When is the earliest possible time for subcision of scar adhesion? (Photos)

Question

I underwent liposuction surgery on my chest about 3 weeks ago for gynecomastia. My left chest/nipple looks fine when relaxed but when I flex the it looks weird and has this "stapled" look to it. The nipple doesn't move freely and its bugging me. How long should I wait for the scar to mature for subcision? Will the subcision cause more scarring? What else should I need to know? Thank you!

Tal T. Roudner, MD, FACS · Answer

I would suggested at this point aggressive lymphatic massage with Ultrasound and Radiofrequency treatments by a qualified certified person for those treatments. You can massage the area on your own as well. I would not go in for corrections for at least 6 to 12 months as that will give the best chance of the scar tissue to soften up and will minimize the corrections needed by then. Fat injections, flaps or other helpful treatments for scar indentions maybe needed.Good luck!

Davin Lim, MBBS, FACD - Account Suspended · Answer

Massage to prevent more scar adhesions, consider subcsion with 18 G NOKOR if not better at 4-6 months. 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 This still can be effective, but its OUTDATED.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.

When is the earliest possible time for subcision of scar adhesion? (Photos)

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