Subcision is a minor surgical procedure used for treating depressed cutaneous scars and wrinkles. It is also called subcutaneous incisional surgery. Subcision is performed using a hypodermic needle inserted through a puncture in the skin surface.
To understand how subcision works, you need to first understand what causes depressed acne scars.
Acne Scars
Acne scars are most often the product of an inflamed lesion, such as a papule, pustule, or cyst. Inflamed blemishes occur when the follicle, or pore, becomes engorged with excess oil, dead skin cells, and bacteria.The greater the inflammation on the skin, the more likely scarring is to occur. Hence, you must try your best to stop the progress of inflammatory acne at the start of its first appearance and don’t wait until it is too late to be treated. This transpires into early application of topical creams or even oral medication to prevent scarring. Prevention of acne scarring yields the best results as the saying goes, “Prevention is better than cure”.
Subcision
As we age, acne scarsbecome more noticeably because our skin loses collagen.
Subcision, fractional CO2 laser and microneedling, improve the appearance of scars by creating wounds in an effort to break up scar tissue and trigger collagen regrowth. Most scar types will respond to surgical subcision better than microneedling – some even better than laser! This is because the majority of patients will exhibit some form of tethering. This tethering needs to be broken down horizontally, and not vertically. Lasers and microdermabrasion all work on a vertical axis while subcision works on a horizontal axis, cutting the scars that pull down on your skin which causes a depressed scar in the first place.
Usually around three to six treatment sessions are required for subcision to produce significant improvement in an acne scar but of course this all depends on the quality of your skin and the severity of your scars. Multiple treatment sessions are required as the bonds underneath the scar which pull down the scar tends to reform. Therefore, repeated treatments are needed to release the bonds effectively. But remember, you can’t expect the scarred skin to appear as smooth as normal as if nothing (acne scar) has happened before. The scar appearance will improve, but not 100% remove. Therefore, don’t ever let scarring set foot on your face. Prevent it by all means, at all costs!
Subcision will cause mild bruising and swelling which fades within five to seven days. When it is done together with fractional CO2 laser, the bruising is not so obvious as it is obscured by the post-laser downtime. When your post-laser flakiness heals, there goes the swelling associated with the subcision. They heal together, using the same amount of time!
In My Practice
My most favourite treatment for acne scar is to perform subcision just before I begin with the fractional CO2 laser. After numbing the skin topically with numbing cream for 30 mins, I will inject the area with local anaesthesia to further numb the area. Subsequently, I will perform subcision using a 23G needle. During the procedure, you can barely feel any pain. You may the most just be able to feel the movement of the needle! After subcision, I will straight away perform the fractional CO2 laser.
The Future
The future is promising for acne scar treatment.
Combination treatments are the go for acne scar revision. Most patients who have acne scars will have a variety of scar types including rolling, atrophic, ice pick scars, together with boxcar scarring.
In summary, subcision for acne scars is a very useful modality for the treatment of acne scar. This statement is worth repeating!
Additionally, new recommendations published in June 2017, in regards to the use of Accutane and fractional devices including subcision shows that these procedures can be conducted safely at the same time. This means patients do NOT have to wait for the 6 to 12 month wash out period before undertaking scar revision procedures. The treatment of early scars, especially early tethered or anchored scars with subcision and other techniques can give better as well as a less invasive acne scar revision procedures. This means patients do not need to live with the burden of acne scarring.
This transpires that acne scars can be treated earlier and more effectively. As we all know, the earlier we get to treat acne scars, the better the results. Prevention of acne scarring yields the best results as patients do no have to go through the emotional stress, discomfort, expense and downtime of acne scar revision.
Written by Dr Tan WW
