Acne scar treatment can be with surgery, chemical peels, laser resurfacing, micro needling, skin needling and PRP.  The most under utilized method is with surgical subcision coupled with dermal fillers.  Surgical subcision targets tethered or anchored acne scars.  Unlike lasers it spares the upper part of the skin but breaks the bonds that hold down acne scars. I use a variety of subcision techniques to help with anchored and tethered scarring.  Results are instant with little to no downtime. This procedure is subsidized by Medicare.

Facts on subcision for acne scars

  • Acne scar treatment should be tailored to acne scar types
  • Surgical subcision is best for anchored or bound down acne scars that are most common around the forehead, temples but also the cheek areas.
  • Subcision can be performed using various techniques including special needles together with fillers
  • Acne scars subcision is a procedure whereby I free up the underlying scar tissue
  • Surgical subcision has little if any downtime.
  • Surgical subcision with the filler often gives the best results as the filler acts as a spacer
  • This treatment is very well tolerated as I use a local anaesthetic within the procedure itself.

What types of acne scars respond best to surgical subcision?

Acne scar types can be classified as ice pick scars, boxcar scarring, rolling acne scars, atrophic acne scars, hypertrophic acne scars, red acne scars and also tethered or bound down acne scars.  These are also known as anchored acne scars.  Anchored acne scar essentially contain scarring which attach to the top layer of your skin pulling down to the muscle layer.  These types of scars are identified with animation namely smiling and moving facial features.  Acne scars subcision is ideal for these types of acne scars. If you see scars that are depressed when you stretch your skin, then most likely you will respond to surgical subcision.

acne scar type brisbane

How do I know if surgical subcision is the best form of acne scar treatments for me?

Tethered, or bound down acne scars are one of the hardest scars to diagnose.  The reason being is that one has to be extremely experienced in regard to identifying this scar type.  Facial animation gives a clue. Another test is stretching the skin gently- this can identify a slight puckering in your skin- this is a give away to tethered scars.  Two dimensional photography is not an accurate way of assessing if you are a good candidate for this procedure.  This is the reason why I see patients formally and not via Skype/two dimensional photographs. Accuracy of scar identification is vitally important. Acne scars subcision is excellent for scars that are held down from the deeper layers to the upper layers of the skin- once again this type of scarring is one of the hardest to identify as they can be very subtle. 

subcision for acne scars

Different types of acne scars respond to different methods of scar revision. Ice Rolling scars, atrophic scars and tethered scars can respond to subcision. Dr Davin Lim.

How does Dr Davin Lim perform subcision for acne scarring?

filler-acne-scars

I use different methods to free up acne scars.  In some cases I use a very fine needle such as for bound down scars in your temple area.  For more tethered scarring around his cheeks, I often use a special Nokor needle. This form of subcision uses a special blade that cuts the fibrous tissue, freeing up acne scars.

I also use various techniques such as the modified Goodman’s pyramid technique and also my tunnelling technique.  I also perform foundation filling at the same time, especially for scars around the temple area.

Is subcision for acne scarring permanent?

Acne scars subcision

Yes.  If scars are purely bound down or anchored then freeing up the scar and placing filler as a spacer will give permanent results.  If your scar types are mixed then certainly subcision can help with bound down scars but the filler may only last up to one and a half years in atrophic scars.  I can only tell if they are atrophic if there is no resistance in the needle once I free up the scar area.

acne scarring-1

How is subcision different from microneedling/skin rolling for acne scars?

Skin rolling and micro needling involves the introduction of a needle vertically. Acne scars subcision is the complete opposite as needles or instruments enter horizontally or at an angle.  The horizontal action of the needle breaks down the scar tissue. If needed filler can be introduced as a ‘spacer’ between the base of the scar and the top of your skin. Fillers can also stimulate collagen.  Skin needling and skin rolling is also known as CIT or collagen-induced therapy.  This is completely different from subcision that is aimed at breaking down the bonds that hold down scar tissue.

microneedling acne scar brisbane

Is subcision for acne scarring safe?

Acne Scars Subcision

Yes.  I have performed several thousand cases over the past decade.  My techniques have been modified over the years depending on the instruments that have been used but most importantly with the advent of newer filler technology.  A decade ago, the spacer I used was autologous blood; however, this produced a higher side effect rate such as seromas and also hard lumps.  Dermal grafting with subcision is another technique that I use to perform – however the risks of cysts were one in ten. Over the years with better dermal filler technology I use a modified technique using biodegradable filler producing much less side effects.

