Types of Subcision for Acne Scars Treatment

Subcision for Acne scars treatment can be emotionally and physically distressing, especially when they persist despite numerous treatments. Among the various options available, subcision has emerged as a highly effective method for treating depressed acne scars, particularly rolling scars. This minor surgical technique works by releasing the fibrous bands beneath the skin that tether the scar down, allowing the skin to lift and appear smoother.

Acne may fade over time, but for many, the scars it leaves behind can be a lasting reminder of painful breakouts. These scars especially depressed or atrophic scars can affect not just your skin, but also your self-esteem and confidence. While countless over-the-counter creams, serums, and treatments claim to erase acne scars, most of them fall short when it comes to moderate to severe scarring. That’s where subcision steps in as a game-changing, dermatologist-recommended treatment.

What Is Subcision for Acne Scars?

Subcision, also known as subcutaneous incisionless surgery, is a minimally invasive dermatological procedure used to treat atrophic (depressed) acne scars. The process involves inserting a special needle under the skin to break the fibrotic strands that anchor the scar tissue to underlying structures. Once these strands are released, the skin is free to lift, and the body initiates natural healing with collagen production, further improving skin texture.

Subcision is often performed in combination with dermal fillers, micro needling, PRP (platelet-rich plasma), or laser resurfacing for enhanced results.

Who Is an Ideal Candidate for Subcision?

Subcision is most effective for :-

1. Rolling scars (broad, shallow scars with sloping edges)

2. Mild to moderate boxcar scars

3. People with good skin elasticity

4. Individuals who do not have active acne or infection

It’s not suitable for raised or keloid scars, as those require a completely different treatment approach.

Types of Subcision Techniques for Acne Scars

There are several different techniques for subcision, each designed for specific scar patterns, skin types, and treatment goals. Let’s explore the main types of subcision procedures dermatologists commonly perform.

Nokor Needle Subcision

Nokor needle subcision is the most traditional and widely used form of subcision.

How it works :-
A Nokor needle, which has a sharp, beveled tip, is inserted under the scar. The practitioner moves the needle back and forth to cut through the fibrous bands tethering the skin.

Best for :-

1. Deep rolling scars

2. Patients needing significant scar release

Pros :-

1. Strong mechanical release of fibrotic bands

2. Can treat multiple scars in one session

Cons :-

1. Can cause bruising and swelling

2. May require local anesthesia

Cannula Subcision

In this method, a blunt-tipped microcannula is used instead of a sharp needle.

How it works :-
The cannula is inserted through a small entry point and gently maneuvered under the scar to break the bands. It’s often combined with filler injections.

Best for :-

1. Patients seeking less invasive treatment

2. Rolling scars and mild boxcar scars

Pros :-

1. Reduced risk of bleeding and bruising

2. More comfortable than Nokor subcision

3. Safer for use in high-risk areas like under the eyes

Cons :-

1. May be less effective for very fibrotic scars

2. Requires an experienced provider for best results

Wire Subcision (Wire Scalpel Technique)

This method uses a thin surgical wire to cut the fibrotic bands with more precision.

How it works :-
A wire is inserted beneath the scar tissue and then pulled back and forth, like a saw, to sever the tethered bands.

Best for :-

1. Extensive or highly fibrotic scars

2. Areas where precision is required

Pros :-

1. Very effective for large treatment areas

2. Offers controlled release of fibrous bands

Cons :-

1. Requires more expertise and special equipment

2. Slightly longer recovery time

Needle Subcision with Dermal Fillers

This combined approach is designed to release the scar and instantly fill the void left underneath.

How it works :-
A needle or cannula is used for subcision, and dermal fillers (like hyaluronic acid) are injected immediately to maintain skin elevation.

Best for :-

1. Patients with moderate volume loss along with scars

2. Those looking for quicker aesthetic improvement

Pros :-

1. Instant improvement

2. Promotes collagen production and volume restoration

Cons :-

1. Fillers are temporary (6–12 months)

2. More expensive due to the cost of fillers

Subcision with PRP (Platelet-Rich Plasma)

This is a regenerative version of subcision that uses the body’s own growth factors to enhance healing.

How it works :-
After subcision (usually with a needle or cannula), PRP is injected into the area to stimulate healing and collagen synthesis.

Best for :-

1. Patients looking for natural, long-term results

2. Those wanting minimal synthetic additives

Pros :-

1. Accelerated healing and reduced inflammation

2. Long-term collagen improvement

Cons :-

1. Requires blood draw and PRP preparation

2. Multiple sessions may be needed

What to Expect During and After the Procedure?

Duration :- Most subcision procedures take 30 to 60 minutes, depending on the area and technique used.

Pain :- Local anesthesia is administered to minimize discomfort. Some soreness or tenderness can occur post-treatment.

Recovery :-

1. Mild swelling, bruising, and redness for 3–7 days

2. Avoid strenuous exercise, sun exposure, and blood thinners

3. Visible improvement may be seen in 2–4 weeks, with continued collagen remodeling over 3–6 months

Downtime :- Generally minimal; most people return to work in 2–3 days.

How Many Sessions Are Needed?

The number of sessions required depends on :-

1. Scar severity

2. Type of scars

3. Skin’s response to treatment

Most patients need 2 to 4 subcision sessions spaced about 4–6 weeks apart for optimal results.

Risks and Side Effects of Subcision

Subcision is generally safe when performed by a skilled dermatologist. However, potential side effects include :-

1. Bruising and swelling

2. Temporary lumps or irregular skin texture

3. Mild pain or tenderness

4. Rarely, hyperpigmentation or infection

These are usually temporary and resolve with proper care.

Combining Subcision with Other Treatments

For best results, subcision for acne scars treatment is often combined with complementary treatments such as :-

1. Micro needling with PRP :- Boosts collagen production

2. Laser Resurfacing (Fractional CO2, Er : YAG) :- Improves skin texture and pigmentation

3. TCA Cross or Chemical Peels :- For icepick or superficial scars

4. Radiofrequency Micro needling :- Enhances scar lifting and skin tightening

Conclusion

Subcision for acne scars treatment is a clinically proven, cost-effective, and minimally invasive treatment for atrophic acne scars, particularly rolling types. With various techniques now available from Nokor and cannula-based methods to wire subcision and filler combinations treatment can be tailored to your individual scar pattern, skin type, and aesthetic goals.