Hi, it's Dr. Young and we're doing some scar revision, and what I wanted to talk about today was subcision. There's a lot of different meanings to that, I think, that I've found in the literature, but one way to do that is actually to use a cannula or a needle to break up the tissue in the deeper layers of the skin to allow it to raise up, and the goal is to create scar tissue to elevate the depressed scar. I wanted to show you the scar here on this person's forehead.

So there's a couple of areas that are depressed. We just got done injecting some local anesthesia, and there's depressed areas here and here. One way to do it is actually to make an incision all the way around, and then elevate it and then close it, in order to create some scar tissue underneath. Now that's definitely a more definitive way to do that, but sometimes doing more is not always as good. In some situations, you can elevate the tissue in here to allow the scar tissue to rebuild in the depressed area of the scar, and these are two instruments that I do that with.

I'll approach this from different vantage points, different directions, and from different areas, and I will go in there to elevate the scar tissue to create some more tissue build up and scar tissue build up underneath to allow it to raise up. This is a V-dissector that I do that with, and this is another 18 gauge needle that you can also do that with to elevate this area, and these hash marks here just denote where I'm going to feather in the subcision in a more mild manner to create just a general elevation.

Another way to improve the scar vision would be just to excise it. However, because it's such a big area, I think that it's more appropriate for us to actually subcise it in this fashion. Now, so the definition is either subcision either by making an incision all the way around it to elevate it or to actually use these cannulas and needles to subcise it in that way, without making an incision around it. So those are two different approaches, one incision, elevation, then closure and the second is elevation with just the cannulas and the needle to create tissue underneath it to elevate the depressed scar.

Thank you. All right, so we're doing a subcision again and right now, we've entered the area underneath the scar with the 18 gauge. I've came from this direction here, and I'm just kind of passing it through in all directions. I know it's very vascular here, so you can't really prevent oozing, but we're going back and forth and then, after doing this with the 18 gauge in all those different routes or different points of entrance, we're going to use this V-dissector here, after we began the whole subcision with the 18 gauge, we're going to do it with the V-dissector cannula and do the same.

So we're just elevating the tissue here, trying to get it to raise up a little bit. It does ooze, can ooze quite a bit here. I'm going to get another gauze. Yeah, we're just trying to break up the scar tissue there. So we're just breaking up that scar tissue with the V-dissector there, right under that main area that we're trying to get to lift up. There's a little bit more scar tissue in this direction.

I'm going to keep doing this, and I'm going to do all the different areas that we're trying to elevate, and what I do a lot of times is I go more superficial and then I go a little deeper to try and get more layers involved, and we're going to continue doing this and over the course of a month to six months, the tissue will build up. You get about 60% of your build up about one month or six weeks and then 80% at six months, so it takes a little while for the build up to occur.

We're going to continue doing this. We're going to go through all these different areas and then we'll be done with our subcision part of this procedure. Thank you.

Acne Scar Revision Treatment Using Subcision

Dr. Philip Young introduces the use of subcision to help with depressed acne scars like box car scars, rolling scars, and ice pick scars. The use of cannulas and needles are often necessary.