Can Subcision get results by itself for rolling acne scars or does it need to be combined with lasers and/or fillers?

Hello,We appreciate your concerns and mention of the need for a cost-effective treatment.  In our practice, we rely heavily on the deep fractionated laser resurfacing for atrophic/rolling/depressed acne scars.  The reason being, the laser has the ability to reach deep as well as untether the scar tissue.  To answer your questions, performing subcision with a needle at the same time as the laser is safe and can be done.  However, you will most likely achieve better and more predictable results with the correct laser technology.  In our practice we charge $1500.00 for a full face treatment.  Most acne scar patients require less than an entire face, so the cost is reduced to $1250.00.  The below link offers more information and before/after photos.  We encourage you to continue your research until you find a practice that is more affordable and delivers good and safe outcomes.  You are more than welcome to contact us for further information as we are in Orange County.Regards.

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

A combination approach will give the most improvement. Rolling scars need a combination of lasers, microneedling/prp, subcision, Cosmelan and fillers. Treatments can be performed on the same day. It will take a series of treatments and may need some treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

In my opinion, subcision is the gold standard for lifting acne depressed scars. Subcision can be done by itself or combined with lasers. We also use a suction device post-operatively to lift the skin and reduce the Reformation of the tethers. There is some advantage to adding fillers or PRP to prevent the scars from Contracting. Find an acne scar expert. Ask to see photos.

Dear sd007,I would certainly have to examine you but in general, treating acne and the scars takes a comprehensive approach.There are a variety of ways to treat the scars.  A good first step is to get on a skin care regiment that normalizes and conditions your skin such as ZO Skin Health.  The next step that is relatively inexpensive is a peel or series of peels.The next step up would be laser resurfacing such as fraxel. Even with laser, some of the "ice-pick" scars still subsist and remain. I've found in my practice that local subscision, using a needle to elevate the scar followed by fat grafting gives the best results for these deeper acne scarsDaniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Subcision is best for rolling acne scars like yours, and using it along would probably get you some good results. However, like others have said, in most cases a combination of a few things (combining it with CO2 laser or a peel, for example) yield the best results when it comes to removing acne scars. 

Often combine both subcsion and laser, depending on the scar type, but also your skin type and downtime. No controlled studies to answer your last question, but for the reduction of downtime, most acne scar specialist will combine procedures to save you both theatre costs but also downtime as both can be conducted safely in the one sitting. 
Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments and not just one device. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help.

For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, PRP and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars.

The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best,

Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.