Why are majority of doctors not keen to do subcision?

I believe subcision is a very low risk procedure when done with cannulas. It breaks up scar tethering to deeper structures. I also believe it is necessary to perform if the scars are deep and any energy based device is used. I think that heat can travel to structures deeper than anticipated in these case and subcision can prevent this. I also give a bit of lidocaine during treatment to help with the discomfort for the laser or RFM performed afterwards.

Your point exactly. Great question. Reason is that subcision is more invasive in the context of acne scarring compared to lasers. I have lectured in Singapore and know the curriculum at NSC (National Skin Centre in Singapore). Surgical dermatologist in the US are exposed to occulofacial surgery on a daily basis, as are some procedural dermatologist in Australia. This means we are more comfortable with dissection and skin surgery on facial areas. Though I employ many lasers on a daily basis, I do believe that in the context of acne scar revision, manual procedures such as TCA Paint, CROSS and multilevel subcision do deliver far superior outcomes in the SUITABLE phenotype of acne scars- such as pick, ice pick, tethered scars, etc.. Singapore has a very high standard of medical dermatologist, however their exposure to skin surgery is not extensive in comparison to Australia and the US. There maybe some procedural dermatologist at the Mandalay Clinic that have surgical experience. All the best, Dr Davin S. Lim. Brisbane, Australia.