Getting acne scars is a common occurrence after an acne breakout.
Often harder to treat than acne itself – acne scars are generally categorized into two main groups: atrophic and hypertrophic scars.
Also known as depressed acne scars, atrophic scars are the most common type of scarring that can be further classified into icepick, boxcar, and rolling scars.
Regardless of which type of acne scar you have, they are the result of acne lesions not healing properly – causing a change in the collagen structures under the skin.
Because acne scars often appear in the deeper layers of the skin (up to 5mm deep) –any treatment utilized needs to be able to reach that level to help resurface the scar tissues and smooth out the skin.
One particular research review revealed that more than 85% of over 1000 patients have deep tethered scars – a type of scar that occurs due to fibrotic strands tethering and pulling your skin downwards – causing a visible depression.
Despite the plethora of treatments available to patients today including micro-needling, chemical peels, subcision, and laser treatments – not all of them can effectively break down the strands that are adhering to the underlying skin.
However, there is one option that is especially successful in treating deep, tethered atrophic scars – and that is subcision.
The lowdown on subcision
Subcision (otherwise known as subcutaneous incision-less surgery) is a minor surgical procedure that was first introduced in 1995. It involves inserting a hypodermic needle deep into the scar tissues at different depths and angles to manually break up the fibrotic strands that are tethering the scars to the underlying skin and anchoring it downwards.
During the process of breaking down the scar tissues, subcision also induces collagen production that accelerates the healing process and further improves the appearance of scars.
There is plenty of research supporting subcision as the go-to treatment for deep atrophic scars such as rolling scars – in a 2011 study comparing 100% trichloroacetic acid (TCA) chemical reconstruction of skin scars (CROSS) versus subcision, the mean decrease in size and depth of rolling scars was significantly greater when using subcision.
A more recent 2019 study also concluded that subcision produces better results, faster healing times, and fewer treatments as compared to micro-needling – although they both help to break up scar tissues and stimulate collagen production.
Performed under local anesthesia, it is a safe and comfortable procedure that feels similar to a “plucking” sensation as the needle physically breaks down the scar tissues in real-time. This manual technique allows doctors to “feel” the scars – and thus assess the depth of acne scars with greater precision and adjust the treatment accordingly.
Common side effects of the procedure include some slight redness and swelling that lasts for 2 – 3 days. Other risks and complications include hematoma, hypertrophic scarring or keloid scars, and temporary post-inflammatory hyperpigmentation (PIH), although they should not occur when the procedure is done with an experienced doctor.
In the original study back in 1995, patients required roughly 3 – 10 treatments before seeing results. However, with the advancement of new subcision tools and techniques, patients today only need 3 – 4 sessions in order to see marked improvements and permanent results!
Why laser treatments aren’t always the best option
Although subcision is a much older and “less advanced” technique, this does not make them obsolete and any less effective than laser treatments.
A 2016 study reported that when subcision is done adequately and properly by a competent doctor, it provides excellent results in treating acne scars – results that are comparable to newer and more costly treatments such as the fractional CO2 laser.
In addition, there have been studies showing patients undergoing treatment with fractional CO2 lasers but with little to no improvement. This is because most acne scars lasers are only able to reach up to 1.5mm deep below the skin.
The key factor that makes subcision superior to laser treatments is depth – while laser treatments work better for treating fine lines, pigmentation, and superficial scars, subcision is the best option for treating treat deep anchored scars.
However, using a combination treatment approach can result in higher patient satisfaction, less complications, faster healing times, and better results than using any one treatment modality!
This is because subcision works in a horizontal axis, while lasers and micro-needling work on a vertical axis. Given that patients often have multiple acne scar types – using a combination of all treatment modalities can maximize your results!
This is further supported by a 2009 study whereby a combination of TCA cross, subcision, and fractional CO2 laser yielded significant improvements in all 10 patients.
This is why doctors often perform subcision prior to using any energy devices such as laser and radiofrequency micro-needling devices – cutting away the connection of the scar tissues before working to resurface and smooth out the skin.
Why subcision + fillers
During subcision, the release of fibrotic tissues leaves a pocket under the skin where blood accumulates – preventing the short-term reattachment of the scars. However, there is still a 50% chance that scar tissues “re-form” after subcision acne scars treatment.
To prevent scar tissues from collapsing and re-attaching to the underlying skin after subcision, regenerative treatment such as fillers can help to support the healing process – in addition to stimulating collagen production, improving volume loss, and achieving an overall smoother appearance.
In fact, the introduction of regenerative treatments after subcision can decrease the chances of scars reoccurring to just 20%!
What do we mean by regenerative treatments? These treatments help to support the healing process and are often used after employing more “damaging” treatments such as chemical peels, surgical excision, and ablative lasers.
The most popular regenerative treatments include Radiesse (Calcium hydroxyapatite), Rejuran Healer (PDRN), and hyaluronic acid (HA) fillers such as Juvederm and Restylane. HA fillers are especially useful as they continue to draw water molecules to the tissues to further push up the depressed acne scar and plump up the skin, and can last up to 18 months before dissolving!
Our regenerative treatment of choice: Rejuran Healer
Rejuran is a regenerative treatment that contains active polynucleotides derived from Salmon DNA, which has been reported for its benefits of increasing the production of fibroblasts – the vital building blocks of healthy, thriving skin.
Helping to improve skin elasticity, hydration, and revitalize the skin – our clinic offers Rejuran S, a more concentrated form of Rejuran Healer to further support collagen remodeling by creating a three-dimensional scaffolding to prevent scar tissues from re-tethering.
Rejuran is hardly used as a stand-alone treatment – due to its powerful bio-stimulating properties, it is a great supplementary treatment to subcision and laser treatments.
If you want to heal scars at a cellular level, improve pigmentation, reverse the signs of aging, and improve the appearance of acne scars – we highly recommend trying Rejuran!
How we treat deep atrophic scars
Our doctors will take into account your specific scar type, scar depth, skin condition, and preferences to come up with a highly-customized treatment plan for you.
We pride ourselves in being able to offer all four types of acne scar treatments including subcision, chemical peels, laser treatments, and radiofrequency micro-needling. This enables us to utilize a combination approach to maximize your results and minimize any side effects and downtime.
With over 10 different technologies at our disposal such as TCA Cross, fractional CO2 laser, Q-switch lasers, INFINI, Secret RF, subcision, and Rejuran – combined with over 18 years of experience treating acne and acne scars – contact us to find out more about your acne scar removal cost and start your treatment with one of the best acne dermatologist today!