Question 1

What is subcision?

Accepted Answer

Subcision dermatology treatment option that's primarily used to release depressed scars (aka atrophic scars) caused by fibrous tissue that pulls down on the skin's surface, creating an indentation with sloping edges.

Also known as subcutaneous incisionless surgery, this minimally invasive procedure can be especially effective in the treatment of acne scars. According to a 2023 review, “subcision has been shown to improve all three atrophic acne scar types,” including:

wide, shallow rolling scars
boxcar scars with more clearly defined edges
deep, narrow icepick scars

Other studies have found subcision to be more effective for rolling scars than other atrophic scars.

Research shows the technique is safe and provides significant long-term improvement for some patients with acne scars, vaccination scars, chickenpox scars, surgical scars, and those caused by skin infections.

While it's mainly used as a scar treatment, subcision can also reduce the appearance of cellulite. It's recommended for cellulite dimples that can be seen when you're sitting or standing, and studies show that the procedure can provide significant improvement for the appearance of cellulite, with a low risk of side effects. The FDA-cleared cellulite treatment Avéli is a form of subcision.

Subcision works by using a needle, cannula, surgical wire, or tiny blade to sever a fibrous band that's tethering the top layer of skin to the lower dermal layer. Once the tether is broken, the fibrotic strands of scar tissue are released from the dermis, and the depression lifts. As it heals, the skin produces new collagen, leading to a smoother, more even texture over time.

To get maximum skin-smoothing results for pockmarks (and lessen the number of treatment sessions), scar subcision is often combined with additional collagen-building treatments, like microneedling, radiofrequency microneedling, platelet-rich plasma therapy (PRP), chemical peels (such as TCA Cross), and fractional laser treatments.

For very deep scars, subcision treatment is sometimes combined with a hyaluronic acid-based dermal filler or fat injections. This promotes new collagen production, helps smooth the depression, and makes it less likely that a new tether will form.

Question 2

What are the pros and cons of subcision?

Accepted Answer

Pros

Subcision is a minor surgical procedure that requires only local anesthesia.
The immediate results of subcision can usually be seen once the swelling from the anesthesia settles.
When performed by an experienced doctor, subcision has been shown to be safe and effective. Consult with a board-certified dermatologist or plastic surgeon and ask to see their personal before and after photos.
Subcision gets a type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el Worth It Rating from patients who have reviewed it on RealSelf, and multiple studies have shown high patient satisfaction for treating acne scars.

Cons

RealSelf Tip: "Before starting scar treatment, it's important for active acne to be controlled—otherwise, continued breakouts will interfere with the scar treatments," says Dr. Nelson Lee Novick, a board-certified dermatologic surgeon in New York City.

Question 3

How much does subcision cost?

Accepted Answer

Your price will depend on your doctor’s practice location, their level of experience, how many scars you have treated, whether you combine subcision with a complementary treatment (like PRP, fat transfer, or a dermal filler like Sculptra), and how many treatment sessions you need.

See our complete guide to subcision costs

Question 4

Subcision before and after pictures

Accepted Answer

The subcision photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

How does subcision work?

Accepted Answer

During your consultation, you’ll learn how many subcision sessions you'll need. Your dermatologist may recommend combining it with another treatment for the best results.

The subcision procedure typically goes something like this:

Your doctor administers local anesthesia—either a topical gel or, more commonly, an injection—to numb the treatment area.
Your provider will then ready their subcision instrument of choice—either a Nokor needle (a small, sharp blade on a short needle), a medium-gauge hypodermic needle, or a cannula, a blunt-tipped needle. "There is frankly no 'gold standard' when it comes to which instrument to use for subcision—each has its particular benefits, and the type of instrument should be chosen by an experienced physician according to the specific needs," says Dr. Novick. "I frequently use more than one instrument during the same procedure, depending upon such factors as the size and depth of the particular depression." (Typically, doctors will use a needle holder to improve control and prevent damage to nearby nerves and major blood vessels.)
After cleansing the skin and marking scars with a surgical pen, your provider will insert the needle into the skin.
Using a back-and-forth fanning motion, they will sever the fibrous band tethering the skin’s surface to the underlying tissue, to release the depressed scar. Even with local anesthesia, you may feel a poking or pulling sensation that can make subcision treatment mildly painful, but it’s usually well-tolerated.

How long the treatment takes depends on the number of scars you’re having treated and whether you're also having dermal filler injected or an ancillary treatment performed, but you can expect one session to last at least 30–60 minutes.

Some providers also treat the skin with PRP, to improve results. "I believe the PRP stimulates new elastin and collagen formation, remodels the scar, and prevents the tethers from reforming," says Dr. Jeff Rapaport, a board-certified dermatologic surgeon in Englewood Cliffs, New Jersey.

Question 6

How many treatment sessions are required?

Accepted Answer

How many treatments you’ll need will depend on your concern and its severity.

For depressed acne scar treatment, "most people require about four treatment sessions to achieve optimal improvement,” according to Dr. Novick. “If they wish to accelerate the process, they can return every six weeks for the next treatment session. If they're not in a rush, then they may return any time they wish after the initial six weeks, even many months later."

Dr. Novick notes that most of the new collagen and elastin fibers are produced in the first four weeks after a subcision procedure, “with a slight trail off in their production in the subsequent two-week period of time."

Doctors recommend treating only one small area at a time, if you have multiple scars. For example, with facial acne scars, it’s best to get one side of the face done during one session and the other during the next, to help minimize swelling.

For cellulite treatment, most patients need just a single subcision treatment session: studies show that nearly 79% of patients were satisfied with their results after one treatment.

Question 7

How long does recovery take?

Accepted Answer

Subcision downtime is minimal. You’ll be able to return to your normal activities immediately after treatment, but swelling and bruising can be intense for a few days to a week, so you may want to plan for some social downtime.

Common subcision side effects include tenderness, bruising, and swelling.

To reduce these effects, doctors recommend applying ice packs to the treatment area immediately after a subcision treatment. They may also prescribe antibiotics and anti-inflammatory drugs.

You can cover any bruises with makeup starting the day after your treatment, as long as you avoid the puncture wounds.

Use a gentle cleanser and avoid skin care with active ingredients like retinol or acids until your skin has fully healed.

Question 8

Is subcision permanent?

Accepted Answer

Subcision can permanently treat rolling scars, as long as the fibrous tissue that was broken up doesn't re-anchor the area down as it heals.

One study of patients undergoing subcision for cellulite treatment showed that 90% of patients were still satisfied with their results at a six-month follow-up. At this point, dimpling had decreased by 49%, and contour improved by 66%, on average.

Subcision isn’t a permanent cellulite treatment for most patients (there are currently no cellulite treatment options that offer permanent results), but benefits have been shown to last up to three years.