Air subcision - Can it damage the nerve that affects speech?

Question

Dr Weiner said that using a cannula for subcision in the area circled(in the pic) would reduce the risk of damaging the nerve that affects speech? (i.e. the Buccal nerve). I live in Korea and I found a place that uses "air subcison" (referred to in the gif attached) - I think they make a pocket with CO2 gas and then inject a HA filler in there. I was wondering if this "air subcision" method could risk damaging the speech nerve in that location?

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

Davin Lim, MBBS, FACD - Account Suspended · Answer

I agree with Dr Weiner. Your treatment of choice is with a cannula. Your nerves are in the parotid, your level of scarring (predominantly) is in the fat. Cannula dissection level is much higher than your CNV7 nerves, especially in this area. (Different for manibular branch as it lies below the platysma mm with very little buffer as it crosses the mandible.)

I agree with Dr Weiner, low risk area, my preference would be a large bore cannula. 
All the best, Dr Davin S. Lim
Brisbane. Australia.

Air subcision - Can it damage the nerve that affects speech?

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Air subcision - Can it damage the nerve that affects speech?

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