Do I need subcision for my acne scars? Do you always need a filler with subcision? (Photo)

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

Although there is no substitute for an-person examination that allows for manipulation and palpation of the scars, the photos do suggest that subcision would be of value. Most forms of depressed (indented, sunken, atrophic) scars from any cause, are at least tethered down by fibrous tissue to some degree. The degree to which the sunken scar is held down, whether it is a rolling scar or a more crater-like boxcar scar, can be determined by simply stretching the surrounding skin to see just how smooth it can be made. Subcision,whether performed by needles, trochars or cannulas, works by breaking these tethers and creating a blood bruise under the skin, which in turn, via the wound healing factors and growth factors contained in the blood, promote new collagen and elastic synthesis. Although a filler is often added to further help fibroblast production of collagen and elastin, this is not absolutely necessary and would be less advisable in the forehead region. I have been performing subcision for twenty-five years when treating all kinds of depressed scars from all causes, including acne, surgery, trauma and infection (e.g. chickenpox) with gratifying results. Be very cautious in evaluating claims for this or that fraxel, ultrasound or radiofrequency treatments, as these relatively expensive approaches are far more backed by device manufacturer supported marketing hype than hard science.  Hope this helps. Best of luck

In  my opinion, the gold standard for treating tethered scars is subcision with PRP. Recent studies have  shown a 25% Improvement in results when adding PRP to subcision. Filler can be utilized at a later time. Find a scar expert.Jeff Rapaport MD FAADRealself Verified All-star