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Medically reviewed by Dr Hoe Ying Min Medical Director
Severe atrophic acne scars (boxcar and rolling type) requiring acne scar subcision

Medical Directors Note - “Deep and depressed acne scars form due to tethering by thick fibrous scar tissue, which need to be released by a subcision procedure. In the right hands, subcision is quick, painless and effective.”

Acne scar treatment is a long journey and requires a multi-modality treatment plan involving lasers, RF microneedling and injectables such as JuveLook

For deeper atrophic scars with significant tethering, subcision may be required to release the skin from scar tissue and achieve a good cosmetic outcome. In this article, we’ll explore how subcision works, the types of scars it targets, and what you can expect from the procedure.

What is Subcision for Acne Scars?

Subcision, or subcutaneous incisional surgery, is a minor surgical procedure to treat depressed acne scars. A specialised needle is inserted into the skin to break up the fibrous scar tissue that pulls the skin down. As the skin heals, new collagen is formed and the skin appears smoother.

Subcision for acne scars
Subcision for acne scars

What Type of Acne Scars Can Subcision Treat?

Subcision is most effective for rolling and boxcar-depressed acne scars. These scars are typically tethered to deeper layers of tissue by fibrous bands, creating depressions in the skin. Subcision addresses these underlying causes, releasing the tension and enabling the scar to rise closer to the skin’s surface.

Subcision is unsuitable for hypertrophic scars or keloids, as these are raised scars resulting from excess collagen rather than tethering bands.

Subcision of depressed acne scars
Subcision of depressed acne scars for rolling and boxcar scars

How Subcision Works on Acne Scars

​​Subcision is an effective treatment for addressing acne scars that appear as depressions in the skin. These indentations are often caused by fibrotic bands, which are thick strands of scar tissue that form beneath the surface and pull the skin downward, creating the uneven texture characteristic of rolling and some boxcar scars.

Subcision physically releases these bands and allows the skin to lift naturally. This process triggers the body’s natural healing response, stimulating collagen production to fill the depressed area and smooth the skin over time.

Subcision is effective for depressed acne scars (rolling and boxcar type) and is not used to treat hypertrophic or ice-pick scars

Benefits of Subcision for Acne Scars

Subcision offers several advantages, making it a popular choice for acne scar treatment:

  • Minimally invasive: It doesn’t involve major surgery or extended downtime. Expect mild swelling and bruising for 2-3 days after the procedure.
  • Targets scar root cause: Subcision addresses the tethering bands responsible for scar depressions. These deep-seated fibrous scar tissues are difficult to treat with Lasers
  • Collagen stimulation: Boosts natural collagen production for long-term skin texture improvement.
  • Customisable: Can be combined with other treatments for enhanced outcomes Subcision is often combined with the injection of a collagen biostimulator such as Sculptra which enhances the final result by accelerating skin regeneration

What to Expect During Treatment

Consultation and treatment planning

Your doctor will assess your condition, before explaining the treatment plan and advise you on what to expect during and after the treatment.

Injection of Local Anaesthetic

The treatment area is injected with a local anaesthetic (eg Lidocaine with adrenaline) to ensure a comfortable procedure and reduce bruising/swelling.

Insertion of cannula or needle for subcision

A blunt-tipped, sharp-tipped or RF-tipped cannula is inserted under the skin. These are specialised needles designed to navigate the subcutaneous and dermal layers to disrupt the scar tissue with minimal unnecessary damage to normal healthy tissue.

Once the needle or cannula is in place, your doctor will move it in a fanning or back-and-forth motion. This controlled movement is crucial for cutting through the fibrotic strands, tethering the scar to the deeper layers of skin. Breaking these bands releases the skin from the underlying tension, allowing it to lift and appear smoother over time. A snapping or crunching sound may be heard as the scar tissue is broken by the needle.

Practitioners may choose different types of cannulas based on the patient’s needs, such as sharp-tipped, blunt-tipped or RF (radio frequency) tip cannulas.

Healing response

After the fibrotic bands are disrupted, the body initiates its natural healing response. This response includes inflammation and repair, where the controlled trauma triggers the production of new collagen, which helps fill the depressed scar area.

Skin remodelling will occur gradually over the next few weeks and months as the newly formed collagen smooths out the skin’s surface, blending the scarred areas with the surrounding skin.

Type of Cannula for Subcision

The tools used for the subcision procedure can make a difference in your experience and results.


Sharp Tip Cannula (eg Nokor Needle)

Advantages:

  • Fast, cuts through thick scar tissue

Disadvantages:

  • High risk of injury to blood vessels or nerves, a possibility of permanent injury
  • High rate of bleeding and bruising after procedure

Blunt-Tip Cannula

Advantages:

  • Gentler on your skin: Unlike sharp needles, the blunt tip glides under the skin without cutting into blood vessels, which helps reduce bruising and swelling.
  • Less trauma, faster recovery: This cannula ensures a smoother recovery by minimising damage to surrounding tissues, allowing you to quickly return to your routine.
  • Combined treatment: Able to deliver collagen stimulators such as Sculptra or Radiesse during subcision procedure

Disadvantages:

  • Unable to penetrate thick scar tissue
  • Slow procedure, requires a high level of experience and skill
Subcision of acne scars
RF (Radiofrequency) Tip cannula subcision of acne scars effectively cuts through scar tissue while keeping bruising to a minimum

RF (Radiofrequency) Tip Cannula

​​The RF-tip cannula combines the mechanical action of subcision with the additional benefits of radiofrequency energy.

