How Subcision Works: A Solution for Deep Acne Scars

Subcision is a minimally invasive surgical technique used to treat depressed acne scars. It works by breaking the fibrous bands that tether the scars to deeper layers of the skin, allowing the surface to rise and smooth out over time. The controlled trauma induced by subcision also stimulates collagen production, further enhancing the skin’s appearance and improving scar texture.

Unlike other acne scar treatments that primarily target the skin’s surface, subcision directly 66addresses the root cause of deep scars. The procedure is especially effective for scars that remain depressed despite other treatments. Since subcision triggers the body’s natural healing response, patients often see gradual improvement over several months. While the treatment is straightforward, it requires skill and precision to ensure optimal results. When performed by an experienced dermatologist, subcision can provide long-lasting improvement with minimal downtime.At MDCS Dermatology, we offer subcision as a treatment for deep acne scars, performed by our expert team, including Snehal Amin, MD, FACMS, FAAD, Noah Gratch, MD, FAAD, Michael Tassavor, MD, MS, and Carolyn Stull, MD, FAAD.

Dr. Snehal Amin is a co-founder and surgical director of MDCS Dermatology. With extensive experience in dermatologic surgery and cosmetic treatments, Dr. Amin is renowned for his expertise in treating acne scars and other skin conditions. He is board-certified and a fellow of the American College of Mohs Surgery (FACMS) and the American Academy of Dermatology (FAAD). Learn more about Dr. Amin’s credentials and practice here.

Dr. Noah Gratch is a board-certified dermatologist specializing in medical and cosmetic dermatology. He is highly experienced in treating acne scars and various skin conditions, offering personalized care tailored to each patient’s needs. Dr. Gratch is dedicated to providing state-of-the-art dermatologic treatments to help patients achieve their best skin health. Learn more about Dr. Gratch here.

Dr. Michael Tassavor is a skilled dermatologist with a background in medical and surgical dermatology. He has extensive experience in treating acne scars and improving skin texture through advanced dermatologic techniques. Dr. Tassavor is committed to patient-centered care and ensuring the best outcomes for those seeking acne scar treatments. Learn more about Dr. Tassavor here.

Dr. Carolyn Stull is a board-certified dermatologist with expertise in both medical and cosmetic dermatology. She specializes in treating acne scars using cutting-edge techniques such as subcision, laser therapy, and microneedling. Her goal is to provide comprehensive care that enhances skin health and patient confidence. Learn more about Dr. Stull here.

Why is Subcision the Best Treatment for Acne Scars?
Subcision is highly effective for deep, tethered scars that do not respond well to topical treatments or superficial resurfacing techniques like chemical peels or microneedling. Unlike laser treatments, which focus on surface-level improvements, subcision directly targets the root cause of depressed scars—fibrotic strands beneath the skin. This makes it one of the most reliable options for significantly improving deep acne scars.

One of the biggest advantages of subcision is its ability to produce long-term results. Because the procedure physically breaks scar tissue and promotes collagen regeneration, the skin continues to improve over time. Many patients notice improvement after the first session, with optimal results developing over multiple treatments. Additionally, subcision can be combined with other treatments like microneedling, laser therapy, or dermal fillers to further enhance the outcome. The procedure is minimally invasive, has a low risk of complications, and requires little downtime, making it an excellent option for individuals looking to improve their skin’s texture and appearance.

What Type of Scars Need Subcision?
Subcision is primarily used for:

• Rolling scars: These are depressed scars with a wave-like texture. They form due to fibrous bands anchoring the skin to deeper layers. Rolling scars tend to respond exceptionally well to subcision because breaking these bands allows the skin to lift naturally. The procedure significantly improves the skin’s smoothness and texture over time.
• Boxcar scars: These scars are deep and well-defined, with sharp edges. They occur when inflammatory acne damages collagen and leaves behind depressions in the skin. Because boxcar scars have a structured depth, subcision helps by releasing the scar from the underlying tissue, allowing new collagen to form and restore a smoother skin surface.
• Icepick scars: These scars are narrow, deep, and resemble tiny holes in the skin. While subcision alone may not fully treat icepick scars, it can be combined with other treatments like TCA Cross or laser therapy for better results. By using a combination approach, patients can achieve a more even skin texture and reduce the appearance of deep pits.
• Some tethered scars: These scars are attached to deeper layers of skin, creating a dimpling effect. Subcision helps release these tethered scars, improving skin texture and smoothness. Since tethered scars are often the result of deep scar tissue formation, subcision can dramatically improve their appearance by releasing the underlying tension pulling the skin downward.

How Subcision Works 
Subcision is a minor surgical procedure in which a dermatologist uses a specialized needle to break the fibrotic strands pulling the scar downwards. This allows the skin to lift naturally, improving the appearance of deep scars. Additionally, the controlled trauma stimulates collagen production, further enhancing skin texture over time.

During the procedure, a special needle or blunt cannula is inserted under the scar through a tiny puncture. The doctor moves the instrument back and forth to break the fibrous bands, releasing the scar and allowing the skin to rise. This process also stimulates collagen production, which helps further improve skin texture over time. Local anesthesia is used to minimize discomfort, and mild swelling and bruising are common after the procedure. Patients typically need 2-5 sessions spaced 4-6 weeks apart for optimal results. While some improvement is seen immediately, full results develop gradually as collagen rebuilds. For enhanced outcomes, subcision is often combined with fillers, microneedling, or laser treatments. It is a highly effective, long-term solution for deep acne scars but may require multiple treatments for the best results.

