Let’s face it, stubborn acne scars are, well, stubborn. Treating and ridding oneself of these scars comes with trial and error, and a lot of it at that. So what if we told you there was another treatment worth researching? Enter subcision.
“Subcision refers to a subcutaneous incision-less surgery that is considered a minor outpatient procedure that can be used to help treat acne scars,” explains board-certified dermatologist Marisa Garshick, MD. “An instrument, either a needle or cannula, is inserted into the skin beneath the scar and rotated around. It works to reduce scarring by breaking up scar tissue and releasing the connections between the scar tissue and the underlying skin.”
Curious if subcision may be the right treatment for you? Read on as Garshick and board-certified dermatologists Purvisha Patel, MD; Azadeh Shirazi, MD; and Rachel Nazarian, MD, break down what subcision is and how it treats your acne scars.
Meet the Expert
- Purvisha Patel MD, FAAD, FASDS, FACMS, is a board-certified dermatologist and founder of Visha Skincare.
- Marisa Garshick, MD, FAAD, is a board-certified dermatologist based in New York City. She is also a clinical assistant professor at Cornell, where she teaches residents about reviewing the latest dermatology literature.
- Azadeh Shirazi, MD, is a board-certified dermatologist who specializes in medical, surgical, and cosmetic dermatology.
- Rachel Nazarian, MD, FAAD, is a board-certified dermatologist at Schweiger Dermatology who specializes in general dermatology, cosmetic dermatology, skin cancer, and dermatological surgery.
What Is Subcision?
The subcision procedure itself helps to “break the fibrous strands that tether the scar to the underlying tissue to release them, allowing the skin to lift up,” Garshick shares. “Simultaneously, the procedure itself can trigger a new wound healing process that can stimulate new collagen.” The almost-surgery-not-quite-surgery typically requires multiple treatments to achieve the desired results, but Nazarian says that the cost is substantially lower than using laser devices, which typically range from $100 to $500 a session depending on the number of lesions on the face that are being treated (as well as other factors including geographical location and the expertise of the professional performing the procedure).
The office procedure is deemed safe, but should always be done by a trained medical professional in a sterile environment. “If not done properly, subcision can be quite damaging, and even create new scars in the process,” emphasizes Nazarian. “This is not a treatment that you can perform on yourself at home.”
Benefits of Subcision
- Lessens the scar tissue
- Improves the overall appearance of depressed or rolling scars
- Promotes new collagen production
- Improves texture of the skin
The benefits of subcision typically tie back to the relief of acne scarring. Patients often turn to subcision after trying hyaluronic acid-based dermal filler, which can be used to treat depressed acne scars such as icepick scars and boxcar scars. Lessening of the scar tissue can prevent new scars from forming due to the surrounding acne and ideally stop the skin while it’s still ahead.
“Subcision works to improve the overall appearance of depressed or rolling scars by helping to relieve the fibrous strands that are tethering the scar tissue down as well as by helping to promote new collagen production,” Garshick shares. “Together, this helps to improve the overall texture of the skin associated with the scarring. It is a great treatment option for those with localized acne scarring as it can effectively target a few scars without impacting the rest of the skin. This makes it particularly good for someone who is concerned about a few scars, while still being an effective option for someone with more scarring as well.”
If all of this sounds good, but you aren’t sure what type of acne you have, it’s important to consult a board-certified dermatologist for a professional evaluation.
How to Prepare for Subcision
It’s also important to consult a dermatologist before scheduling a procedure like subcision, especially if you are on oral acne medications (i.e. Accutane). “Make sure that you are not on any blood thinners, such as aspirin, alcohol, ginkgo, or vitamin E before the procedure,” Patel adds.
Additionally, Garshick tells us “the skin should be thoroughly cleansed prior to subcision, as a needle will be introduced through the skin and any break in the skin can risk infection. Subcision should not be performed in an area of active infection or active breakouts.”
What to Expect During Subcision
Patients should expect to be numbed for this procedure to minimize any pain and discomfort. “A small bifurcated needle is inserted beneath the skin’s surface,” explains Shirazi. “The needle is moved from side to side under the scar repetitively to help release the scar from the underlying tissue. There may be a soft crackling sound as the skin fibers are broken up. This process may be repeated depending on the size and shape of the scar. Once the procedure is over, cold compresses are applied to help reduce bleeding and inflammation. Oftentimes the procedure is followed by a laser resurfacing or filler treatment for further improvement of the scars.”
Before and After
The before and after differences from subcision treatment are noticeable. Shirazi’s patient's skin appears more even, with less visible red acne. The scars also appear to be far more subtle than they were prior to treatment.
Potential Side Effects of Subcision
The subcision process does involve a needle entering the skin, so there is the risk for infection when not performed in a sanitized workspace by a medical professional. “Formation of more scars from subcision can happen depending on the healing response of the patient,” Patel warns. “This should not be performed on those with keloidal skin. Hyperpigmentation and infection can also happen, so meticulous aftercare is necessary.”
The patient may bleed, bruise, or swell at the injection site, and healing can take several days, so be patient and kind to your skin during this process, Shirazi tells us.
In the first 24-48 hours, it’s normal for skin to feel tender and sore. Patients may take over-the-counter antibiotics and anti-inflammatory drugs for 5-7 days post-treatment for any lingering pain or irritation. Like any procedure, avoid touching the face, and make sure your hands are always clean and sanitized. Patel shares that it is important to wash the face with antibacterial soap twice a day (wait 8-12 hours for the first wash). Apply a sunblock of SPF 30 or higher to keep your skin safe and to prevent hyperpigmentation. She also shares that resuming your acne regimen a few days after the procedure is important to prevent more pimples. Consult your dermatologist for an exact timeline.
The Final Takeaway
Considering subcision for your acne scars? There are a few important things to note. Subcision will not completely rid you of your acne scars. It will, however, lessen the shadowing of the skin by making the scar less depressed. It’s also important to note that subcision does not replace treatment for acne, so it’s crucial that you continue your acne regimen as prescribed by your board-certified dermatologist to minimize new breakouts from forming and reduce the potential for scarring. For best results, repeat the subcision process monthly in conjunction with lasers and peels until the scarring fully disappears.
Chandrashekar B, Nandini A. Acne scar subcision. J Cutan Aesthet Surg. 2010;3(2):125-126.