Advantages:

  • Keeps bleeding under control: The RF energy cauterises tiny blood vessels as the fibrotic bands are released, keeping bleeding and bruising to minimal
  • Fast, able to cut through thick scar tissue effectively. 

Disadvantages: 

  • Skill dependent, experience required.

Which Cannula is Right for You?

At Bay Aesthetics Clinic, we don’t recommend using a sharp-tipped cannula due to the higher risk of complications. Our patients typically choose either a blunt-tipped cannula or an RF-tipped cannula for acne scar subcision.

Recovery after Subcision

Subcision is a minimally invasive procedure, but like any treatment, it comes with a short recovery period. Most patients find the healing process manageable, with side effects typically resolving within a week. Here’s what you can expect and how you can take care of your skin to ensure the best results:

What to Expect After Subcision

It’s normal to experience the following after subcision:

  • Mild swelling: The treated area may appear slightly puffy as your skin reacts to the procedure. It is part of the body’s natural healing process.
  • Bruising: Since the subcision involves breaking fibrotic bands and working beneath the skin, minor bruising is expected. The discolouration usually fades within 5–7 days.
  • Tenderness or soreness: Some patients report mild discomfort in the treated areas, which should subside within a few days.
How to Care for Your Skin During Recovery

Taking a few simple steps can help minimise discomfort and speed up the healing process:

  1. Avoid strenuous activities: For the first few days, refrain from intense workouts, heavy lifting, or any activity that increases blood flow to the treated area.
  2. Use cold compresses: Applying a cold compress to the treated area can soothe inflammation and minimise swelling. To protect your skin, wrap the compress in a clean cloth.
  3. Keep the area clean: Gently cleanse the treated skin as directed by your practitioner to prevent infection and promote healing. Avoid using harsh skincare products until your skin has fully recovered.
  4. Hydrate and moisturise: Drinking plenty of water and using a gentle moisturiser can support your skin’s recovery from within and on the surface.
  5. Follow practitioner’s instructions: Your practitioner may provide additional aftercare advice, such as using topical antibiotics or avoiding sun exposure. Adhering to these guidelines is key to achieving the best results.
When to Contact Your Practitioner

While complications from subcision are rare, reach out to your practitioner if you notice any of the following:

  • Excessive or worsening swelling.
  • Severe pain that doesn’t improve with time.
  • Signs of infection, such as redness, warmth, or pus at the treatment site.

With proper aftercare, you can expect your skin to heal smoothly and start seeing improvements in texture as collagen production continues over the weeks following the procedure.

Results Timeline

Results from subcision vary depending on the individual and the severity of the acne scars. Many patients notice initial improvements within 2–4 weeks as the swelling subsides and collagen production begins.

Full results typically take 1-2 months, with multiple sessions often recommended for optimal outcomes.

Combining Subcision with Other Treatments

For moderate and severe acne scars, subcision can be paired with other treatments to amplify results:

These treatments are often spaced out over several months to allow the skin to heal and regenerate effectively.

Are You a Suitable Candidate?

Subcision acne scar treatment is suitable for individuals with:

  • Rolling scars or boxcar scars.
  • Good overall skin health without active infections or severe acne.
  • Realistic expectations about the treatment’s potential and limitations.

A consultation with a qualified practitioner is essential to determine whether a subcision is right for you.

Contraindications for subcision include:

  • Active skin infection or open wound
  • bleeding or clotting disorders (coagulopathy)
  • History of keloid or hypertrophic scars

Risks of subcision include:

  • Excessive bleeding, hematoma
  • Infection, abscess
  • Keloid or hypertrophic scar formation
  • Injury to facial blood vessels or nerves

Acne Scar Treatment with Subcision

Subcision is a good option for improving the appearance of acne scars and restoring smoother skin. Proper planning and professional care can significantly enhance skin texture and confidence.

Bay Aesthetics Clinic and Medispa take pride in helping patients regain confidence through smoother, healthier-looking skin. Whether your scars are mild, moderate, or severe, our team is equipped to guide you through all the steps of subcision treatment.

Book an appointment today.

Frequently Asked Questions

How many sessions of subcision do I need?

This depends on your skin condition, typically 2-5 treatments are recommended for best results. A common practice is to perform 1-2 initial treatments and monitor the response, before proceeding with further sessions

How can I prepare for my subcision treatment?

We recommend arriving for your appointment with a clean face. Wash your face thoroughly to remove any makeup, oils, or dirt. Your skin should be free of any residue.

Is subcision better than laser?

Subcision and laser treatments serve different purposes. While subcision targets tethering bands in depressed acne scars, lasers focus on improving overall skin texture and pigmentation. The best option often involves combining both treatments.

How painful is subcision?

Subcision is generally well-tolerated with the use of local anaesthesia. Patients may feel mild discomfort during and after the procedure, but this subsides quickly.

Is microneedling better than subcision?

Microneedling is effective for superficial scars and overall skin texture, while subcision specifically targets deeper, tethered scars. The treatments can be complementary rather than mutually exclusive.

What not to do after subcision?

Avoid activities that can strain the treated area, such as intense exercise, excessive sun exposure, and applying makeup for at least 24 hours.

Can a subcision be made if I have fillers?

Yes, subcision can be performed if you have fillers, but it’s essential to inform your practitioner so they can plan the treatment appropriately.

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