How to Perform Subcision for Acne Scars

1. Assessment: A dermatologist evaluates the type and severity of scars to determine if subcision is the right approach.
2. Preparation: The skin is cleansed, and local anesthesia is applied for a pain-free experience.
3. Needle Insertion: A specialized needle or blunt cannula is used to penetrate the skin and break the fibrotic bands tethering the scars.
4. Scar Release: The dermatologist carefully moves the needle back and forth to release the scar tissue, allowing the skin to elevate.
5. Post-Treatment Care: Ice packs and anti-inflammatory measures help reduce swelling and enhance healing.

How Many Subcision Sessions Are Typically Needed?
The number of sessions required depends on the severity of the scars and the individual’s skin healing process. While some patients notice improvement after just one session, most require between 2 to 4 treatments, spaced about 4 to 6 weeks apart, to achieve optimal results. Combination treatments with microneedling, laser therapy, or dermal fillers may further enhance the outcome.

Acne Subcision Side Effects
Subcision is a safe and well-tolerated procedure, but like any medical treatment, it may have some side effects, including:

• Temporary swelling and bruising: These typically resolve within a week.

• Mild discomfort or soreness: This can be managed with over-the-counter pain relievers if necessary.

• Possible risk of infection: This is rare with proper aftercare and sterile techniques.

• Temporary lumpiness under the skin: As the collagen rebuilds, some minor irregularities may be felt but usually resolve over time.

Comparison Between Subcision and Other Treatments
Each acne scar treatment has unique benefits and limitations. Subcision is particularly effective for deep, tethered scars, but other treatments may be better suited for different types of scarring. Here’s a detailed comparison:

• Subcision vs. Laser Resurfacing
  Subcision works by breaking the fibrous bands beneath the skin, allowing the scarred area to lift. However, it does not significantly improve skin texture on its own. Laser resurfacing, on the other hand, removes layers of skin and promotes collagen production, making it more effective for smoothing shallow scars and improving skin tone. While subcision is best for rolling scars, laser resurfacing is more effective for boxcar scars and surface irregularities. However, laser treatments have a longer downtime and may not be suitable for darker skin tones due to the risk of hyperpigmentation.
• Subcision vs. RF Microneedling
  Both subcision and RF microneedling target deep scars, but they work differently. Subcision directly releases tethered scars, providing immediate improvement. RF microneedling stimulates collagen over time, gradually remodeling the skin. RF microneedling is better for overall skin tightening and treating a mix of shallow and deep scars, while subcision is more effective for scars that are deeply anchored. Many dermatologists combine these treatments for enhanced results.
• Subcision vs. Chemical Peels
  Chemical peels exfoliate the skin and encourage new cell growth, making them more suitable for superficial scars and pigmentation issues rather than deep, tethered scars. While subcision focuses on the structural cause of rolling scars, chemical peels primarily enhance skin texture and even out discoloration. Chemical peels are best used as a complementary treatment rather than a standalone solution for deep scars.
• Subcision vs. Dermal Fillers
  Subcision addresses the root cause of rolling scars by releasing fibrotic bands, but it does not add volume. Dermal fillers can be used alongside subcision to plump up depressed scars immediately after the procedure. However, fillers are temporary (lasting months to a few years), while subcision provides a longer-lasting improvement. In many cases, a combination of both treatments yields the best results.

Does Subcision Get Rid of Acne Scars Permanently?
Subcision can provide long-term improvement in acne scars, but whether it removes them permanently depends on the individual's skin response and collagen production. The fibrotic bands that cause tethered scars do not grow back, but some scars may need additional treatments to fully smooth out the skin. Combining subcision with other treatments like fillers, laser resurfacing, or RF microneedling often yields the best results. Maintenance sessions may be necessary in some cases to achieve the desired outcome.

Common Questions About Subcision

1. Is subcision painful?
A local anesthetic is used to numb the area, so the procedure itself is not painful. However, some patients may feel mild pressure or discomfort as the needle moves beneath the skin. After the procedure, there may be some soreness and bruising, but this typically resolves within a few days.

2. How many subcision treatments are needed?
The number of treatments varies based on scar severity. Some mild scars improve with 1-2 sessions, while deeper scars may require 3-5 sessions spaced 4-6 weeks apart. Many patients see noticeable results after the second or third treatment.

3. What is the downtime after subcision?
Swelling and bruising are common and can last for 3-7 days. Some patients return to work immediately, while others prefer to wait until the bruising subsides. Post-treatment care includes avoiding excessive sun exposure and following aftercare instructions provided by the dermatologist.

5. Can subcision be combined with other treatments?
Yes! Subcision is often combined with fillers (to provide immediate volume after breaking scar tissue), laser resurfacing (to improve skin texture), or RF microneedling (to further stimulate collagen). A combination approach typically yields the best long-term results.

If you’re struggling with deep acne scars and want to explore subcision as a treatment option, schedule an appointment with MDCS Dermatology. Our expert dermatologists are here to help you achieve smoother, clearer skin!

Book your consultation today.