Clinic Services

Subcision

New Method Treatment for Acne Scar

Cannula‐based subcision:

Subcision is a procedure used to treat acne scarring, specifically depressed acne scars. Depressed acne scars are caused when fibrotic strands pull the skin downwards, creating the superficial indentations. During treatment a small needle cuts these fibrotic strands thereby releasing the tension of the scar, allowing the skin to rise.
Depressed Acne Scars (atrophic) – This type of scarring occurs when the body produces an insufficient amount of collagen, resulting in small, cave-like depressions in the skin as it heals.

Numerous surgical modalities are being used to treat acne scars. Superficial procedures such as light chemical peels and microderm abrasion have shown limited results in treating depressed acne scars, although laser resurfacing procedures can resurface acne scars by ablating the epidermis and a part of the dermis and then facilitating remodeling of the skin. Filler substances have similarly been applied with variable achievement rates to elevate deep scars.Surgical mo- dalities such as excision and punch grafting have been used in cases of dramatically changed scar morphology in some examined patients. Subcision, also known as subcutaneous incisionless surgery, is a term described by Orentreich in 1995 to explain the surgical procedure for treating deep scars and wrinkles using a tribeveled hypodermic needle inserted under the scarred area and moved back and forth, break- ing up the scar tissue. The principle of this procedure is to release the fibrotic strands that tether the scar to the underlying subcutane- ous tissue, and this procedure generally decreases the depth of the scar depressions. The depression is lifted by the releasing action of the subcision surgery, as well as from the connective tissue and collagen that form during the course of wound healing.This is a simple technique, but the primary problem is that surgery should be repeated several times in each deep area. Scar subcision plays an important role in “ice pick” and “rolling” type scars .
Subcision stimulates new skin and collagen remodeling, while laser and peeling provide additional resurfacing benefits. Although needle subcision is a simple, valuable, and practical method, depression recurrence is a very common side effect, and overall achievement in this procedure is mild to moderate.
Acne scarring can be divided into three basic types:

  • ice pick scars
  • rolling scars
  • boxcar scars

Although rolling scars tend to be shallow, correction of the subdermal component is essential for treatment success. Because of the common re-depression of acne scars in our patients in the first 2‐3 weeks after needle subcision, we hypothesized that an alternative method such as cannula subcision might prevent re-depression by inducing more hemorrhage in the dermal layer, de- laying the healing time, and stimulating the formation of more new connective tissue and collagen at the scar area.


What are the contraindications to subcision?

Subcision may not be suitable in the following circumstances:

  • Patients with a history of hypertrophic or keloid scars.
  • Current or recent systemic oral retinoid.
  • Bleeding or blood clotting disorders (coagulopathy).
  • Active bacterial or viral infection.


How is subcision performed?

The procedure of subcision is described below.

  • The area to be treated is cleansed to remove dirt and make-up
  • The scar margins may be defined with a surgical marker, adjusting overhead lighting to delineate depressions.
  • Local anaesthetic is infiltrated.
  • A tri-bevelled needle or a Nokor needle is inserted at an acute angle adjacent to the scar with the bevel upwards and parallel to the skin surface. Smaller gauge may be used for small superficial scars and wrinkles.
  • The cannula is advanced through the dermis and moved back and forth in a fan-like motion. A snapping sound is heard as fibrous bands are transected in the deep dermis and deep dermal subcutaneous plane.
  • The needle is removed and squeezed circumferentially around the exit point to prevent large haematoma formation due to bleeding.
  • Manual pressure is applied to the wound for several minutes.

Benefits of New method (Cannula‐based subcision):

  • For treating severe acne scars, also increases the therapeutic results of other procedures such as peeling or laser.
  • saving time.
  • Easy  for working  .
  • Excellent treatment results.
  • Just a small hole on each side of the face.
  • Decrease in patients’:
    • pain level
    • length of recovery (only two to three days).
    • bleeding and bruising.
  • Usage for all phenotypes of skin.
  • The special advantage of this method, unlike laser therapy or peeling that is done in any season and there are no special restrictions in terms of the presence of intense sun.