To date I have not had one incidence of infection. Aggressive acne scars subcision can lead to hematomas and seromas in 3% of cases. This can be resolved using corticosteroid injections, massage and time.

subcison brisbane-1

This is an ideal candidate for subcision and filling. Notice the depression and tethering? This can be corrected in 2-3 sessions.

Can surgical subcision be combined with other acne scar treatment?

Absolutely.  In some cases I performed subcision at the same time I perform laser resurfacing or Infini PRP also known as PRP +.  I also use PRP as a donor for surgical subcision as this can also be used as a spacer.  PRP stands for platelet rich plasma, which contains growth factors and helps stimulate collagen production.  The down side about doing multiple procedures in the one sitting is the fact that recovery is often prolonged.  The worst case scenario is if aggressive subcision was to be performed on extremely bound down severe acne scars, bruising may last for up to 10 days. I also combine subcision with various lasers and also TCA CROSS if ice pick scars are present.

subcion brisbane scar

Is subcision painful?

No. This procedure is well tolerated as I always use a local anaesthetic.  This may be a numbing gel prior to the procedure, local anaesthetic injection or even a local anaesthetic mixed in with the filler. If large procedures are planned, I often perform this in theatre under sedation. Pain is never an issue, as I will always ensure optimal patient comfort for any acne scar revision procedure.

acne scarring-subcision

Can subscion be used to treat chicken pox scars and traumatic scarring?

Acne scars subcision

Yes, this method can be used to improve chicken pox scars. 2-3 sessions are needed for 50% to 70% improvement. Subcision can also be used to treat traumatic and surgical scars.

What is the cost of surgical subcision?

The cost of this acne scars subcision starts from $1790 per treatment. However rebates apply in the majority of cases. 

A Medicare rebate applies if this procedure is performed by specialists including dermatologist or plastic surgeons.  This procedure has no rebate if it is performed by cosmetic GP’s physicians. This procedure counts under the Medicare Threshold Ruling. Only Grade 4 acne scars can be claimed under the rebate scheme. If you are over the Medicare threshold, your out of pocket cost is only $390 per procedure. 

 

In most cases patients may require up to three to four treatments, depending on the severity and scarring.  For mild cases of acne scarring, one to two sessions are needed, with moderate cases two to three, for more severe cases four to six. The Medicare Threshold applies to cases of surgical subcision.

Does private health insurance cover subcision for acne scarring?

No it does not. The flip side; however, is that Medicare does recognize this as a scar revision procedure if performed by a specialist- Plastic surgeon or Dermatologist. Surgical revision of facial scarring comes under a special item number for Board Accredited Specialists, and not GPs.

subcision brisbane acne scar

How do I book in for this procedure?

The most important aspect regarding success or failure is correct assessment of acne scar types. This is essential.  Close visual examination together with animation, angle lighting and touch will give me an idea whether you are a suitable candidate for subcision or subscision- filler.  This procedure cannot be recommended on two-dimensional static photography.  Please book in for a face-to-face consultation and I will assess your scars accordingly.

acne scar subcision

Acne scar identification and accurate assessment is the key to success for this procedure. Acne scars subcision technique is one of the most under utilised skills but can deliver good outcomes. Dr Davin Lim.

Dr Davin Lim's opinion on surgical subcision for acne scarring

By Dr Davin Lim
Laser and Aesthetic Dermatologist
Dr Davin S. Lim copy

Acne scars subscision and dermal filling techniques

Surgical subcision is one of the most frequently performed procedures for acne scarring.  This is due to the fact that most patients will have some element of tethered or anchored acne scars.  These type of acne scars lie deep in the skin, beyond the reach of lasers and microneedling.  Additionally, the use of skin rolling is virtually useless in regard to the treatment of these forms of acne scars.  Over the years I have modified different techniques firstly with using autologous blood as a donor to act as a spacer; however, over the years, this has progressed to involve different fillers.  I also use PRP along with surgical subcision in extensive areas of acne scarring.  Acne scars subcsion techniques, especially if combined with PRP or dermal filler has minimal downtime compared to procedures such as laser resurfacing. The other advantage is that results are instantaneous.  I always aim for permanent results, namely to break down the bonds; however, in some cases where scars are purely atrophic, then the filler itself will only last year and a half.  Remember the best results are achieved by treating the acne scar type and not using a particular device itself. This is the concept to grasp for successful treatment of acne scars. 

Dr Davin S. Lim, Laser and aesthetic dermatologist. Brisbane. Australia.