31, risk of displacing existing cheek filler with subcision to improve acne scars?

Question

I am 31, I had hyaluronic acid/calcium hydroxylapatite filler placed in my cheeks about 5 months ago due to volume loss. I recently was recommended Taylor liberator subcision to help improve acne scars. What is the risk of displacing the existing filler/nerve damage with this procedure? I have not had any other fillers placed besides the cheek filler. My last session of cheek filler was about 2 months ago (I had 3 sessions total)

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

Nelson Lee Novick, MD · Answer

I have been performing subcisions since 1995, both Field Subcisions & Individual subcisions for acne boxcar/rolling scars and other indented scars and folds. Subcisions have a long track record for safety and efficacy when performed alone or when combined with natural fillers. On the other hand, I have treated a number of patients for excessive fibrous tissue following the Taylor Liberator procedure, which is an aggressive form of subcision. Without photos or the benefit on an in-person examination, based upon my experience with treating patients who had undergone the Taylor Liberator procedure elsewhere, I would suggest a consultation with a board certified cosmetic dermatologist scar specialist to discuss the potential benefit and safety for conventional, time-tested subcision especially in the case where previous filler has been used.  Hope this helps.

Mats Hagstrom, MD (license on probation) · Answer

I’ve yet to see an impressive outcome from Subsicion for acne scars.
Surgically releasing scar tissue contracture bands will generally follow by more scar tissue formation.
Before having any aesthetic treatment message, ask you ask the provider to show you long-term follow up with an ample supply of quality before and after pictures.
Subsicion may give temporary improvements, but I’m not optimistic that long-term in this treatment by itself will do much. If your provider has ample amounts of quality, long-term follow ups, then they may know something I don’t. Generally speaking an experienced provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.
The standard of care for Icepick acne scars is select direct excision.
When done with technical precision on individuals who have favorable skin complexion that treatment can give consistent quality improvements.
Acne scars are one of the most difficult conditions to treat successfully and despite numerous providers, offering many different treatment options. Most of them don’t really deliver.
Best,
Mats Hagstrom, MD

31, risk of displacing existing cheek filler with subcision to improve acne scars?

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31, risk of displacing existing cheek filler with subcision to improve acne scars?

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