Subcision is a minimally invasive surgical technique that has gained recognition as an effective treatment for various types of depressed scars, particularly acne scars.
This comprehensive guide delves into the details of subcision treatment, exploring how it works, suitable candidates, recovery expectations, and more.
What is Subcision?
Subcision, also known as subcutaneous incisionless surgery, is a specialized procedure designed to treat depressed scars caused by acne, chickenpox, or other skin conditions.
The treatment utilizes a special needle or cannula inserted beneath the damaged skin to target and break apart the fibrous bands causing the scars.
These fibrous bands or scar tissue form during the healing process of acne inflammation and remain after healing, pulling the skin downward and creating visible depressions on the skin surface.
By releasing these tethering bands, subcision allows the skin to rise to its natural level, significantly reducing the appearance of scars.
Read more: FAQs About Acne Scar Treatments In Singapore
How Does Subcision Work?
The subcision procedure works through a multi-step process:
- Breaking Fibrous Bands: A specialized needle or cannula is inserted beneath the skin to mechanically break the fibrous bands that anchor the scar tissue to deeper layers of skin.
- Blood Accumulation: During the procedure, the disruption of blood vessels promotes blood accumulation in the treated area. This coagulation of blood prevents new attachments of fibrous bands to the scars, allowing for smoother healing.
- Collagen Production: The controlled injury created during subcision triggers the skin’s natural healing response, stimulating new collagen production. Over time, this fresh collagen helps fill in the depressed areas and improve the skin’s texture.
- Scar Elevation: As the fibrous bands are released and collagen production increases, the depressed scars gradually elevate to become more level with the surrounding skin surface.
Related article: Which Acne Scar Treatment Clinic in Singapore Should You Consider? (Sort by Reviews)
Types of Acne Scars Suitable for Subcision
Subcision is particularly effective for certain types of acne scars:
Rolling Scars
Rolling scars appear as broad depressions with gently sloping edges, creating a wave-like appearance on the skin.
These scars are caused by fibrous attachments between the skin and subcutaneous tissue. Subcision is particularly effective for this type of scar.
Boxcar Scars
Boxcar scars are circular or oval depressions with sharp, well-defined edges. They are often broader than ice pick scars but not as wide as rolling scars.
While subcision can help with boxcar scars, it may not be as effective as treatments like Fractional CO2 Laser or Rejuran S for this specific type.
Ice Pick Scars
Ice pick scars are deep, narrow, pitted scars that extend into the dermis. They appear as small, deep holes in the skin, as if the skin has been punctured with an ice pick. Subcision alone is generally not as effective for ice pick scars compared to treatments like TCA CROSS or punch grafting.
Chickenpox Scars
Similar to acne scars, chickenpox scars often create depressed areas in the skin that can be effectively treated with subcision.
Other Scar Types
Subcision can also be beneficial for certain stretchable scars resulting from injury or surgery, as well as deep wrinkles caused by skin tethering.
You might be interested: The Ultimate Guide to Acne Removal in Singapore
Subcision Methods
There are two primary methods used for subcision:
Blunt Tip Cannula Method
- Coverage: Able to cover a wider area of acne scarring
- Flexibility: More flexible than needles
- Trauma level: Less traumatic to surrounding tissues
- Risks: Lower risk of hematoma, swelling, or serious bruising
- Pigmentation issues: Minimal risk of hyperpigmentation
- Entry points: Fewer entry points required, reducing overall trauma
Needle Method
- Focus: Better for localized tethered scarring
- Access: Multiple needle insertions required
- Trauma level: More traumatic to surrounding tissues
- Risks: Higher risk of hematoma, swelling, or serious bruising
- Precision: May offer more precise targeting of specific scars
Studies have shown that blunt cannula subcision typically results in greater patient satisfaction and fewer side effects compared to the needle method, while achieving similar improvement and recovery rates.
You might be interested: The Ultimate Guide to Acne Treatments in Singapore
The Subcision Procedure
The subcision procedure typically follows these steps:
- Assessment and Preparation: The medical professional cleans the skin and conducts a full assessment to correctly identify the types of scars and areas of concern.
- Mapping: The doctor maps out the areas to be treated, including indicating the entry points for the needle or cannula.
- Anesthesia: Local anesthesia is applied to minimize discomfort during the procedure.
- Insertion: A hypodermic needle creates an entry point, through which the treatment needle or cannula is directed under the area to be treated.
