Dr. Michele Green is an international expert in acne scar treatment and utilizes Fraxel, eMatrix, Vbeam laser, TCA Cross, chemical peels, Thermage, BBL, and injectable fillers to rejuvenate and remove acne scars. An expert in minimally invasive cosmetic dermatology procedures and skin cancer, Dr. Green uses subcision as a means to improve the cosmetic appearance of acne scars with her private patients patients in her upper East Side NYC dermatology office. Dr. Green is especially sensitive to her patients with acne scarring, and is committed to the cosmetic improvement and treatment of these patients. Helping acne scar patients improve their scars and regain their self esteem is a priority. Dr. Green is an authority in acne scar subcision and has showed it to be a highly effective method of improving atrophic acne scars, especially rolling scars. Dr. Green is frequently cited in NY Magazine and the NYTimes as one of the best dermatologists in New York who specializes in treating acne scars.
What is Acne Scar Subcision?
Subcision, also known as subcutaneous incisionless surgery, is a minor surgical procedure which can be used to treat depressed scars including rolling scars. A nokor needle, cannula, or number 18 or 20 gauge hypodermic needle, is used to puncture the skin surface and the sharp edge of the needle is used to break up the fibrotic stands of tissue, which formed during the course of normal wound healing, and are tethering the scar to the underlying tissue.
Once these fibrotic bands of scar tissue are released, the area is promoted to heal with new collagen deposition in the area. Over months, new collagen is produced, and a noticeable cosmetic improvement of the acne scars are seen.
How is Subcision for acne scars performed?
- The area to be treated is degreased with alcohol and all dirt and makeup is removed. Patients are asked not to wear makeup to the office the day of the procedure.
- You are advised to discontinue any blood thinners (such as Aspirin, Advil, Aleve, Motrin), Vitamins, or oral supplements, such as Fish Oil, for one week before your procedure.
- The treatment area is anesthetized with a topical numbing cream to minimize any discomfort from the procedure.
- The scars being treated are marked with a surgical marker and overhead lighting is used to visualize the depressions.
- An 18 or 20 gauge needle is inserted into the skin, at an acute angel adjacent to the scar, with the bevel of the needle pointed upwards and parallel to the skin surface. The needle is moved back and forth through the dermis, via a horizontal fanning motion, to displace the scar tissue, and in turn promote collagen regrowth which will aid the healing of the skin tissue. This regrowth is what reduces the appearance of depressions in the skin and help “lift” the skin back into the correct place.
Pre-Op Instructions for Subcision
- Do not tan the skin for two weeks before the procedure.
- Do not wax the skin for two weeks before Subcision.
- Refrain from using retinoids, alpha hydroxy acid creams, or other exfoliating products for 3 days before the procedure.
- Do not have any laser resurfacing or chemical peels for two weeks before your procedure.
Post-op Instructions after Subcision
- Pressure should be applied immediately after the Subcision with ice packs.
- Topical antibiotics should be applied twice a day to the treated area.
- Arnica can be taken orally to minimize bruising.
- Refrain from exercise, saunas, steam rooms, and intense physical activity for two weeks after the procedure.
- Return in one month for follow-up from the procedure and photographs of the treated area.
How long does Subcision take to heal?
In general, it takes about one week to heal form a subcision. If dermal fillers were added and there is additional bruising, it can take up to 10 days to completely heal from the procedure. You can apply makeup during this time to camouflage any bruising.
What are the side effects of Subcision?
- Patients can expect come bruising or swelling post treatment. In general, there is little downtime and it takes approximately one week for the skin to heal from the Subcision treatment. Some patients develop hematoma from the procedure due to bleeding.
- Rare side effects are infection or worsening of acne lesions. Oral or topical antibiotics may be prescribed where indicated.
- Hypertrophic scars are another possible side effect of Subcision. The most common areas which are susceptible to this type of keloid scarring are the periorbital, glabella, and perioral area. The first treatment of subcision should be performed on a limited basis to gauge the patient’s response to the procedure.
- Post-inflammatory pigmentation which will resolve on its own. Strict sun avoidance should be maintained after the procedure.
How many treatments of Subcision are needed?
Subcision as a single treatment can be effective, but does need multiple treatments in order to achieve full results. Most patients with moderate acne scars will require between three and six sessions of Subcision and it is generally recommend that these sessions are scheduled between four and six weeks apart. With this in mind, the treatment plan can take up to a year to complete. The good news is, that that any results that occur are permanent, once the collagen within the skin has regrown.
Can Subcision be combined with dermal fillers?
Dr. Green often combines dermal fillers with Subcision. The choice of dermal filler depends on the type of acne scar. Dr. Green combines Juvederm, Restylane, and Bellafill, as fillers with the subcision procedures, raising and filling out the scar area, which gives an instant improvement to atrophic scars, such as rolling scars. In most cases, not only is there an immediate improvement, but shortly after, the Subcision helps to increase the body’s natural collagen production.
What are the contraindications to Subcision?
