Subcision of acne scars

Acne scars 

Active acne breakouts are frustrating enough, but sometimes they can leave scars which are even more unpleasant. The good news is that these scars can be treated. Having said so, active acne breakouts can lead to new scar formation. It is thus crucial to treat the active breakouts first, before treating the acne scars. Active acne breakouts can be treated with topical creams, oral medications and lasers. Speak to our doctor for an individualized treatment plan for your acne breakouts.

Acne can result in different types of scarring. It can result in:
1. Skin surface issues
    a. Atrophic scars – depressed scars
        i. Icepick scars
        ii. Rolling scars
        iii. Boxcar scars
    b. Hypertrophic scars – raised scars
2. Pigmentation issues
    a. Post inflammatory hyperpigmentation (PIH) – dark spots or marks after acne breakout
    b. Post inflammatory erythema (PIE) – residual red/pink/purple spots or marks after acne breakout

It is important to differentiate the different types of scarring that can come as a result of acne breakouts as there are different treatment modalities for the different scars. Pigmentation issues are best treated with lasers. We have a Pico laser for PIH and a Dual Yellow Laser for PIE. Hypertrophic scars may be treated with steroidal injections or ablative laser treatments. There are many treatment options for atrophic acne scars. These include a fractional Pico Laser, Secret RF treatment (microneedling with radiofrequency), chemical peels and subcision with or without the use of Rejuran. Many factors such as the type of acne scars, patient’s choice, downtime etc. will affect the choice of treatment.

What is Subcision of acne scars? 

Subcision is a procedure which uses a needle or cannula (blunt tip needle) to break fibrous bands that tether the scar to the underlying tissues. The procedure also stimulates collagen formation as part of the wound healing process.

Is Subcision for me? 

Subcision will improve any condition in which the skin is being pulled downwards by scar tissue. This includes rolling acne scars and tethered boxcar acne scars.

If you see an area of depression or surface irregularity on your face that is made worse on movement such as smiling or talking, this means that there are fibrous bands anchoring down these scars to the underlying structures. These are the scars that will improve with Subcision. Most other treatments such as lasers, microneedling or chemical peels will not be able to reach this layer to relieve these fibrous bands.

Is Subcision suitable for everyone? 

Subcision is a very safe procedure, and it is usually suitable for most people, as long as it is indicated. However, it cannot be performed if a patient has an active skin infection over the treatment area. Patients who are prone to keloid scarring or on blood thinners will also need further counselling on whether the treatment is suitable.

What is the procedure like? 

The treated area will be thoroughly cleansed first. Thereafter, a topical numbing cream will be applied to the area. Depending on the size of the treated area, as well as type of scars present, a tiny needle or cannula will be inserted in a “fanning” fashion to manually break the fibrous bands that are anchoring down the skin. Occasionally, a patient may choose to combine the treatment with Rejuran and this will then be delivered in the same sitting. Once completed, pressure will be applied to reduce bleeding, bruising and swelling. A topical antibiotic gel will then be applied.

What are the risks of subcision? 

Subcision is a very safe treatment. A patient may however feel mild pain/discomfort during the treatment. There will be bruising and swelling after the treatment. Depending on the depth of scars treated and how aggressive the treatment is, this can infrequently last up to 1-2 weeks. Rarely if there is blood trapped under the skin, a hematoma can form. Lastly, there is a very small risk of infection. This risk is minimal since we thoroughly cleanse your skin before the procedure and try to maintain sterility throughout the procedure.

How many treatments of Subcision do I require? 

There are often visible results even after a single session. However, depending on the severity and extent of scarring, some patients may require between 2-3 subcision treatment sessions, at least 4 weeks apart.

Can I combine Subcision with other treatments? 

Yes, you can. Subcision breaks fibrous bands that tether the scar to the underlying tissues. Occasionally, Rejuran may be delivered in the same setting. Rejuran can help repair damaged cells, and stimulate collagen, helping to remodel acne scars. Patients can also consider skin resurfacing procedures after Subcision for optimal results.

Are the results permanent, and how long do they take to show? 

Yes, the results are permanent. It may take a few weeks for the results to show. There will be continued improvement for the next 6 months as the scar remodelling continues.

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