Persistent facial swelling after acne subcision?

38 years old man, underwent bilateral acne scar subcision using Nokor needle. There is significant improvement in acne scars, however after about 6 months, there are 2 cyst like non-tender, non-erythematous soft swelling on both buccal areas with the size of 4x4 cm. Looks like some fluid filled cysts, however aspiration does not return any fluid or blood. No US or MRI is done. 1. What would be the diagnosis? 2. What should be the next step? 3. What would be the treatment?

Doctor Answers 4

Subcision and Swelling

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I suggest posting photos or seeing an acne scarring/laser specialist.  This may need steroid injections or radiofrequency/laser treatments.  There are options for this type of issue.  Best, Dr. Emer.

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 reviews

Options for swelling after subcision

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Swelling should not be prolonged after subcision. In some cases, we recommend antibiotics if swelling persists and perhaps a Medrol dose pack. 

Dr. Karamanoukian 
Los Angeles

USS then possibly steroid injections

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I had a similar case 6 weeks ago. Persistent swelling 2 months post subcision, settled with 2 weak - dilute A5 triamcinolone CS injections. Given your case, I would suggest an USS, for my case I tried aspiration as without success. 

My theory is that that may represent an organised haematoma. 

All the best

Dr Davin Lim 
Laser and aesthetic dermatologist
BRISBANE, Australia. 

Persistent Facial Swelling after Acne Subcision

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You were correct to mention US and MRI/CT as the next steps in the process.  I would also repeat the cultures to ascertain if an infection was missed.  Please keep us posted. The scars can eventually be treated with lasers. Best, Dr. Green

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