- Currently on Accutane (Isotretinoin) or have taken it in the past 12 months since this will lead to poor wound healing
- Blood clotting disorder
- Active herpetic infection
- History of keloid scars
- Active bacterial infection
- History of silicone injections in that area
- Recent history of laser resurfacing treatment
Which other acne scar treatments can be combined with subcision?
There are many different modalities and therapeutic treatments which can be combined with subcision and used to improve both the texture and tone of the skin in post-acne scars such as:
- Microneedling with Dermapen or Eclipse
- Chemical peels
- Fractional CO2 laser treatment: Fraxel laser
- eMatrix radiofrequency laser treatment
- Vbeam laser treatment
- laser skin resurfacing treatments such as ablative lasers
- Clear & Brilliant
- TCA Cross
- Dermal Fillers
- Cosmelan or mesopeel
- Topical skin care
Combining PRP with Subcision for acne scars
One of the most popular procedures that Dr. Green performs to enhance the positive results from Subcision is Platelet Rich Plasma (PRP) with microneedling. PRP has been shown in studies to improve the appearance of atrophic scars when combined with Subcision. Platelet Rich plasma entails drawing your blood and removing the platelet rich growth factors which encourage wound healing and new collagen formation. This allows the depressed scars to heal more quickly and improve the texture and appearance of your acne scars.
What is the cost for Subcision for acne scars?
The price for Subcision ranges both based on experience of the physician, the geographic location, and the extent of the acne scars. The average price for subcision is $1,500 per session. If dermal fillers are performed at the time of the Subcision, the price for the syringes needed of Juvderm, Bellafill, or Restylane, are an additional cost based on the syringe.
Does Subcision work for acne scars?
Subcision is very effective for treating acne scars. Alam, Omura and Kaminer published a seminal paper showing the positive improvement of subcision for acne scars. Other medical journals have since published additional papers highlighting the improvement of acne scars with Subcision in conjunction with other treatments of acne scars, such as Platelet Rich Plasma, and laser treatments. A careful analysis of the type of acne scars, rolling scars, ice pick, or boxcar scars is important. Dr. Green will give you an honest assessment and advise you on the best combination of treatment options for your own individual acne scars.
Can Subcision cause acne or make acne worse?
There is a risk of making acne scars worse. Five percent of patients can develop keloid scars from a subcision, but typically this occurs in patients prone to keloids, around the mouth and eye area. Acne can flare after your Subcision, and if you are still prone to acne breakouts it is advised to take a course of oral and topical antibiotics at the time of the procedure.
How long does it take to see results from Subcision?
The results of Subcision start to be evident after the procedure. New collagen is generated shortly after and increases to improve over the next few months. Each subsequent Subcision procedure continues to produce new collagen with the cosmetic results enhancing.
Combing acne scar treatments with Subcision
Most patients who have acne scars will have a variety of types of acne scars, including rolling, atrophic, boxcar, and icepick scars. While Subcision can be done as a stand alone procedure, most acne scars require a combination of treatment options to improve the appearance of these different types of acne scars. Dr. Green often combines other scar revision procedures, such as energy-based devices, eMatrix, Fraxel laser, Vbeam, or Picosure, and Erbium lasers, to improve the texture and tone of the skin after subcision. Laser treatment will help resurface the skin and treat both the tone and texture of your skin. Many of these lasers are an option for all different skin types, including Asian, Hispanic, and African American skin.
For ice pick scars, TCA Cross is the gold standard treatment. In this technique, 50% to 100% trichloroacetic acid (TCA) is applied meticulously with a wooden applicator to each ice pick scar. The scars develop a frost from the TCA, scab, heal, and the process induces new collagen to form and heal these ice pick scars. Some patients may need punch excision to remove small acne scars as well.
Scars that are red can be removed by treating these acne scars with the Vbeam laser treatment. The Vbeam is the gold standard in removing redness from the face, surgical scars, and acne scars. After 3 to 5 treatments of the Vbeam laser, the redness is reduced and your complexion cleared.
Many patients with acne scars also suffer from hyperpigmentation or discoloration from their acne and acne scars. Dr. Green often combines skin care products, such as hydroquinones, from her MGSKINLABS products with chemical peels to reduce the pigmentation, and even out the discoloration and texture. She also uses the Fraxel laser to treat skin pigmentation, and remove brown spots, sun damage, acne scars, and wrinkles.
Subcision can be combined with dermal fillers such as Restylane, Juvederm, and Sculptra. When a dermal filler is added, this can help enhance the overall effects of the subcision procedure, so we do recommend this for many of our patients. When suffering from acne scars, most patients lose volume and collagen in their skin. Restoring this lost volume with dermal fillers rejuvenates the skin and improves the appearance of your acne scars.
Is Subcision effective for acne scars?
Subcision is very effective for the right type of acne scar. However, the treatment of acne scars is a unique process as each individual has scars in their own unique way. Dr. Green will customize a skin care and acne scar treatment program to rejuvenate your skin and improve the cosmetic appearance of your acne scars. If you are concerned about acne scars there are treatments which can help. Contact us online today or call 212-535-3088 to learn more about Subcision and other acne scar treatments that would be best for you.