- Breaking Scar Tissue: The needle or cannula is advanced through the dermis and moved back and forth in a fan-like motion. A snapping sound may be heard as the fibrous bands are broken.
- Optional Filler Application: In some cases, dermal fillers may be injected concurrently as a “spacer” to prevent the reattachment of fibrous bands and improve results.
- Compression: Manual compression is applied to the treated area to prevent the formation of large bruises (hematomas).
- Repetition: The doctor repeats the process for other scar areas as needed.
- Post-Procedure Care: A topical antibiotic ointment is applied to prevent infection and promote healing.
Benefits of Subcision
Subcision offers several advantages compared to other acne scar treatments:
- Reduced Hyperpigmentation Risk: Unlike some laser treatments, subcision carries no significant risk of hyperpigmentation.
- Effectiveness for Deep Scars: Particularly effective for deep rolling scars that may not respond well to surface treatments.
- Visible Early Results: Results can often be seen from the first session, though multiple sessions may be required for optimal outcomes.
- Versatility: Can treat most kinds of depressed acne scars, though effectiveness varies by scar type.
- Complementary Treatment: Can be combined with other acne scar treatments for enhanced results.
Recovery and Downtime
The recovery process after subcision typically involves:
- Immediate Effects: Redness and swelling for the first 2-3 days following the procedure.
- Pain Level: Minimal pain following the treatment.
- Bruising: Bruising is common and will typically fade within 2-10 days, depending on individual recovery rates and skin type.
- Entry Points: The entry points used for subcision usually close within a day, with a small scab forming.
- Total Recovery Time: Generally less than 10 days for visible signs of the procedure to subside.
- Results Timeline: While some improvement may be visible within weeks, the full benefits of subcision develop over approximately 2 months as collagen production increases.
Combining Subcision with Other Treatments
For optimal results, subcision is often combined with other acne scar treatments:
Subcision and Fractional CO2 Laser
Combining subcision with fractional CO2 laser treatment can accelerate healing and enhance results.
The laser induces microscopic injury to stimulate collagen production, helping the skin repair itself more effectively.
Subcision and Rejuran S
Rejuran S complements subcision by stimulating higher collagen production.
Its healing properties can also act like a filler to fill depressed scars and prevent new fibrous tissues from forming.
Read more: Is Rejuran Healer Treatment in Singapore Safe and Effective?
Subcision and Dermal Fillers
Fillers provide a temporary solution to “fill” depressed areas and improve the appearance of acne scars.
Results typically last 5-8 months, making this a good option for upcoming events where immediate improvement is desired.
Related article: Dermal Fillers in Singapore: The Comprehensive Guide
Subcision and RF Microneedling
Radiofrequency microneedling involves inserting microneedles into the dermis and transmitting high-tension radio frequency pulses into the targeted tissue.
This stimulates elastin and collagen fiber production, enhancing skin texture improvements.
You might like: The Ultimate Guide to Microneedling in Singapore
Subcision and TCA CROSS
For mixed acne scarring (the most common form), subcision can be performed alongside TCA CROSS (TrichloroAcetic Acid Chemical Reconstruction Of Skin Scars), which is particularly effective for ice pick and deep atrophic acne scars.
Treatment Protocol
For optimal results, subcision treatment typically follows this protocol:
- Treatment Time: Approximately 30 minutes, depending on the extent of scarring
- Sessions Required: 2-4 sessions for most patients (may vary based on scar severity)
- Recommended Intervals: Sessions are typically spaced approximately 4 weeks apart
- Recovery Time: Swelling typically lasts 2-3 days, with complete healing taking up to 10 days
Who Is Suitable for Subcision?
Subcision is generally suitable for:
- Males or females suffering from rolling and deep rolling acne scars
- Patients looking for an acne scar treatment with minimal side effects
- Patients seeking a comprehensive acne scar solution
Who Should Avoid Subcision?
