Is Subcision Required to Get Results With RF Microneedling? (photos)

Question

Can results be achieved without doing subcision in unison with RF microneedling and/or fractional CO2 lasers for correcting acne scarring (specifically, rolling acne scars)? Or is subcision just recommended to enhance the results?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HIDEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be been improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional laser such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone.

Subcision works well alone and in combination with other laser and RF platforms, including fillers and air subcision. TCA Cross can be combined with subcision. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian

Nelson Lee Novick, MD · Answer

Subcision, which I have been routinely performing since 1994, is a simple, relatively inexpensive technique for elevating & smoothing all kinds of depressed (indented, atrophic) acne scars. From the photo, there appears to be quite a bit of cheek sinking likely the result of generalized facial acne-related atrophy. With the "foundation" of the cheek sinking in this fashion, like a huge sinkhole, the overlying scars appear worsened as the craters of the boxcar and rolling scars exhibit more shadowing. So, a Field Subcision to elevate and smooth and restore the underlying "foundation" of the cheeks would likely go a very long way to a significant, on-the-spot improvement in appearance. After that individual subcisions of the any remaining troubling boxcar and rolling scars can be performed. Once the aforementioned are done, THEN professionally performed microneedling (manually or with electric pen) can be peforrmed, if still needed, to improve any remaining, residual superficial texture and color irregularities. No need for expensive, energy-based devices for whom the hard science to support their use lags woefully behind the heavy marketing to promote their use. Hope this helps. Best of luck.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Subcision can be very helpful for deep, thick, and tethered scars to assist with release. I will identify the worst scars and do this prior to microneedling. I almost always employ it in some form with significant acne scarring. CO2 in my opinion is great for very heaped scarring as it can create leveling. Hope that helps you!

Is Subcision Required to Get Results With RF Microneedling? (photos)

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Is Subcision Required to Get Results With RF Microneedling? (photos)

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