What is subcision for acne scar treatment? When is a combination therapy needed?

This article is compiled and medically reviewed by the Dermatology Specialists at BonBoz Clinic.

Subcision is a technique that uses a needle or a specialized instrument inserted beneath the skin to sever the fibrous bands pulling the scar tissue downward, releasing the scar base so it can lift. This method is often considered for rolling scars that are anchored down, and in many cases, it is combined with lasers or microneedling to achieve better results. However, as this is a subdermal invasive procedure, it must be performed by a physician.

How does subcision work?

In many atrophic scars, the scar base is pulled down by underlying fibrous bands, creating a persistent depression. The physician inserts a needle beneath the scar base and severs these fibrous bands, releasing the scar base and allowing it to gradually lift. At the same time, the controlled micro-injury from subcision stimulates tissue regeneration, contributing to gradual scar filling over time.

Why is subcision highly suitable for rolling scars?

Rolling scars are typically wide, shallow, and anchored by fibrous bands—the exact issue that subcision targets. For this type of scar, surface-level treatments alone are sometimes insufficient because the root cause lies in the underlying fibrous bands. Conversely, deep and narrow ice-pick scars usually require other techniques. Correctly classifying the scar type before choosing a method is therefore crucial.

Why is subcision often combined with other treatments?

Subcision releases the scar base, but to fill the depression and improve skin texture, physicians often combine it with microneedling, lasers, or other regenerative treatments within the same session or in subsequent visits. The combination and sequence depend on the specific scar condition. Therefore, subcision is typically one component of a comprehensive treatment plan, rather than a standalone solution for all scar types.

Who is a good candidate and who should be cautious?

Subcision is generally considered for individuals with prominent rolling scars whose skin is free of active, severe acne. Individuals prone to bruising, those with bleeding disorders, those taking medications that affect blood clotting, individuals with a history of keloid scarring, or those with active skin infections must be thoroughly evaluated by a physician before undergoing the procedure. Because it involves inserting a needle beneath the skin, subcision must be performed under sterile conditions by a qualified physician.

What should be noted after subcision?

Following the procedure, mild bruising and swelling in the treated area for a few days are common reactions; it is essential to keep the area clean, avoid harsh friction, and apply rigorous sun protection. Improvement occurs gradually and usually requires multiple sessions or a combination of methods, rather than a single treatment. Adhering to post-care instructions and follow-up appointments allows the physician to monitor your response and adjust the treatment plan accordingly.

Frequently Asked Questions

Is subcision painful?

Clinics typically apply local anesthesia before the procedure to minimize discomfort. Mild soreness and bruising may occur afterward, the extent of which depends on individual pain tolerance and the number of treated areas; your physician will discuss this with you beforehand.

Does subcision leave new scars?

When performed with the correct technique under sterile conditions, this is a well-established procedure in scar treatment. However, as with any intervention, there are inherent risks, which is why a prior medical evaluation and proper post-care are essential.

How many sessions are needed to see improvement?

The number of sessions depends on the severity and type of scars, often requiring multiple sessions and combined modalities. There is no universal number for everyone; the degree of improvement varies based on individual skin response.

If you have rolling scars and want to know whether you are a suitable candidate for subcision, lasers, microneedling, or a combination therapy, let a dermatologist analyze your skin and classify your scars before selecting a treatment plan.