Subcision with or without fillers for Acne Scar Removal*

Before and after

The above photo is a before and after of one of our patients with atrophic acne scars. These are the results from three sessions of subcision with filler, each session 6 to 8 weeks apart.

What are atrophic scars?</h2

Atrophic acne scars are those with depressed, i.e. tethered indentation on the skin such as boxcar and rolling scars. The type and depth of the scars dictate the kind of procedure we choose to treat them. Here is an overview of the different types of acne scars

What is Subcision?

Subcision is a minor surgical procedure where the underlying tethering created from the atrophic scar is released. As a result, the skin indentation and depression area is lifted in order to remove the scars.

How is the procedure performed?

After proper sterilization and cleaning of the skin, a surgical sharpie is used to mark the border of the scars with indentation. Subsequently, the treated area will be completely anesthetized with a filtration technique. The medication we use to numb the area will also slow or block the blood flow to the planned area. After the area is completely numbed, a special needle with a tiny blade-shaped tip will be inserted through a puncture into the skin. Next, subcision is performed by pushing the tiny blade of the needle to break the fibrotic strands, which tether the scar to the underlying tissue. Experience is very important since the depth and technique for different types of skin and scars differ.

As a result of subcision, tethered indented scar is released. Thereafter, during wound healing, new tissue and collagen are produced under the skin. New connective tissue lifts the depressed acne scar and the skin becomes more leveled over the following few months.

Subcision plus fillers

Filler injections can be inserted into the area where subcision is done.Fillers help to add volume to the depressed area and enhance the lifting effect of the subcision.

What is the best filler to be combined with subcision?

Dr. Shafa recommends hyaluronic acid (HAs) based fillers to be injected in combination with subcision to lift the depressed scar. Our preferred HA for this purpose is Restylane, which is made of sugar chains and is a very skin-friendly product. The advantages of Restylane are that it is soft, colorless, moldable, and attracts water to keep the treated area hydrated. Restylane is gradually absorbed while new replacement tissue is formed over the following 6 to 9 months.

What is the downtime of the procedure?

To simplify it, remember Dr. Shafa’s “ONEs” rules:

Discomfort one hour,
Swelling one day,
Bruising one week,
PIH (post-inflammatory hyperpigmentation) one month,
PIH (post-inflammatory hyperpigmentation) one month,

After the procedure, bruising and swelling of the treated area is expected. The extent of the bruising, swelling and healing time may vary depending on the size and location of the treated area as well as the thickness and texture of the skin. The good news is that discomfort and swelling right after the procedure can be controlled with icing. Starting the day after the procedure, you can camouflage the discoloration with makeup since the skin surface after the procedure is intact therefore applying product to cover the bruise does not interfere with the healing.

How many treatments of subcision are recommended?

The number of treatments depends on the depth and extent of the scar. It can be anywhere from one to three sessions of subcision, with one or two months between each session for optimal results. If subcision is combined with filler, a faster and better result is expected.

How do I know subcision is the best treatment option for my acne scar?

“One size fits all” is not true in medicine. Each individual case may have different issues and expectations. Typically, a combination of different acne scar treatment modalities results in the best outcome.

Contact us

We offer a complimentary consultation for acne scar evaluations. During your visit, you meet Dr. Shafa to discuss the best treatment plan for you. Julie, our cosmetic consultant, will educate you in detail about the pros and cons of the planned procedure. Call us to make your complimentary consultation.

Other Treatments