Subcision may not be suitable for individuals with:
- Unrealistic expectations about complete scar removal
- History of forming hypertrophic scars or keloids
- Active bacterial or viral infections
- Active acne close to the treatment site
- Bleeding disorders or those taking blood thinners
- Individuals who are prone to abnormal skin scarring
Comparison with Other Acne Scar Treatments
To help understand how subcision compares to other acne scar treatments, here’s a comparative overview:
| Treatment | Pain Level | Downtime | Effectiveness |
|---|---|---|---|
| Subcision | Mild (2.5/5) | 4-10 Days | ★★★★☆ (Permanent) |
| CO2 Laser | Mild (2/5) | 5-7 Days | ★★★★★ (Permanent) |
| RF Microneedling | Medium (3.5/5) | 3-5 Days | ★★★★☆ (Permanent) |
| Chemical Peel | Mild (2/5) | 1-2 Days | ★★★☆☆ (Permanent) |
Pre-Treatment Instructions
Before undergoing subcision, patients should:
- Inform their doctor of all medications and supplements they are taking
- Disclose their complete medical history
- Plan ahead and schedule treatment at least 1 month prior to any special events to allow for full recovery
Post-Treatment Care
After subcision treatment, patients should:
- Use a gentle cleanser during the recovery period
- Apply antibiotic cream to the entry points as directed
- Take any prescribed anti-inflammatory medication as indicated
- Use sunscreen and avoid unnecessary sun exposure to reduce the risk of post-inflammatory hyperpigmentation
- Avoid strenuous activities, alcohol, and facial treatments shortly after the procedure
- Apply ice packs as needed to reduce swelling
Potential Risks and Complications
While subcision is generally considered safe with minimal downtime, potential risks include:
- Bruising (hematoma)
- Pain and tenderness at the treated site
- Hypertrophic or keloid scars (5-10% risk)
- Infection (usually manifests as acne at the entry point)
- Temporary post-inflammatory hyperpigmentation
- Suboptimal response or lack of response to scarring
- Injury to nerves and blood vessels (extremely rare when performed by trained professionals)
Frequently Asked Questions About Subcision
How many sessions of subcision are needed for acne scars?
Most cases require 2-4 subcision procedures spaced approximately 4 weeks apart.
However, the number of sessions depends on the individual, scar type, scar depth, and skin type. Visible improvement can often be seen after the first session.
Can I undergo subcision while taking Isotretinoin (Accutane)?
According to recent studies, having subcision acne scar therapy while taking Accutane or Oratane is generally considered safe.
This means patients may not need to wait the previously recommended 6 to 12-month washout period before having scar revision surgery. Treating acne scars earlier often leads to better results.
Is subcision painful?
Most patients tolerate subcision well. The procedure is performed under local anesthesia to minimize discomfort.
Numbing cream is typically applied to the face before treatment to ensure comfort.
How long does it take to recover from subcision?
Recovery typically involves some redness and swelling for 2-3 days following the procedure.
Pain is minimal post-procedure. Bruising is common and will fade within 2-10 days, depending on individual healing rates and skin type. Blood clots (hematomas) under the treated area may take several weeks to fully subside.
Can subcision be paid for through insurance or Medisave?
Subcision is generally considered a cosmetic treatment and cannot be paid through medical insurance or savings programs like Medisave.
Neither government nor private clinics typically offer coverage for this procedure.
Who performs subcision treatments?
Subcision should be performed by qualified medical professionals, typically dermatologists or plastic surgeons with specific training in the procedure.
The skill of the practitioner significantly impacts the safety and effectiveness of the treatment.
Is subcision suitable for all skin types?
Subcision can be performed on all skin types. However, individuals with darker skin tones should be treated by practitioners experienced with their skin type to minimize the risk of post-inflammatory hyperpigmentation.
How soon will I see results from subcision?
While some improvement may be visible shortly after the procedure (once swelling and bruising subside), the full benefits develop gradually over approximately 2 months as collagen production increases.
Multiple sessions are typically needed for optimal results.
Can subcision treat deep wrinkles as well as acne scars?
Yes, subcision can be effective for deep wrinkles, particularly those that have a tethered appearance due to fibrous bands pulling the skin downward.
What is the difference between subcision and microneedling?
While both treatments can improve skin texture, they work differently.
Subcision targets the fibrous bands beneath scars using a single needle or cannula, while microneedling creates multiple tiny punctures in the skin’s surface to stimulate collagen production.
They are often complementary treatments rather than alternatives.
Conclusion
Subcision stands as a valuable treatment option in the arsenal against acne scarring, offering particular benefits for rolling scars and depressed skin areas.
While not a complete solution for all scar types, its ability to release tethered skin and stimulate natural collagen production makes it an effective component of a comprehensive acne scar treatment plan.
For optimal results, subcision is often best combined with complementary treatments tailored to specific scar types and individual needs.
Consultation with a qualified professional is essential to determine the most appropriate treatment approach for each patient’s unique scarring pattern and skin characteristics.
With proper technique, appropriate candidate selection, and realistic expectations, subcision can significantly improve the appearance of acne scars, helping patients achieve smoother, more even skin texture and renewed confidence.