Subcision versus punch excision - what is best for deep rolling scars? (Photo)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

I am certainly not surprised with your disappointment with the device treatments you have had and with PRP. I have been warning my regular readers for years that these expensive "bells and whistles" treatments are supported far more by heavy marketing and social media hype and very little hard science. Sorry. I have personally been performing subcision since 1995 for elevating and smoothing all kinds of indented (depressed, atrophic) scars for all causes, including the boxcar and rolling scars from prior acne, in all skin types. It requires no cutting on the surface of the skin, so little to no significant downtime is engendered and there is little concern for causing additional scarring. By contrast, punch excision is a surgical procedure that typically involves a deep cut and the placement of stitches--hence more expensive and of course real post-surgical downtime. But, even more disquieting is the fact that surgery is performed in areas subject to a significant amount of static tension or movement, there is a real risk for the subsequent development of stretch scars and even tram track stitch tracks. You would be wise to consult with a board certified cosmetic dermatologist. Best of luck.