Is it okay to combine subcision with filler at the same time, or is it useful to wait a few weeks?

I have been performing subcisions for over twenty-four years and have been injecting fillers of all kinds for over three decades and it is not only possible to inject a filler, but advantageous to do so, at the time of subcision. Relatively quick and inexpensive to perform, manual subcision is best performed at multiple levels within the skin in order to optimally achieve release of the downwardly pulling, tethering fibers beneath all kinds of depressed (sunken, indented, atrophic) scars; the accompanying use of a biostimulatory filler further helps in promoting new, native collagen and elastic fiber synthesis during the critical four to six week period following the procedure. Restylane Lyft works well for this and is my go-to in my NY office and Hyabell Deep, my first choice in my Israel satellite facility, where a far greater number of regulatory agency approved fillers are available. Finallyy, there is frankly no magic "gold standard"  when it comes to which instrument to use for subcision, whether Nokor, needle, or cannula--each has its particular benefits, and the type of instrument should be chosen by an experienced physician according to the specific needs. Personally, I frequently use more than one instrument during the same procedure, depending upon such factors as the size and depth of the particular depression. Make sure you consult with a board certified aesthetic physician and be certain to ask to see his/her personal before and after photos before agreeing to proceed. Best of luck.

In my opinion, subcision and filler should be done at the same time. This prevents the tethers that are broken up by subcision from reforming. PRP can also serve the same function and improve healing. The gold standard for performing external subcision is the use of a Nokor needle. If internal subcision is performed, I like the Taylor instrument.

Yes, it is- even though I personally use cannula, your Specialist will have their own method for subcsion. I respect their METHOD, as everyone will have their own skill sets. Be guided by your expert, not by myself. Filler can be used, I often use this as a spacer, or buffer. If your scars are atrophic, I treat them at the same time of subcsion, usually with HA fillers. Subcsion is highly dependent upon the skill of your dermatologist or plastic surgeon.

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.