Will subcision with fat grafting injections work on my skin scarring? (Photos)

Question

What would you suggest would give me the most Improvement I've already had Pearl fractional laser with no improvement and can I have my lip scar removed

Jason Emer, MD · Answer

A combination approach will give the most improvement. These types of scars need a combination of lasers, microneedling/prp, subcision, Cosmelan and fillers. It will take a series of treatments and may need life-long treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Nelson Lee Novick, MD · Answer

Close up photos would have been more helpful. However, it does appear, particularly from both the tilted head photos, that there are a number of rolling scars on the right cheek, as well as significant textural and pigmentary irregularities on both cheeks. If this is indeed so, then subcision for the rolling scars would be an appropriate and relatively inexpensive approach. I would personally not use injectable fat, since lumps, which will be very difficult to treat, can occur. Instead I would choose a biostimulatory filler, such as Restylane Lyft which, through its ability to stimulate new, native collagen and elastic fiber synthesis, can serve to further enhance the effects of the mechanical subcisions. Following this, medical microneedling can prove helpful for blending the residual surface color and texture problems. Subcision, which has been around for over a quarter of century, and medical microneedling that also has an over two decade history, are both relatively inexpensive and tried and true procedures. I am hardly suprised by the lack of success with the fraxel lasers. I have been writing for years that these over-hyped and over-advertised, relatively expensive devices are far more backed by industry-supported marketing hype than actual hard science. The same in my opinion applies to radiofrequency and ultrasound devices. Unfortunately, the quality of the lip photos is not adequate enough for me to comment. You would do well to seek consultation and treatment by a board certified aesthetic physician. Best of luck to you.

Peter J. Jenkin, MD, FAAD · Answer

I agree completely with using the Infini device for acne scarring.  Since I got the device a few years ago I have stopped using any laser treatments for the scars-the results with Infini are better and occur sooner.  Best

Omar Ibrahimi, MD, PhD · Answer

These types of acne scars typically do well with the Infini device. I have over 23 different devices in my office and this is usually my go to for acne scarring.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Yes 2-4 sessions of subcision with filler can achieve good results. Like many experts who have answered, I would use filler over fat in THIS case of scarring, this is because filler has finesse, fat may result in lumps or no result due to absorption. See a specialist like Novick, Emer, Weiner or Rullan in the US.

Subcsion was first reported in 1995. Since then this technique has taken many pathways. Most dermatologist and plastics still perform the old method- using sideways motion to break scars down. In the original papers this took 6-10 sessions using a needle. This still can be effective, but its OUTDATED. Since then other methods have evolved including-

The use of other size needles
The use of NOKOR or cutting needles
The use of cannula techniques

Of all these techniques, cannula stands out. The most recent paper this year shows that it has the best rate of scar breakdown with much less side effects than with NOKOR. Namely less bruising and ‘lumps’ from bleeding.

The results of subcision is extremely variable and will depend on the technique and experience of your Plastics or Dermatologist. Ensure they can perform all techniques competently. This is especially important with dermal fillers (or fat transfer). If one subcises a depressed scar and find it has NOT got significant tethering, a filler is needed. In this situation filler or fat is needed to elevate the scar. Subcision is my preferred method for scar revision, as I can feel how many scars I am breaking with my 3 level cannula technique. This is now considered the Gold Standard in subcsion as reviewed by peer papers. All other modalities including lasers, energy devices and peels are considered ‘instruments’ in the way I practice acne scar revision. Remember treat the scar type with a method, and you will achieve the desired outcomes. Subcsion releases and remodels acne scarring from underneath. Needless to say this just a method, the results you will achieve is 90% dependent on the skill sets of your Plastic surgeon or Dermatologist.

All the best, Dr Davin Lim

Acne Scar Specialist. Brisbane. Australia.

Will subcision with fat grafting injections work on my skin scarring? (Photos)

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