Should I go and get subcision for acne scarring after my RF Microneedling treatments?

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best,
Dr. Raffy Karamanoukian
Realself100 Surgeon

subcison and fillers can be done at the same time as microneedling RF and lasers. we do this in combination.

at home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules weekly) should be started now

if you have post inflammatory hyperpigmentation/melasma/discoloration that needs cosmelan or enlighten peels at home which we can do virtually and send to your home along with aerify peels regularly, vivatia foam, restorsea 10x, faith essence serum, and cosmelan 2 cream.

Acne scar treatment needs a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif or fractora microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we already pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments.  Best, Dr. Emer. 

Hello,
Acne scarring can be very difficult to treat. Treatments depend on a array of things including, how much collagen is in the skin, the type of acne scarring and more. In my experience, RF Microneedling with subcison works best to break up the scar tissue and to stimulate collagen production to the area. RF Microneedling is more advance than traditional microneedling as it uses radiofrequency energy to stimulate collagen. Subcision is a treatment used for treating depressed scars - it uses a needle glided under the skin to break up scar tissue that is tacking down the skin. Larger and more diffucult scars may need to be excisided (surgically removed) as the skin is too damaged to achieve desired results. Using a combination of these treatments has given great results to my patients.
- Dr. Ife Rodney

There's really no right answer as to when to do subcision for acne scarring. In your case, I'd finish the RF-microneedling and that way you can clearly judge the results from that treatment; if you intermix subcision, it will be hard to tell the benefits of each. Once you finish your series, I'd move onto subcision with your local dermatologist - this is a complex treatment requiring good anatomical knowledge and that is why its not done in spas/salons etc.

Thank you very much for your question. It is important to remember that any device is only as good as the person operating it. I would highly recommend that you get assessed by board-certified dermatologist to formulate a plan unique to you

Generally speaking it is always best to combine modalities when treating acne scarring - Especially if they are deep or if there are different types of scars.

In our clinic we most frequently recommend a combination of resurfacing (radiofrequency vs laser) with subcision and dermal filler placement. Occasionally we may also recommended certain scars be excised

In general it is always best to start with subcision if that’s what’s needed. This is because subcision can sometimes leave post inflammatory hyperpigmentation that the laser or radio frequency can help heal faster.

However many of our patients have budget restrictions so we have to formulate a plan with that in mind as well.

If this is the issue we most frequently start with radio frequency microneedling as it tends to give the most benefit with the minimal risk

With regards to your question on subcision it also Depends on what type is going to be used - there are many ways to do it!!

We have recently posted an educational video on the different types of subcision on our Instagram. You can check it out at your own leisure

Good luck and happy to help

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. The choice for subcsion in the context of your scars depends on the clinical picture.

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.