Getting off of Accutane here shortly. How soon can I get subcision/fillers?

Question

Doctor identified my scars as atrophic and rolling, so he has suggested subcision and fillers, which I totally agree with. I've found a doctor where I am that does subcision, and am wondering when it's safe for me to get it done? I'm currently on what is supposed to be my final month of accutane. Can I get subcision done right after accutane? I've looked up lots of articles on it and it seems inconclusive, some derms say 6 months while others say you can even do it while on accutane.

Benjamin Barankin, MD, FRCPC · Answer

I'd say you can start 1 month, but to be totally safe 3 months, after stopping isotretinoin/Accutane. Most importantly is to seek a dermatologist expert in subcision, it is not a spa/salon treatment and requires training/expertise for optimal results & safety.

Steven F. Weiner, MD · Answer

There are 2 consensus papers stating that subcision and fillers are ok during accutane therapy. Procedures are definitely a no go with accutane are: Deep chemical peels, ablative lasers, dermabrasion. I wouldn't hesitate to proceed with the planned treatment.

Davin Lim, MBBS, FACD - Account Suspended · Answer

JAMA article of 2017 is a good reference point, even then I am careful to monitor patients on isotret, especially if concurrent meds. Your subcision dermatologist or PS may want to discuss this with your medical dermatologist. 
The ideal treatment for acne scars will depend on the morphology of individual scars. For example, rolling scars are best treated with subcision, atrophic scars with fillers, pick-ice pick scars with TCA or Phenol CROSS/ Paint, box-scar scars with fractional laser/ modified TCA/ phenol chemical peels, hypertrophic scars with steroid injections/modulated fractional delivery.

Energy devices such as lasers, microneedling RF and bipolar radiofrequency are other methods to treat ‘general’ scar types. For example devices can improve rolling-tethered scars as well as ‘deep - superficial scars’ such as broad ice-pick scars and broad box-car scars. Devices should be viewed as a method of scar revision, and rarely as a sole modality. Exceptions do apply- for example in patients with predominantly shallow/broad box-car scars and or superficial pits.

Another factor that will determine the ideal combination of treatment is the skin type of patients. Skin typing used to determine the ‘skin colour’ of patients. Darker skin patients will require modifications to treatment parameters. This includes a lower percentage of chemical peels, conservative protocols for lasers and energy devices and in some cases pre and post treatment of skin to reduce but not eliminate the chances of PIH- post inflammatory hyperpigmentation- skin darkening.

The very first step in scar revision is to accurately determine the subset of scars you have. This is best done with a real time examination. Factors such as animation (rather than static photographs) are frequently used to determine the amount of ‘deep scarring’ /anchored scars or tethering. Palpation or touch is also extremely important to determine the presence of dermal and subdermal fibrosis. Scars that have altered ‘texture’ either hard or soft (atrophy) are more challenging to treat compared to scars with ‘normal’ texture. In some cases the use of angled lighting can be employed to accurately map scar types.

My answers given in the context of this question is a general plan given the limited information. For an accurate guide, one has to take into consideration factors such as animation, touch, feel, real time examination and most importantly subjective measures, namely patient expectations. A real time consult with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis.

All the best, Dr Davin S. Lim, Dermatologist. Brisbane. Australia.

Getting off of Accutane here shortly. How soon can I get subcision/fillers?

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