent the normal collagen remodeling process that subcision does alone? Thanks!

Harold J. Kaplan, MD · Answer

Hi Everlast.  We always use filler with subcision when we are treating a large depressed acne scar.  The reason is that when we perform subcision on the scar, we are releasing the hard fibrous bands below the scar.  By placing the filler in a void under the scar, you give the body the chance to stimulate the production of new collagen as the product dissipates over time.  We repeat the process several times over the period of 2-3 years to get a more permanent lift in the depressed area.  Using filler is cheaper than fat injections and yields similar benefits with more consistent results.  A nice example of before and after pictures for a Los Angeles patient we treated with subcision and Restylane can be found at the link below.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF 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 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 scars and indented  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 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 lasers 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. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your 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
Realself100 Surgeon

A. David Rahimi, MD · Answer

Subcision can significantly improve deep atrophic and depressed scars. I often suggest a filler in conjunction with Subcision, but not always. Certain scars are really deep and tethered down. Fillers such as Juvederm and Restylane can fill the void created by Subcison and not allow the fibrous attachment to re-build.The draw back is that fillers dissipate and are expensive. Fat transfer is another option. I also combine Subcision with Mixto CO2 laser or non ablative Cooltouch laser.Please look for us on FB at Treat Acne Scars by Dr. Rahimi and watch videos of Subcision and more. Thank you.

Jason Emer, MD · Answer

Subcision works better with filler this is no doubt.  and even better with microneedling or laser treatments.  It is best you get evaluated however, as all scars are different and some will not respond to subcision and require other treatments such as surgical removal or TCA cross peel method.  I wish you the best, Dr. Emer.

Michael H. Gold, MD · Answer

If you are having
acne scar treatments with subcision, most of us would recommend that a filler
be added to enhance the effects of the subcision procedure. I would recommend
that you have a consultation with a board-certified dermatologist or plastic
surgeon in your area and make sure that you are getting the proper treatment
for your acne scars and that you know all the different options out there that
exist for these scars, including the plethora of lasers and RF fractionated
devices that are now available and giving great results for our patients.

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Subcision with or without filler?

Answers (6)

Answer: Subcision with Filler

Answer: Subcision with Filler

Answer: Filler and Subcision for Acne Scar Treatment

Answer: Filler and Subcision for Acne Scar Treatment

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Our mission is to create a world where every investment in modern beauty is Worth It.