Regular subcision vs. subcision with fillers? Use suction method for both approaches? (Photos)

I have been using ordinary manual subcision lifting for treating deep rolling and boxcar acne scars for over twenty-two years. There is no need to pay for bells and whistles machines to provide suction, since it is very simple to manually pinch the scar upward in order to access different levels below the scar. The use of a lifting filler, such as Restylane Lyft (which would be my choice in my Upper East Side Manhattan office) or Hyaluronica 2, which would be my go-to for this purpose in my Israel satellite facility, where a far greater number of regulatory agency approved fillers are available, can further improve the result of the subcision by providing immediate elevation and improvement and additional stimulation of new, native collagen and elastic fiber synthesis. Vis-a-vis microneedling, I am hardly surprised by its lack of success for you, given the deep nature of many of your scars. No technique is going to be particularly effective if it used for the wrong indication. Microneedling is NOT particularly useful for deep acne scars; it is most appropriate for blending surface color and textural irregularities that may persist following treatment with other modalities. In a recent lecture presentation at the 2016 American Society For Dermatologic Surgery meeting in New Orleans, a prominent laser physician herself admitted "microneedling is already replacing fractionnated lasers..." for treating "enlarged facial pores, in lieu of ablative and noablative fractionated lasers; various scars(from acne, trauma, surgery)...The skin wounds produced by microneedling enhance neocollagenesis, with minimal postoperative recovery, avoiding prolonged.. erythema often produced with heat-producing lasers." What this means is that microneedling may play a valuable added role following subcision lifting for your deeper scars and TCA CROSS for the ice pick (pit) scars. Make sure that you seek consultation and treatment by a board certified aesthetic physician with expertise in all forms of acne scar treatments and be cautious of any claims for "one size fits all" laser, radiofrequency or ultrasound devices. Best of luck to you.

In my opinion you have deep saucer-shaped scars, boxcars and some acne pits. There may be a few ice picks. The deepest scars need to be lifted. Subcision is an excellent technique however it may be inadequate. We like to combine subcision with infini as well as PRP, lasers  and suction to give you more of a lift. After this is complete, the addition of fillers is a possibility. Find an acne scar expert. Good luck.

You have some rolling and ice pick scars. This will take a combination approach and a series of treatments to get improvements. Keep in mind, you will need additional treatments to maintain. I recommend lasers, microneedling/prp, TCA cross, punch excision, and fillers. See an expert in acne scarring for a formal evaluation. Best, Dr. Emer

The deeper scars need to have filler. My choice is Bellafill. I don't think that microneedling will touch this. I feel that microneedling is about 1/10th the effectiveness of Infini. Infini with Bellafill is clearly needed. Some of the ice pick scarring can be treated with TCA cross. Subcision is done in conjunction with the Bellafill. In regards to Infini: it has insulated needles which are important to deliver the RF energy deep into the dermis and protect the epidermis. This energy causes coagulation of the tissues which leads to maximal collagen remodeling and proliferation. Don't be mislead that noninsulated needles are more robust. The energy for these devices must be less or there would be significant downtime, wound care, and risks of hyperpigmentation/scarring. Heat/power is not the limiting factor with the Infini, it is the skin's tolerance to the energy that limits the settings..

I agree with the Surgeons below, microneedling itself, given the severity and depth will do very little. My first method will be Infini RF combined with PRP in an over and under method. The under method of PRP will provide some subcision. 3 sessions one month apart, followed by filler and subcision. The later is technique dependent. Bellafill or HA filler will give you a good result. You will require 3-4 sessions of this combination. Expect up to 70% improvement with 7-8 sessions, as you have one of the hardest types of scarring to treat, the good news is that they can be improved with realistic expectations. Dr Davin Lim. Brisbane. Australia.