Subcision for Acne Scars

Subcision, also known as subcutaneous incision, is a dermatological procedure developed in 1995 that involves using specialised tools to release fibrous bands of scar tissue beneath the skin. These bands often create a ripple effect on the skin's surface, causing deep, rolling acne scars to appear. By freeing up these bands, subcision can help raise the scar and improve the overall appearance of the skin's texture.

To begin with, your dermatologist will examine and map out your scars to determine which type of scars will be responsive to subcision treatment.

Subcision is typically performed under local anesthesia.

‍

The effectiveness of subcision treatment largely depends on the skill and expertise of the surgeon performing the procedure. Various subcision variations include:

• Point subcision, which utilises sharp instruments
• Field subcision, using both sharp and blunt devices
• Minimal subcision in combination with soft tissue filler augmentation

The duration of the procedure can range from 5 to 40 minutes, depending on the severity of the acne scarring.

‍

Subcision is particularly effective in treating rolling scars, which are characterised by wave-like depressions visible even under normal lighting. These scars are caused by fibrous bands lying beneath the skin's surface and respond well to subcision treatment.

Deep ice pick scars and boxcar acne scars can also benefit from subcision, as the fibrous bands in these types of scars extend deeper into the subcutaneous layer.

‍

Yes, subcision can be performed on individuals of all skin types and ethnicities since the treatment works beneath the surface of the skin. In some cases, additional techniques may be employed alongside subcision to address scar revision, such as hybrid lasers, RF microneedling, TCA peels, and dermal fillers. The specific devices and techniques used will depend on the patient's skin tone.

Most patients require local anesthesia before the procedure, ensuring that it is painless. We take patient comfort seriously and strive to minimise discomfort during and after treatment.

‍

Following subcision, patients may experience a dull ache and swelling, which typically takes between 3 to 7 days to subside.

‍

Your dermatologist will provide you with an estimated recovery time, which can vary depending on the extent of treatment. The downtime can range from 1-2 days for limited point subcision to 8 days for multi-level field subcision. Since subcision involves a keyhole incision, the overlying skin remains unharmed.

In many cases, the duration of downtime is influenced by secondary procedures such as TCA and laser resurfacing, rather than the subcision procedure itself.

‍

The outcome of subcision treatment can vary depending on the specific subcision technique and instrumentation used, as well as the amount of scar tissue and collagen loss.

Typically, patients can expect to see a visible improvement of over 50% within 3 to 7 days following treatment. This improvement will continue to develop over time. In most cases, multiple sessions of subcision treatment (usually 2-4) are required to achieve optimal scar revision results.

‍

The outcome of subcision treatment can vary based on several factors, including the surgeon performing the procedure, the technique used, and the instrumentation employed.

Cosmetic dermatologists are trained to perform surgical procedures safely, effectively, and efficiently, which is critical in achieving optimal results.

Other factors that can affect the outcome of subcision treatment include the specific instrument used (sharp vs blunt), the immune response of the patient, and the amount of background inflammation present (such as active acne).

‍

Subcision is considered a minimally invasive surgical procedure with a low risk of complications. The risk of side effects is proportional to the aggressiveness of the procedure and the type of instrumentation used, as well as the anatomical site and depth of the scars being treated.

Potential risks of subcision treatment include bleeding, clotting, hematoma formation, infection, nerve damage, damage to retaining ligaments, and post-procedure bruising. However, not all of these risks may apply to your specific procedure. Your treating dermatologist will discuss any potential risks and specific considerations relevant to your unique scar pattern.

‍

While subcision is most effective for deep rolling and tethered scarring, other treatments may be necessary to address superficial scars such as boxcar, ice-pick, linear, saucer, and undifferentiated polymorphic scars. These additional treatments may include laser therapy and surgical excision as recommended by your dermatologist.

In some cases, soft tissue fillers may be injected during the subcision procedure itself. This approach is typically reserved for large volume atrophic acne scars.

‍

There are several less invasive procedures that may be used to treat rolling and mixed acne scars, although these may be less effective than subcision. Some options include RF microneedling using devices such as the Secret RF, the use of fractionated hybrid lasers with laser assisted drug delivery or CO2 devices to target rolling scars.

Non-surgical procedures can typically be performed by your dermatologist or laser specialist nurse. To determine the best treatment plan for your specific needs, it is recommended to discuss your options with your dermatologist.

‍

In the context of treating deep rolling acne scars, surgical subcision is generally considered the primary treatment of choice and tends to produce better outcomes than machines, including state-of-the-art lasers.

While lasers and microneedling may be effective in improving the appearance of many types of scars, they are not as specific as subcision for treating deep rolling acne scars. Ultimately, patients are free to choose the treatment that best suits their needs based on factors such as cost, invasiveness, and personal preference.

The body is not as efficient at building and remodeling collagen when there is ongoing inflammatory acne. As such, it is important for acne to be in complete remission before undertaking scar revision treatment for optimal results.

Your dermatologist will assess your condition and provide you with effective solutions for both your acne and acne scars, helping you achieve the best possible outcome.

‍

Acne scar revision is a big step, so at Scars & Lasers we focus on setting you up for the best possible outcome. First, we’ll want your acne to be well controlled before starting scar work—ongoing breakouts can limit results, and we can help coordinate acne management if needed. We’ll then match the treatment to your specific scar pattern (rolling, boxcar, ice-pick, texture), rather than using a one-size-fits-all approach. Most people need a series of sessions (often 2–4+, sometimes more) to get a meaningful change, because scar remodelling takes time.

‍

Costs can add up over multiple visits, so we’ll talk through options and stage the plan to suit your priorities and budget. Downtime is part of the process—redness, swelling, and peeling are normal depending on the treatment, and we’ll help you plan around work and events. Sessions are usually spaced around 6 weeks apart to allow proper healing and collagen rebuilding. Sticking with the plan and timing is what helps you get the smoothest, most consistent improvement.

Once you commence the journey, it’s important to treat it as a commitment and follow the scheduled plan we set together. Acne scarring responds best when treatments are timed properly—your skin needs the right spacing to heal, rebuild collagen, and progress safely—so stretching sessions out too far or stopping halfway often slows results and can lead to uneven improvement.

‍

Because our approach at Scars & Lasers is holistic, scar revision is rarely “just one laser.” We may combine different lasers and techniques, plus supportive acne control and skin-repair steps, to match your scar pattern and reduce the chance of new scarring. For that reason, results depend not only on the individual treatment day, but on following through with the full programme (including aftercare and any recommended acne management). While we’ll always tailor the plan to your tolerance, downtime, and budget, meaningful improvement typically requires consistent attendance and completion of the recommended course.

‍