Subcision Vs. Saline Subcision

Question

My (light-skinned asian) young adult son is considering subcision or saline subcision--perhaps in combination w/TCA CROSS--to reduce acne scars on his cheeks. A female relative nurse mentioned that her MD was skeptical whether saline subcision is aggressive enough to break the "tethering" of depressed acne scars. I'd appreciate your opinions about this and also how "mature" a scar has to be before it can be treated (my son's acne only cleared up w/in the last year). Thank you! Fujiko

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

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

Philip Young, MD · Answer

Subcision would work but you might want to consider something with more regenerative powers. I prefer a multilayered approach that incorporates some type of subcision principle but I like this with co2 laser resurfacing and some dermasanding / dermabrasion.

Mark Taylor, MD · Answer

Tumescent Anesthesia, subcison and Fraxel Repair laser can give him great results. Saline subcision is not enough to permanently break the teathered scar bands. I fill the scarred area with tumescent anesthesia, do extensive subcison with a custom surgical tool, and then blend the surface with the Fraxel Repair Laser. I get consistently 75+ percent improvement after one treatment. The only challenge is managing the post inflammatory hyperpigmentation that will often occur post treatment in Asian skin. With good sun protection and good skin care management, the skin heals with wonderful results.

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