How can subcision and fillers for rolling acne scars stay permanent?

Question

F/58 I’m thinking of subcision fillers for my rolling acne scars. My question is how can the results stay permanent? I read that subcision is usually combine with fillers. Does that mean I would have fillers done all the time. I’m aware that treatment will never be 100 percent but if I want to invest in something that means so much to me at least I want it to be permanent. I read fat could act like a filler. How is that done? would that be a permanent solution? Please help.

Jason Emer, MD · Answer

Acne scars need a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  Best, Dr. Emer.

Jeff Rapaport, MD · Answer

Subcision  done with  hyaluronic acid filler will give you  one to two years results.. Subcision done with bellafill will be permanent. Subcision done with fat is variable depending upon if the fat is absorbed. Subcision done with PRP can be permanent. Subcision cuts the tethers that hold the scar down. Normal wound healing with subcision will usually allow the base of the scar to fill in with collagen and elastic fibers and give a long lasting result. Using this technique, several treatments will be necessary to build up enough under the scar to keep it lifted to the level of the skin. If one uses a filler, the lifting is more immediate but the longevity can be affected by the ability of the filler to remain in place and not be degraded by the normal remodeling process. Find a scar expert. Ask to see photos.

Davin Lim, MBBS, FACD - Account Suspended · Answer

See my latest YOUTUBE video as this explains with a video and pictures - fillers in some situations act as a buffer and NOT as a cosmetic filler. Video explain in great detail. 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.

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